Retinal haemorrhage after cardiopulmonary resuscitation of a patient

Abstract

Aims/Purpose: We present a rare case of a patient who presented with bilateral retinal haemorrhage after cardiopulmonary resuscitation (CPR).Methods: A 37‐year‐old man, with a medical history of allergic bronchial asthma and a BMI >35, was referred to our emergency department from the cardiology clinic. He complained of sudden, painless, monocular visual acuity reduction after cardiac arrest and CPR because of an acute myocardial infarction (right coronary). He underwent a complete ophthalmic examination, as well as multimodal imaging and he was under close monitoring for the following months.Results: In his initial ophthalmic examination, best corrected visual acuity was 0.1 in his right eye and 1.0 in his left eye (Snellen's chart). Intraocular pressure was 14 mmHg and 15 mmHg in his right and left eye, respectively. Dilated fundus examination showed bilaterally scattered sub‐retinal, intraretinal and pre‐retinal haemorrhages in the posterior pole, with involvement of the right fovea. After the resolution of the haemorrhages, a fluoroangiography was performed which revealed delayed central retinal vein filling in the right eye. 2 months later, during follow‐up examination, visual acuity in the right eye was 0.7 and in the left eye 1.0. The haemorrhages have been absorbed bilaterally, leaving in the right eye a sub‐foveal photoreceptor and RPE disruption.Conclusions: Retinal haemorrhages can be observed after CPR. According to the literature, there have been reports of retinal haemorrhages in infants after CPR. Meanwhile, there is only one published case of an adult with associated comorbidities with this clinical presentation. The underlying pathophysiology of this clinical entity is still unclear, although a potential relationship between the increase in central venous pressure during CPR, and sequential retinal venous stasis is suspected.