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Photo Essay
January 2004

Ischemic Oculopathy as a Complication of Surgery for an Atrial Myxoma

Arch Ophthalmol. 2004;122(1):130-131. doi:10.1001/archopht.122.1.130

A 45-year-old Chinese woman underwent surgery for left atrial myxomacomplicated by right femoral artery occlusion, requiring embolectomy, andinfarcts involving the territory of the left middle cerebral artery, leftbasal ganglia, and left cerebellum. The ophthalmologist was consulted forleft painless visual loss, present since the cardiac surgery 3 weeks earlier.Visual acuities were 20/30 OD and no light perception OS. A left relativeafferent pupillary defect was present. Intraocular pressures were 13 mm HgOD and 8 mm Hg OS. The left macula as well as the area temporal to the maculawere pale and edematous, with a sclerosed inferotemporal arteriole. Radialchorioretinal pigmentation was noted in the nasal and temporal periphery (Figure 1). The optic disc was pale. No retinalhemorrhages or emboli were present. The right eye was normal. The patientwas diagnosed as having left ophthalmic artery occlusion with central retinalartery occlusion, choroidal ischemia, and ischemic optic neuropathy. Becausethese multiple embolic phenomena manifested after the surgical excision, theocular ischemia was likely to have resulted from embolism consequent to manipulationof the tumor intraoperatively. Doppler ultrasound failed to show a site ofvascular occlusion.

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