Posterior ischemic optic neuropathy following postoperative bleeding and internal jugular vein compression

• Published in: Nagoya journal of medical science Vol. 84; no. 4; pp. 877 - 883
• Main Authors: Kohyama, Keishi, Kato, Hisakazu, Kuroki, Masashi, Okuda, Hiroshi, Shibata, Hirofumi, Ohashi, Toshimitsu, Ogawa, Takenori
• Format: Journal Article
• Language: English
• Published: Japan Nagoya University 01.11.2022
• Subjects: Aged; Case Report; Humans; Jugular Veins; Male; Neck Dissection - adverse effects; Optic Neuropathy, Ischemic - etiology; Postoperative Complications - etiology; Postoperative Hemorrhage - etiology; Prognosis; ischemic optic neuropathy; postoperative bleeding; blindness; internal jugular vein; hematoma
• ISSN: 0027-7622; 2186-3326
• DOI: 10.18999/nagjms.84.4.877

Perioperative blindness, especially posterior ischemic optic neuropathy (PION), is an uncommon but potentially devastating complication. We report a case of a 65-year-old male patient who underwent laryngopharyngectomy, bilateral neck dissection, and free jejunum flap reconstruction, but then experienced PION in his right eye following postoperative bleeding and bilateral internal jugular veins (IJVs) compression. Despite systemic corticosteroid therapy, his visual recovery prognosis was poor. The specific mechanism responsible for PION remains unclear, and no therapy has been shown to improve this condition. As such, prevention of perioperative PION remains the only available strategy. Surgeons should be aware of this rare potential complication and its risk factors and strive to avoid it. As postoperative bleeding and IJV compression are one of important risk factors for PION, avoiding these are critical.