Postoperative Vision Loss Following Bariatric Surgery: Case Report and Literature Review

Postoperative blindness following non-ophthalmic surgeries is a rare but devastating complication, most commonly associated with spine and cardiovascular procedures. Thus far, there have been no reports of total blindness after metabolic surgeries in the literature. We present a case of transient total vision loss after laparoscopic sleeve gastrectomy in a young obese female patient with poorly controlled type 2 diabetes mellitus and hypertension on antihypertensive agent. Following induction of general anesthesia, the patient experienced severe hypertensive episodes lasting approximately five minutes, although the remainder of the intraoperative course was uneventful. She was transferred to the surgical intensive care unit (SICU) for postoperative monitoring. 30 minutes later, she reported sudden complete blindness while remaining hemodynamically stable and alert. During transfer for neuroimaging, she developed a generalized seizure and a decreased Glasgow Coma Scale (GCS) score, necessitating endotracheal intubation and mechanical ventilation. Brain CT and MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES). Although her GCS improved within 24 hours, visual impairment persisted until gradual recovery commenced on the second postoperative day, with full restoration by day three. The patient was subsequently transferred to the ward and later discharged with close outpatient follow-up. This case highlights PRES as a rare cause of perioperative vision loss and underscores the critical importance of rigorous blood pressure management in the perioperative period to mitigate neurological complications.