Posterior ischemic optic neuropathy following percutaneous nephrolithotomy

Purpose: To report a case of posterior ischemic optic neuropathy (PION) following percutaneous nephrolithotomy (PCNL). Case Report: A 57-year-old man with history of diabetes mellitus, hyperlipidemia and mild anemia underwent PCNL for treatment of nephrolithiasis. He noticed painless visual loss in both eyes immediately after the procedure. Visual acuity was light perception, however ophthalmologic examinations were unremarkable and the optic discs were pink with no swelling. Visual fields were severely affected, but neuroimaging was normal. Within three months, visual acuity and visual fields improved dramatically but the optic discs became slightly pale. Conclusion: This is the first report of PION following PCNL. PION is a rare cause of severe visual loss following surgery. Severe blood loss, hypotension, anemia and body position during surgery are the most important risk factors. Ophthalmologists, urologists and anesthesiologists should be aware of this condition and this rare possibility should be considered prior to surgery.