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Commentary: Central retinal arterial occlusions after phacoemulsification: Our perspective

As per our sterilization protocol it was routine to use ETO sterilized instruments after an aeration period of 12 hours (in accordance to manufacturer’s recommendation). After consultation with experts, we increased the aeration time to 48 hours and rinsed the probes thoroughly with normal saline before use and did not encounter any further CRAO cases post cataract surgery. OCT was done in all cases of PCR occurring during the next 6 months after changing our ETO protocol. However, we did not encounter any similar case after the ETO protocol change. Stoppage of occurrence of CRAO on changing our ETO protocol made us believe that residual ETO on vitrectomy probes could have been responsible for this series of post‐operative CRAOs. We noted 185 events of PCR wherein anterior vitrectomy was done, however only 14 out of these had CRAO. This could be explained on the basis that we have used fresh probes in some cases and in others the residual ETO content might not be high enough to cause vascular spasm. Only those cases wherein there was significant residual ETO may have had CRAO. The limitation of this study is that we could not directly prove the causality. Further experimental models can help in conclusively establishing the association.