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Published on: November 29, 2015
Bilateral Posterior Ischemic Optic Neuropathy Following Midface Advancement Surgery in a Pediatric Patient With
Brianna A Blasingame1, Elliot Cherkas, John D Ng
1Department of Oculofacial Plastic and Reconstructive Surgery, Casey Eye Institute, Oregon Health and Science University, Portland, OR.
Insights
This study reports the first pediatric case of bilateral posterior ischemic optic neuropathy after craniofacial surgery. Tight flaps and hypotension caused vision loss, highlighting a rare surgical risk.
Area of Science:
- Ophthalmology
- Pediatric Surgery
- Neurosurgery
Background:
- Craniofacial surgery carries risks, including potential vision complications.
- Posterior ischemic optic neuropathy (PION) is a rare but serious complication.
- Pediatric cases of PION following major surgery are exceptionally uncommon.
Purpose of the Study:
- To report the first case of bilateral PION in a pediatric patient after craniofacial surgery.
- To identify contributing factors and potential risk factors for PION in this context.
- To raise awareness among surgeons regarding this rare complication.
Main Methods:
- Case report of a 13-year-old male undergoing Le Fort II midface advancement.
- Detailed review of intraoperative events, including hypotension and blood loss.
- Postoperative assessment of visual function and ophthalmological examination.
Main Results:
- The patient experienced bilateral vision loss with nonreactive pupils on postoperative day 5.
- Contributing factors identified: bicoronal flap tightness (scarring from prior surgery), permissive hypotension, and anemia.
- This represents the only documented instance of bilateral PION in a pediatric patient post-craniofacial surgery.
Conclusions:
- Bilateral PION is a rare complication that can occur after major pediatric craniofacial surgery.
- Surgical technique, patient factors (like scarring), and hemodynamic management are critical.
- This case underscores the importance of vigilant monitoring for visual changes in pediatric surgical patients.
Abstract:
This article presents the first reported case of bilateral posterior ischemic optic neuropathy in a pediatric patient following major craniofacial surgery. A 13-year-old male patient developed bilateral vision loss with dilated and nonreactive pupils after extubation on postoperative day 5 following Le Fort II midface advancement. During the procedure, he had permissive hypotension and an estimated blood loss of 800 mL. It was determined on institutional review that his vision loss was attributed to the tightness of the bicoronal flap due to scarring from past Le Fort III procedures in combination with permissive hypotension and anemia. This case demonstrates the only documented episode of bilateral posterior ischemic optic neuropathy in a pediatric patient and describes a rarely documented risk factor.
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