Mechanical displacement of retinal arterial embolus during vitrectomy: A simplified surgical approach and literature review

Purpose: The management of retinal artery occlusion (RAO) remains controversial and lacks standardized guidelines. We report a case of branch retinal artery occlusion (BRAO) treated with pars plana vitrectomy (PPV) and mechanical embolus displacement 22 h after onset, along with a focused practical review of current surgical strategies. Methods: A 50-year-old man with type 2 diabetes and hypertension presented with sudden visual loss and an inferior field defect in the left eye. After unsuccessful digital massage, IOP-lowering therapy, and anterior chamber paracentesis, a 25-G three-port PPV was performed 22 h after symptom onset. Posterior vitreous detachment was induced; intraoperative IOP was set at 8 mmHg; a diamond-dusted membrane scraper was used to gently displace and fragment the embolus distally. A PubMed search for qualitative synthesis identified 20 studies (61 eyes). Results: Retinal perfusion was restored intraoperatively. Best-corrected visual acuity improved from counting fingers to 6/9 at 1 week and 6/6 at 1 month, remaining stable at 6 months. OCT showed resolution of inner retinal edema; fluorescein angiography confirmed complete reperfusion without recurrence. Literature analysis compared surgical approaches regarding PPV technique, invasiveness, timing, and visual outcomes versus non-invasive strategies. Conclusions: PPV with minimally invasive embolus manipulation may restore retinal perfusion and achieve meaningful visual recovery beyond the conventional 4–6-h therapeutic window. This case in association with the reviewed literature suggest that in selected patients, vitrectomy, controlled IOP and targeted instrumentation is a viable and relatively safe option. Prospective trials are needed to define optimal timing, techniques, and patient selection. © The Author(s) 2025