Korean J Ophthalmol.  2010 Feb;24(1):57-61. 10.3341/kjo.2010.24.1.57.

A Case of Decreased Visual Field after Uneventful Cataract Surgery: Nonarteritic Anterior Ischemic Optic Neuropathy

• Lee H
• Kim CY
• Seong GJ
• Ma KT

• KMID: 1098796
• DOI: http://doi.org/10.3341/kjo.2010.24.1.57

Abstract

The purpose of this article is to report a case of nonarteritic anterior ischemic optic neuropathy (NAION) after uneventful cataract surgery. A 53-year-old Filipina underwent cataract surgery. She had a small optic disc with cup-to-disc ratio of 0.2 in the left eye and 0.3 in the right eye. On the first postoperative day, the uncorrected visual acuity (UCVA) was 20/20, with an intraocular pressure (IOP) of 20 mmHg in the left eye. At one week after operation, the UCVA was 20/20 and the IOP was 15 mmHg. Three weeks later, she underwent cataract surgery in the right eye. On the first postoperative day, her UCVA was 20/20 in both eyes, but she complained of a visual field decrease in the left eye. A relative afferent pupillary defect (RAPD) was noted and the optic disc was pallid and swollen diffusely. A red-free photo showed defect surrounding the optic disc. A visual field test showed tunnel vision sparing the central vision. In this report, the authors hypothesize an association between cataract extraction and delayed NAION. Since the risk of NAION in the fellow eye is 30-50%, visual acuity, visual field, fundus exam and RAPD should be routinely checked.

Keyword

Cataract; Ischemic optic neuropathy

MeSH Terms

Cataract Extraction/*adverse effects/methods
Female
Humans
Lens Implantation, Intraocular
Middle Aged
Optic Neuropathy, Ischemic/diagnosis/*etiology/*physiopathology
Phacoemulsification
*Visual Fields

Figure

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  Fig. 1 Preoperative fundus photograph: relatively small bilateral optic disc with a cup-to-disc ratio of 0.2 in the left eye and 0.3 in the right eye.

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  Fig. 2 Fundus photograph of the left eye on postoperative day 1 showing optic disc pallor and swelling.

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  Fig. 3 Stratus optical coherence tomography image of the left eye on postoperative day 1 showing an increase in nerve fiber layer thickness due to optic disc swelling. TEMP=Temporal; SUP=Superior; NAS=Nasal; INF=Inferior; OS=Oculus Sinister.

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  Fig. 4 Red-free photo of the left eye on postoperative day 1 showing a nerve fiber layer defect around the disc.

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  Fig. 5 Visual field test of the left eye with a Humphrey perimeter on postoperative day 1.

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  Fig. 6 Visual field test of the left eye with a Goldmann perimeter on postoperative day 3.

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  Fig. 7 Fluorescein angiography of the left eye on postoperative day 3 showing hyperfluorescence of the disc at the late stage.

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  Fig. 8 MRI image of the brain and orbit on postoperative day 10 showing only age-related changes.

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