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Retinal vascular occlusion after ocular surgery is a rare but serious complication. A history of cardiovascular diseases, retrobulbar anesthesia injection, high intraocular pressure during the perioperative period, and drug toxicity have been reported as possible causative factors. We report here two cases of multiple retinal vascular occlusions after the subconjunctival injection of gentamicin at the end of uncomplicated 25-gauge vitrectomy. Case 1 was a 61-year-old man who developed a macular hole in the right eye. Phacovitrectomy with gas tamponade was performed. On postoperative day (POD) 1, dot hemorrhage was observed on the temporal side of the optic disk. On POD10, macular whitening, retinal hemorrhage, and multiple occlusion of retinal arteries and veins were observed. Case 2 was a 51-year-old woman who was diagnosed with rhegmatogenous retinal detachment in the right eye and underwent phacovitrectomy with gas tamponade. On POD3, macular whitening with cotton wool spots and retinal hemorrhage were observed with macular ischemia owing to occlusion of retinal arteries and veins. In both cases, subconjunctival injection of gentamicin given at the end of surgery was the most suspected cause of retinal vascular occlusion.

Purpose: To report the clinical significance of ankle-brachial index (ABI) and pulse wave velocity (PWV) in retinal vascular occlusion. Method: We measured the ABI and PWV, which are used as clinical indicators of arteriosclerosis, of 106 patients with retinal vascular occlusion (RVO) as well as hypertensive retinopathy (HR) and diabetic retinopathy (DR), and 100 age-matched healthy control subjects. Results: ABI decreased with advancing age in patients with RVO, whereas no age-related changes were observed in non-RVO patients and control subjects. Furthermore, ABI was significantly lower in patients having combined presence of HR, DR and RVO than it was in patients with either HR, DR, RVO, HR+DR, HR+RVO or DR+RVO. Five out of six patients with abnormally low ABI values (less than 0.9) had associated central retinal artery occlusion (CRAO). In contrast, no such associations were observed in PWV among the groups. Conclusion: Our present data provide the first evidence that measurement of ABI may be a clinical marker for management for retinal vascular occlusion, especially for CRAO.