Transient bilateral cortical visual loss after coronary artery bypass grafting in a normotensive risk-free patient

Postoperative blindness has been mentioned as a rare complication of heart surgery. The majority of reported cases are caused by retinal artery occlusion or ischemic optic neuropathy. We report a case of transient visual loss due to cortical ischemia after coronary artery bypass grafting (CABG).

A 52-year-old nondiabetic man developed complete bilateral visual loss immediately after CABG. He had been normotensive throughout the operation. An ophthalmologic exam detected no causative ocular damage. The results of a Doppler study of the carotid, vertebral, and ophthalmic arteries were completely normal, and an echocardiography examination showed no left ventricular clot. Magnetic resonance imaging of the brain, however, showed several ischemic plaques in watershed areas and a small subacute infarct in the occipital lobe. Recovery began on postoperative day 4, and the patient's vision was restored in 6 months.

Although most cases of visual loss after open heart surgery have been caused by injuries to the peripheral optic system, cortical blindness may occur following open heart surgery in the absence of any preexisting risk factor. Fortunately, the course of recovery is promising one, as it was for our patient.