Anterior segment ischemia and ischemic optic neuropathy following encircling scleral buckling surgery and air tamponade.

Background: Anterior segment ischemia (ASI) and non-arteritic anterior ischemic optic neuropathy (NAION) are two rare events that are unlikely to coexist.We present a case report in which the patient experienced ASI and NAION following a scleral buckling intervention. Case report: In this case report, a 55-year-old patient with retinal detachment underwent a scleral buckling procedure involving the placement of an encircling 5mm oval sponge at 13 mm posteriorly from the limbus, cryopexy, subretinal fluid drainage, and air tamponade. On the second postoperative day, the patient presented conjunctival congestion, corneal edema, Descemet's membrane folding, 2+ cells in the anterior chamber, and a dilated and poorly reactive pupil. By the fourth postoperative day, an edematous optic nerve was also observed, and the visual field exhibited a significant altitudinal defect. The diagnosis of ASI and NAION was made. Due to a lack of improvement with systemic and topical steroid therapy, the scleral buckling was loosened 15 days after the initial procedure. A progressive anatomical and functional improvement was subsequently observed. Conclusion: The anterior ischemia resolved with the simple loosening of the oval sponge, avoiding the need for the removal of the entire encircling element and maintaining correct indentation on the break. Unfortunately, the NAION led to irreversible damage, significantly deteriorating the quality of vision for our patient, despite achieving a very high final visual acuity.