Postoperative vision loss after colorectal laparoscopic surgery

Postoperative loss of vision is a serious but under-appreciated complication after surgery. Although more commonly seen with cardiac and spinal surgery, we report a rare case where ischemic optic neuropathy is associated with laparoscopic surgery. An ASA-2 middle-aged man with hypertension and obesity underwent a laparoscopic resection of rectosigmoidal adenocarcinoma. Intraoperatively, no surgical complications were noted with minimal blood loss encountered. He was positioned in a steep Trendelenberg position for 5 continuous hours, and had a mean blood pressure of at least 75 mm Hg throughout. Postoperatively, he had obvious facial and periorbital swelling. Initial decreased visual acuity was noted immediately and this only partially improved over several days and weeks. Magnetic resonance imaging and angiography revealed no structural abnormality and after ophthalmology review, a diagnosis of ischemic optic neuropathy was made. We describe a case showing the association of postoperative loss of vision with laparoscopic surgery and prolonged Trendelenberg positioning.