Posters

Unilateral visual loss following cataract surgery in a patient with multiple sclerosis: ms related optic neuritis or an interesting case of nonarthritic anterior ischemic optic neuropathy?

Poster Details

First Author: A.Papazacharia GREECE

Co Author(s): V. Margaritis   E. Kanonidou                 

Abstract Details

Purpose:

Cataract surgery is a common, highly effective and safe ophthalmic surgical procedure; however, the surgery can still cause various postoperative complications. Among many of them, cataract extraction(CE) may be associated with an increased incidence of nonarteritic anterior ischemic optic neuropathy(NAION). The risk of NAION after CE is low, approximately one occurrence in every 2,000 cases. This represents a significantly greater incidence than the general population, which is estimated to be 2.3 to 10.2 per 100,000 people among patients 50 years and older. Our purpose is to present an interesting uncommon case of NAION in a middle-age patient after cataract extraction.

Setting:

Hippokrateion General Hospital of Thessaloniki, Thessaloniki, Greece

Methods:

58-year old male presented due to sudden and painless visual loss of the right eye, one month postoperatively of cataract surgery. His medical history included kidney transplant (2011), hypertension, hyperuricaemia, secondary HPT, antiphospholipid antibody syndrome (APS), and he underwent cataract surgery in his left eye 8 months ago. Ocular examination revealed: VA: CF RE, 8/10 LE, IOP: 14mmHg bilaterally, slit lamp examination without pathological findings. Fundoscopy revealed RE optic disc swelling and normal LE optic disc. Pupillary light reflex in his RE was poor. An MRI scan as well as neurological examination was then programmed.

Results:

Visual field examination showed central defect in his right eye. MRV scan was normal. MRI scan revealed demyelinating lesions in the periventricular white matter. The patient was then referred to the neurology unit, where he was hospitalised. After 5 days of systemic treatment with corticosteroids, his visual fields showed mild improvement and his visual acuity was: 1/10 BCVA RE and 9/10 BCVA LE. The optic disc swelling also improved.

Conclusions:

Case reports and case series suggest that cataract extraction (CE) may be associated with an increased incidence of nonarteritic anterior ischemic optic neuropathy (NAION) weeks to months after surgery, whereas the mechanism of pathogenesis causing NAION after cataract extraction is controversial and has not been clearly elucidated. Therefore, NAION should always be considered as a potential diagnosis in individuals with recent CE history.

Financial Disclosure:

None