Posterior Ischemic Optic Neuropathy after Surgery: A Case Report and Review of Literature

Case Report

Austin Ophthalmol. 2023; 7(1): 1045.

Posterior Ischemic Optic Neuropathy after Surgery: A Case Report and Review of Literature

Boussetta S1,2*; Homaide S1,2; Cheikh Z1,2; Mchachi A1,2; Benhmidoune L1,2; Rachid R1,2; Elbelhadji M1,2

¹Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca Morocco

²Department of Ophthalmology, Hospital 20 August 1953, CHU Ibn Rochd, Casablanca, Morocco

*Corresponding author: Sophia Boussetta Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca Morocco. Email: salma_moataz@hotmail.fr

Received: March 07, 2023 Accepted: April 11, 2023 Published: April 18, 2023

Abstract

We propose in this work to report a case of perioperative posterior ischemic optic neuropathy, after a cardiac surgery.

This is a 45-year-old patient, operated for Coronary Angioplasty and Stenting. 24h after the surgery he noticed a bilateral loss of vision.

Examination of the both eyes revealed visual acuity decreased to no light perception, absent pupillary light reflexes and normal fundus. The neurological examinationis normal, macular OCT and cerebral magnetic imaging were normal. Visual evoked potentials were absent confirming the diagnosis of right retrobulbar optic neuropathy.

The evolution was marked by no improvement of vision and the development of optic nerve atrophy. Perioperative posterior ischemic optic neuropathy during cataract surgery is an extremely rare incident.

Posterior ischemic optic neuropathy is an uncommon complication Its physiopathology is multifactorial and dominated by hypotension and anemia. Its prognosis is bad and visual recovery is generally poor.

Keywords: Optic atrophy; Perioperative visual loss; Posterior ischemic optic neuropathy

Introduction

Posterior Ischemic Optic Neuropathy (PION) is an uncommon type of Ischemic Optic Neuropathy (ION) that presents clinically as a retrobulbar optic neuropathy resulting in an initially normal appearing optic disc despite severe visual loss. Its treatment is discussed. The prognosis is reserved.

Purpose

We report the case of perioperative PION, to determine etiopathogenesis, the diagnosis criteria, the treatment and the evolution of this optic neuropathy and to underline the imp-rtance of preventing its occurrence.

Case Report

A 45 year old men presented with acute bilateral and profound visual loss 24 hours after a a Coronary Angioplasty and Stenting Surgery was performed under general anesthesia and lasted 12 hours. The patient was placed in a prone position. The ophtalmic examination revealed decreased visual acuity to no light perception in the both eyes with absent pupillary Light Reflexes. The fundus exam revealed normal optic discs in both eyes.