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Abhishek Karra and Ravindra Karra
This 62YO female presented with a 1-week history of decreased vision in her left eye. Vision was 20/20 in her normal OD and 20/200 OS.
Color photography shows a fibrosed RAM in the superotemporal macula surrounded by intraretinal hemorrhages. Fine lipid deposits are noted temporal, inferior, and nasal to the RAM. Multiple small patches of preretinal blood are present along the inferotemporal arcade. OCT scanning through the central macula shows a retinal detachment with variable hyperreflective subretinal fluid. Hyperreflective lipid is noted in the mid to outer retina, and hyperreflective subretinal foci also probably represent lipid deposits. The hyper-reflective RAM indents the inner retina.
Learning Points:
A RAM is thought to occur in a weakened arterial wall from arteriosclerosis and appears as a yellow-white dilated lesion along a retinal artery within the first 3 bifurcations from the optic nerve. There are 2 distinct presentations: hemorrhagic or exudative. The hemorrhagic type often presents, as in this case, with pathognomonic multiple layers of blood. Acute macular exudation can be treated with observation, anti-VEGF injections, or thermal laser.
An intravitreal ranibizumab injection was given. Thermal laser to the RAM was planned but unfortunately she was immediately lost to follow-up.
J Vitreoretin Dis. 2026 Apr 26:24741264261432182. doi: 10.1177/24741264261432182.
Post-phaco RRD: Up to 10 years post-op sustained increased RD risk. Risk 0.27% at 1-month and 1.41% at 10-years — Retrospective, TriNetX database
Purpose: To evaluate the short-term and long-term incidence and prevalence of retinal detachment (RD) and retinal tear, in addition to the relative risk (RR) of RD and retinal tear development following phacoemulsification.
Methods: Patients who received bilateral phacoemulsification were identified through US-based electronic health records, with incidence and prevalence of RD and retinal tear reported. The second objective was a retrospective cohort design with greedy nearest neighbor 1:1 propensity score matching based on age, sex, race, ethnicity, and known risk factors for RD and retinal tear. Matched cohort analysis was reported as RR with 95% CI at 1 month, 3 months, 6 months, 1 year, 3 years, 5 years, and 10 years after phacoemulsification.
Results: There were 742 337 patients identified. The prevalence of RD after phacoemulsification increased from 0.27% at 1 month to 1.41% at 10 years, while prevalence of retinal tear increased from 0.16% at 1 month to 0.97 % at 10 years. The highest incidence of RD and retinal tear occurred between 1 and 3 years in 0.37% and 0.27% of patients, respectively. Among 731 362 matched patients, phacoemulsification was associated with a significantly increased risk of RD and retinal tear from 3 months to 10 years. The RR of retinal tear peaked at 1 year (1.54; 95% CI, 1.46-1.63), and the RR of RD peaked at 3 years (1.57; 95% CI, 1.52-1.62).
Conclusions: Phacoemulsification is associated with sustained increases in RD and retinal tear risk even among patients matched for baseline risk. These findings underscore the need for long-term monitoring and education on potential complications.
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