title: Transient retinal artery occlusion during phacoemulsification cataract surgery.
abstract: OBJECTIVE
  Transient retinal artery occlusion (TRAO) is a potentially underdiagnosed cause of immediate 'pad off' visual loss following phacoemulsification cataract surgery under sub-Tenon's anaesthesia.
  
  
  METHODS
  We describe a series of three patients presenting with enigmatic 'pad off' visual loss following phacoemulsification surgery, each diagnosed with TRAO. We describe the variable clinical presentation, illustrate the value of optical coherence tomography (OCT) imaging in establishing the diagnosis, and present the final visual outcomes.
  
  
  RESULTS
  Clinical findings alone may be subtle and inadequate in localising the pathology in patients with TRAO. Cross-comparison of superior and inferior macula OCT profiles in branch-pattern arterial occlusion-and between healthy and affected eyes in central-pattern arteriolar occlusion-is critical in clinching the diagnosis. The typical evolution of OCT appearance is acute-phase inner retinal thickening/oedema and hyperreflectivity followed by progressive, late-phase inner retinal atrophy. Visual acuity may recover but central scotomas, and defects in colour perception may persist.
  
  
  CONCLUSIONS
  The diagnosis of TRAO is challenging; delayed presentation may resolve fundal and retinal angiographic abnormalities. OCT may be the only imaging modality that can provide objective evidence of TRAO. Meticulous comparison/segmentation of OCT images is therefore mandatory in patients presenting with acute post-operative visual loss to exclude TRAO.
authors.affiliation: The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK.
authors.forename: I H
authors.initials: IH
authors.lastname: Yusuf
authors.affiliation: The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK.
authors.forename: T Hm
authors.initials: TH
authors.lastname: Fung
authors.affiliation: The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Wasik
authors.affiliation: The Oxford Eye Hospital, West Wing, John Radcliffe Hospital, Oxford, UK.
authors.forename: C K
authors.initials: CK
authors.lastname: Patel
mesh_terms: D000368:Aged; D005451:Fluorescein Angiography; D006801:Humans; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000009:adverse effects*; D015356:Retinal Artery Occlusion / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology; D041623:Tomography, Optical Coherence; D015354:Vision, Low / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014792:Visual Acuity / Q000502:physiology; D058609:Visual Field Tests; D014794:Visual Fields / Q000502:physiology
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