{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:45:13Z","timestamp":1782992713113,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Central retinal artery occlusion (CRAO) is a rare but vision-threatening complication following retinal detachment surgery. We report a man in his late 60s who underwent combined phacoemulsification with intraocular lens implantation and segmental scleral buckling for macula-sparing rhegmatogenous retinal detachment caused by inferotemporal ora dialysis. Shortly after surgery, he developed recurrent ocular pain with marked intraocular pressure (IOP) spikes, anterior chamber shallowing, iris bombe, and secondary angle closure. Approximately 3 h post-operatively, visual acuity deteriorated to no light perception. Fundus examination showed diffuse retinal whitening, a cherry-red spot, and marked retinal arterial attenuation. Fluorescein angiography demonstrated delayed retinal arterial filling, with focal choroidal hypoperfusion, consistent with CRAO with associated focal choroidal hypoperfusion rather than primary ophthalmic artery occlusion. Anterior segment optical coherence tomography showed forward displacement of the intraocular lens\u2013iris diaphragm and angle closure. The patient was treated promptly with repeated anterior chamber paracentesis, topical pilocarpine, topical and systemic IOP-lowering therapy, intravenous mannitol, oxygen therapy, and adjunctive supportive treatment. IOP gradually normalized, and anterior chamber depth recovered. However, visual recovery was limited, with hand motion vision persisting during follow-up. Although the mechanism cannot be proven definitively, the temporal sequence and anterior segment findings suggest that buckle-related anterior segment crowding may have led to forward displacement of the intraocular lens\u2013iris diaphragm, secondary angle closure, and recurrent acute ocular hypertension, thereby contributing to critically reduced ocular perfusion pressure and retinal ischemia. This case highlights the need for urgent reassessment of IOP, anterior chamber configuration, and retinal perfusion when recurrent ocular pain and shallow anterior chamber occur after scleral buckling surgery.<\/jats:p>","DOI":"10.3389\/fmed.2026.1889588","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:10:16Z","timestamp":1782990616000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case report: Central retinal artery occlusion following scleral buckling surgery with secondary angle closure and recurrent acute ocular hypertension"],"prefix":"10.3389","volume":"13","author":[{"given":"Jing","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, People's Hospital of Leshan","place":["Leshan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, People's Hospital of Leshan","place":["Leshan, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1038\/s41572-024-00501-5","article-title":"Retinal detachment","volume":"10","author":"Lin","year":"2024","journal-title":"Nat Rev Dis Primers."},{"key":"B2","doi-asserted-by":"publisher","first-page":"376","DOI":"10.1097\/ICU.0000000000001065","article-title":"The necessity and role of scleral buckling for rhegmatogenous retinal detachment","volume":"35","author":"Wang","year":"2024","journal-title":"Curr Opin Ophthalmol."},{"key":"B3","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1007\/s00417-019-04562-1","article-title":"Scleral buckling: a brief historical overview and current indications","volume":"258","author":"Wang","year":"2020","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1136\/bjo.2008.144683a","article-title":"Arterial occlusion after scleral buckling","volume":"503","author":"Aslam","year":"2010","journal-title":"Br J Ophthalmol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1186\/1752-1947-7-223","article-title":"The CARE guidelines: consensus-based clinical case reporting guideline development","volume":"7","author":"Gagnier","year":"2013","journal-title":"J Med Case Rep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1927","DOI":"10.1016\/S0140-6736(20)31559-2","article-title":"Retinal vascular occlusions","volume":"396","author":"Scott","year":"2020","journal-title":"Lancet."},{"key":"B7","doi-asserted-by":"publisher","first-page":"4589","DOI":"10.1167\/iovs.16-19887","article-title":"The characteristics of retinal emboli and its association with vascular reperfusion in retinal artery occlusion","volume":"57","author":"Cho","year":"2016","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B8","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1016\/j.ajoc.2018.10.001","article-title":"Central retinal artery occlusion on postoperative day one after vitreoretinal surgery","volume":"12","author":"Russell","year":"2018","journal-title":"Am J Ophthalmol Case Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1097\/ICB.0000000000001713","article-title":"Central retinal artery occlusion after scleral buckling surgery with gas insertion in a patient with sickle cell disease","volume":"20","author":"Jalil","year":"2026","journal-title":"Retin Cases Brief Rep."