Retinal Artery Occlusion and Cataract: Treatment Strategies and Current Approaches

Central retinal artery occlusion (CRAO) is a rare but vision-threatening ophthalmic emergency characterized by sudden, painless loss of vision. This review discusses the incidence, clinical presentation, diagnostic methods, and management strategies of retinal artery occlusion (RAO), with a special emphasis on postoperative cases following ophthalmic surgeries under regional anesthesia, especially cataract surgery. The pathophysiological mechanisms behind RAO include embolism, vasculitis, and iatrogenic factors such as anesthetic techniques. Despite its low incidence, RAO has been observed after various types of ocular blocks, and no single anesthetic agent or technique has been definitively linked. Risk mitigation strategies include the use of shorter needles, avoidance of adrenaline or preservatives in local anesthetics, and limiting anesthetic volume and ocular compression. Transient RAO (TRAO), a likely underdiagnosed condition, can result in temporary visual symptoms postoperatively and may be detectable via optical coherence tomography. The paper emphasizes the importance of early recognition, risk factor assessment, and tailored anesthetic approaches to minimize the incidence of this serious complication.