Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: a case report

• Published in: Journal of medical case reports Vol. 12; no. 1; p. 11
• Main Authors: Niro, A, Sborgia, G, Sborgia, A, Alessio, G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.01.2018; BioMed Central; BMC
• Subjects: Anterior ischemic optic neuropathy; Case Report; Conventional coronary artery bypass graft (CCABG); Coronary artery bypass; Coronary heart disease; Dosage and administration; Drug therapy; Fluorescence angiography; Hyperhomocysteinemia; Patient outcomes; Risk factors; Type 2 diabetes; Vasodilators; Anterior ischemic optic neuropathy; Hyperhomocysteinemia; Conventional coronary artery bypass graft (CCABG)
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-017-1539-1

The incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy. A 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia. Hyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft.