A51-year-old man with a 2-year history of disabling vitreous floaters in his left eye was referred to me by one of my practice partners. The patient had been carefully followed with documentation and had persistent hyperplastic primary vitreous (PHPV) and amblyopia in his right eye with 20/80 vision. He was 20/20 in his left eye, but the floaters were impairing his ability to work, so he underwent 23-gauge pars plana vitrectomy with retroblubar block in his left eye. There were no complications during surgery, but 6 hours postoperative the patient reported the onset of photopsias. He described his symptoms as fireworks going off in his eye. The patient reported no pain, no coughing, no headache, and no sneezing. His vision in the left eye was reduced to hand motion and his intraocular pressure measured 10 mm Hg. The color fundus photo is shown in Figure 1. Figure 2 is the postoperative fluorescein angiography (FA), which shows normal filling time, suggesting that the vessels may be slightly dilated throughout the eye. Additionally, there is evidence of folding in the macula. Upon reviewing the patient's spectraldomain optical coherence tomography (SD-OCT; Figures 3 and 4) taken with the SPECTRALIS SD-OCT (Heidelberg Engineering, Heidelberg, Germany), we clearly saw folding of the macula.

Initially, we thought that this could be an unusual case of vitreomacular traction (VMT) where it appeared that there was tenting of the retina. We evaluated the vitreomacular interface of the volume scan using the vitreous option in the software (Figure 5) and did not observe any evidence of VMT. It was then suggested that this patient might have hypotony maculopathy, but what I thought was key to making a diagnosis was the whitening of the retina throughout.

At day 5 postoperative, the OCT (Figure 6) and indocyanine green (Figure 7) images showed no change and the patient's vision continued to be hand motion. We determined that the patient may have suffered an artery occlusion the night after surgery. We recently saw this patient back for follow-up and the eye appears normal with an ischemic nerve and sclerotic vessels.

Jeffrey S. Heier, MD, is a Clinical Ophthalmologist specializing in diseases of the retina and vitreous at Ophthalmic Consultants of Boston. Dr. Heier is a member of the Heidelberg Scientific Advisory Board. He does not have a financial interest in Heidelberg. Dr. Heier is a member of the Retina Today Editorial Board. He can be reached at jsheier@eyeboston.com.