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[Bilateral posterior ischemic optic neuropathy following subdural hematoma drainage]
Keiko Asayama1, Hiromasa Tsuda, Noriko Saito
1Department of Ophthalmology, Nihon University School of Medicine, Tokoyo, Japan.
Purpose:
We report a case of bilateral posterior ischemic optic neuropathy after subdural hematoma drainage.
Case:
A 52-yr-old man under continuous peritoneal dialysis underwent subdural hematoma drainage. After administration of a sedative, he complained of bilateral visual loss. His visual acuity was light perception in the right eye and no light perception in the left eye. Neither pupil reacted to light stimulus. Funduscopic findings revealed a slightly pale optic disc and renal retinopathy with macular folds in both eyes. No other neuro-ophthalmologic or neurologic abnormalities were observed. Based on these findings, the patient was diagnosed as having bilateral posterior ischemic optic neuropathy and was treated with intravenous corticosteroids. From about 50 days after the operation, visual acuity gradually improved, and papillary light reaction was immediate. In cranial magnetic resonance imaging, no characteristic lesions of multiple sclerosis could be detected. Six months later, visual acuity improved to 20/20 in both eyes.
Conclusion:
In patients with renal failure and underlying systemic vascular disease and anemia, the risk of posterior ischemic optic neuropathy should be considered even in minor surgery with stable vital signs and without severe blood loss.