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e1595","DOI":"10.1111\/aos.15142","article-title":"Retinal detachment after cataract surgery: a population-based study","volume":"100","author":"Thylefors","year":"2022","journal-title":"Acta Ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"S164","DOI":"10.4103\/IJO.IJO_813_24","article-title":"Scleral buckling in retinal detachment due to retinal dialysis: a vitreoretina fellow's perspective","volume":"73","author":"Balaji","year":"2025","journal-title":"Indian J Ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1080\/08820538.2017.1353816","article-title":"Postoperative complications of scleral buckling","volume":"33","author":"Papakostas","year":"2018","journal-title":"Semin Ophthalmol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1136\/bjo.84.1.31","article-title":"Effects of scleral buckling and encircling procedures on human optic nerve head and retinochoroidal circulation","volume":"84","author":"Nagahara","year":"2000","journal-title":"Br J Ophthalmol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1080\/08820538.2023.2223271","article-title":"Evaluation of the effect of scleral buckling on anterior segment and refractive changes using anterior segment optical coherence tomography","volume":"39","author":"Wang","year":"2024","journal-title":"Semin Ophthalmol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1016\/j.ophtha.2009.06.052","article-title":"Anterior chamber depth is significantly decreased after scleral buckling surgery","volume":"117","author":"Goezinne","year":"2010","journal-title":"Ophthalmology."},{"key":"B16","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1016\/j.ogla.2023.12.005","article-title":"Long-term treatment outcomes for malignant glaucoma","volume":"7","author":"Jin","year":"2024","journal-title":"Ophthalmol Glaucoma."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1007\/s00417-024-06381-5","article-title":"Aqueous misdirection syndrome: clinical outcomes and risk factors for treatment failure","volume":"262","author":"Senthil","year":"2024","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.4103\/ijo.IJO_1155_22","article-title":"Secondary glaucoma following vitreo-retinal surgeries","volume":"71","author":"Kolipaka","year":"2023","journal-title":"Indian J Ophthalmol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"82","DOI":"10.1177\/0310057X231215826","article-title":"Retinal artery occlusion after ophthalmic surgery under regional anaesthesia: a narrative review","volume":"52","author":"Chua","year":"2024","journal-title":"Anaesth Intensive Care."},{"key":"B20","doi-asserted-by":"publisher","first-page":"945","DOI":"10.4103\/IJO.IJO_2826_23","article-title":"Update on central retinal artery occlusion","volume":"72","author":"Venkatesh","year":"2024","journal-title":"Indian J Ophthalmol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1016\/j.jcjo.2020.06.006","article-title":"Ophthalmic artery occlusion after dermal fillers injection","volume":"55","author":"Toh","year":"2020","journal-title":"Can J Ophthalmol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"2512","DOI":"10.4103\/ijo.IJO_294_20","article-title":"Concurrent ophthalmic artery occlusion and optic nerve infarction after cosmetic facial filler","volume":"68","author":"Cho","year":"2020","journal-title":"Indian J Ophthalmol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.preteyeres.2014.02.001","article-title":"Functional and morphological characteristics of the retinal and choroidal vasculature","volume":"40","author":"Yu DY Yu","year":"2014","journal-title":"Prog Retin Eye Res."},{"key":"B24","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1159\/000055622","article-title":"Regulatory mechanisms in the retinal and choroidal circulation","volume":"32","author":"Delaey","year":"2000","journal-title":"Ophthalmic Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/WNO.0000000000002440","article-title":"Updates in central retinal artery occlusion","volume":"46","author":"Paddock","year":"2026","journal-title":"J Neuroophthalmol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s00417-022-05797-1","article-title":"Efficacy and safety of intra-arterial thrombolysis in patients with central retinal artery occlusion: a systematic review and meta-analysis","volume":"261","author":"Huang","year":"2023","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"720","DOI":"10.18240\/ijo.2026.04.11","article-title":"Effectiveness and safety of superselective ophthalmic artery thrombolysis beyond 24 h in central retinal artery occlusion","volume":"19","author":"Zhang KK Li","year":"2026","journal-title":"Int J Ophthalmol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1597","DOI":"10.1016\/j.ophtha.2018.03.054","article-title":"Management of acute retinal ischemia: follow the guidelines","volume":"125","author":"Biousse","year":"2018","journal-title":"Ophthalmology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1161\/STR.0000000000000366","article-title":"Management of central retinal artery occlusion: a scientific statement from the American heart association","volume":"52","author":"Mac Grory","year":"2021","journal-title":"Stroke."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2319","DOI":"10.1038\/s41433-024-03029-w","article-title":"Central retinal artery occlusion: a stroke of the eye","volume":"38","author":"Chen","year":"2024","journal-title":"Eye."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889588\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T11:10:21Z","timestamp":1782990621000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1889588\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1889588"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1889588","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,2]]},"article-number":"1889588"}}