Juxtapapillary nerve fiber layer infarction as a complication of coronary artery bypass surgery

Recent studies have detailed the prevalence and etiology of ocular complications resulting from coronary artery bypass surgery. Of these, retinal nerve fiber layer infarctions are reported most commonly. The clinical sequelae of nerve infarction may include loss of visual acuity, compromised pupillary function, and visual-field defects (the severity of which may be correlated with the location and extent of the insulted tissue).

A patient who had experienced bilateral juxtapapillary nerve fiber layer infarction with subsequent loss of visual acuity and peripheral visual field was followed postoperatively for more than 6 weeks. Immediately before our examination, he underwent quadruple coronary artery bypass graft surgery.

From the data collected during initial and follow-up examinations, it was determined that the nerve fiber layer infarction was probably the result of a systemic ischemic event during an otherwise uncomplicated surgery. Such events may include hypovolemic blood loss, systemic hypotension during or following surgery, or a host of complications that would prevent adequate perfusion to capillaries in select regions of the eye.

The pathology of bilateral juxatapapillary nerve fiber layer infarction as a result of substantial transient systemic ischemia may be explained by examining the microcirculation of this region of the retina. Due to certain anatomic and physiologic characteristics, the capillaries supplying the peripapillary zone are most susceptible to arterial vascular events such as ischemia. It is important to recognize this clinical presentation in order to rule out other possible causes for decreased visual acuity and field defects in the postoperative coronary bypass surgery patient.