전신마취 후 발생한 양안 급성폐쇄각녹내장에 동반한 비동맥염 앞허혈시신경병증

Bilateral Nonarteritic Anterior Ischemic Optic Neuropathy Following Acute Angle Closure Glaucoma After General Anesthesia

Purpose: To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) following acute angle closure glaucoma (AACG) after general anesthesia. Case summary: A 65-year-old woman, who had had open reduction and internal fixation under general anesthesia for her right femur fracture, presented with a 2-day history of visual loss in both eyes. Best corrected visual acuity was finger count and intraocular pressure (IOP) was 40 mmHg in her both eyes. There were diffuse corneal edema and shallow peripheral anterior chamber under slit lamp examination, and fundus examination revealed a swollen optic disc in both eyes. With no lesion found in emergent brain magnetic resonance imaging, optical coherence tomography (OCT) showed diffuse retinal nerve fiber layer (RNFL) thickening. She started glaucoma medications for lowering IOP and laser iridotomy was performed in her both eyes. Two months later, optic disc swelling was improved but OCT showed diffuse RNFL thinning in both eyes and peripheral visual field defects remained in the visual field test. Conclusions: Either stress by general anesthesia or several drugs given after the operation can be attributed to bilateral AACG. Acute rises in IOP may lead to bilateral NAION by decreasing optic nerve head perfusion pressure, which results in ischemia of the optic disc.