Arterial occlusion after scleral buckling

We present a report of a young man with bilateral retinal dialyses in whom surgery, in the form of scleral buckling, was initially performed only to one eye. Post-operatively, he developed features of combined central retinal and distal choroidal artery occlusions in the operated eye. Postulated mechanisms for this complication included a period of systemic hypotension during surgery, and previously undiagnosed polycythaemia and activated protein-C resistance which were found on subsequent haematological investigations, these being risk factors for thrombosis. This case serves to highlight the need for caution in performing simultaneous bilateral scleral buckling surgery without routine haematological screening, due to the extremely rare but potentially devastating effects of bilateral vascular occlusion.