A patient who underwent cataract surgery 1 month ago presents with sudden painless monocular vision loss. Fundoscopy shows pale disc, diffuse retinal whitening with cherry-red spot and retinal artery pulsations on gentle pressure. The most likely intraoperative complication that directly preceded this is:
- A Suprachoroidal hemorrhage with severe IOP spike causing central retinal artery occlusion (CRAO) ✓
- B Posterior capsule rupture with vitreous loss
- C Corneal endothelial decompensation (bullous keratopathy)
- D Macular edema (Irvine-Gass syndrome)
Correct answer: A. Suprachoroidal hemorrhage with severe IOP spike causing central retinal artery occlusion (CRAO)
Explanation
Suprachoroidal hemorrhage during cataract surgery causes an acute, massive elevation of IOP that can result in central retinal artery occlusion (CRAO). The cherry-red spot with retinal whitening (ischemic inner retina) and spontaneous retinal artery pulsations are hallmarks of CRAO. Although uncommon, this represents a devastating vision-threatening complication. Posterior capsule rupture and Irvine-Gass syndrome do not cause CRAO. Bullous keratopathy affects vision through corneal edema, not retinal ischemia.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.