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Optic nerve enhancement in hypotensive ischemic optic neuropathy
1Department of Ophthalmology, University of Alabama, 700 South 18th Street, Birmingham, AL 53233, USA. vaph@uab.edu
Summary
Hypotensive ischemic optic neuropathy (HION) following cardiac surgery can cause permanent vision loss. This case study highlights persistent optic nerve enhancement on MRI, a finding previously unreported in HION.
Area of Science:
- Ophthalmology
- Neurology
- Cardiovascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a major cardiovascular procedure.
- Hypotensive ischemic optic neuropathy (HION) is a rare but severe complication potentially leading to vision loss.
- Optic nerve enhancement on MRI is a known imaging finding in various optic neuropathies.
Observation:
- A 57-year-old woman experienced cardiac arrest and hypotension during CABG.
- Postoperatively, she developed HION with complete vision loss (no light perception) in both eyes (OU).
- Serial magnetic resonance imaging (MRI) revealed persistent bilateral mid-orbital optic nerve enhancement.
Findings:
- The patient presented with persistent no light perception vision, dilated pupils, and pale optic discs.
- MRI demonstrated persistent bilateral optic nerve enhancement, a finding not previously documented in HION.
- Optic nerve enhancement is typically associated with radiation-induced, arteritic, or nonarteritic ischemic optic neuropathies.
Implications:
- This case expands the known imaging characteristics of hypotensive ischemic optic neuropathy.
- Persistent optic nerve enhancement may indicate ongoing inflammatory or ischemic processes in HION.
- Further research is needed to understand the significance and prognostic value of optic nerve enhancement in HION.