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Bilateral ischemic optic neuropathy after transurethral prostatic resection: a case report
Luis M Sadaba1, Alfredo Garcia-Layana, Miguel J Maldonado
1Ophthalmology Department, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona (Navarra), Spain. lmsadaba@unav.es
BMC Ophthalmology
|October 13, 2006
Summary
This case study highlights a rare complication: bilateral, simultaneous anterior ischemic optic neuropathy following transurethral prostatic resection. Anemia and hypotension were identified as key risk factors for this devastating visual loss.
Area of Science:
- Ophthalmology
- Neurology
- Urology
Background:
- Nonarteritic anterior ischemic optic neuropathy (NAION) causes sudden, painless vision loss.
- Risk factors for NAION include advanced age, hypertension, diabetes, and small cup-to-disc ratio.
- Postoperative NAION is linked to prolonged surgery, hypotension, anemia, and prone positioning.
Observation:
- A 66-year-old man developed bilateral, simultaneous NAION after transurethral prostatic resection.
- Postoperative complications included significant drops in blood pressure, hemoglobin, and hematocrit.
- The patient experienced nausea, vomiting, and complete vision loss (no light perception) bilaterally.
Findings:
- Funduscopy revealed optic disc swelling and hemorrhages, progressing to optic disc atrophy.
- Visual evoked potentials were unreactive bilaterally.
- Severe anemia (hemoglobin 7.0 g/dL) and hypotension (90/50 mm Hg) were noted during the vision loss.
Implications:
- Bilateral, simultaneous NAION is a rare but severe surgical complication.
- Transurethral prostatic resection carries a risk of NAION, particularly with concurrent anemia and hypotension.
- Prompt management of anemia and hypotension is crucial in preventing postoperative NAION.
