BILATERAL PARACENTRAL ACUTE MIDDLE MACULOPATHY AFTER CARDIOPULMONARY BYPASS. Issue Volume 16:Issues 3(2022) (6th February 2020)

• Record Type: Journal Article
• Authors: Michalak, Suzanne M.; Mukherjee, Nisha; Gospe, Sidney M.
• Is Part Of: Retinal cases & brief reports. Volume 16:Issues 3(2022)
• Page Start: 285
• Page End: 288
• Publication Date: 2020-02-06
• Subjects: cardiopulmonary bypass -- ischemic optic neuropathy -- paracentral acute middle maculopathy -- optical coherence tomography -- retinal ischemia; Retina -- Diseases -- Periodicals; Retina -- Periodicals; Retinal Diseases -- Periodicals; Retina -- Case Reports; Retinal Diseases -- Case Reports; 617.7
• DOI: 10.1097/ICB.0000000000000982
• Languages: English
• ISSNs: 1935-1089

Abstract

Abstract : We describe the first two observations of paracentral acute middle maculopathy after cardiac surgery involving cardiopulmonary bypass. Bilateral cotton-wool spots and unilateral ischemic optic neuropathy were also observed. We discuss possible mechanisms of multifocal microvascular nonperfusion in the setting of extracorporeal oxygenation and circulation of blood. Abstract : Purpose: To report the first two observations of bilateral paracentral acute middle maculopathy in the early postoperative period after cardiopulmonary bypass procedures. Methods: Comprehensive ophthalmic examinations were performed, including best-corrected visual acuity, Humphrey visual field testing, dilated fundus examination, and optical coherence tomography. Results: Two patients complained of unilateral vision loss after cardiac surgery involving cardiopulmonary bypass. Unilateral optic disc edema consistent with ischemic optic neuropathy was observed in the symptomatic eye of each patient, whereas scattered cotton-wool spots were identified bilaterally. In addition, optical coherence tomography imaging revealed bilateral paracentral acute middle maculopathy, correlating with visual field defects detected on automated perimetry in the asymptomatic eyes. Conclusion: Although symptomatic postoperative vision loss is a rare complication of cardiac surgery, intraoperative retinal microvascular nonperfusion as a consequence of extracorporeal circulation of blood may be a more common and under-recognized occurrence.