2805 Complete Vision Loss after Laparoscopic Hysterectomy: A Case Report

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Study Objective NA Design Case-report. Setting University-affiliated hospital. Patients or Participants 1 Interventions NA Measurements and Main Results Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a 34 year old female who experienced POVL following an uncomplicated laparoscopic hysterectomy. Her medical history was remarkable for anxiety, depression and endometriosis. She underwent a total laparoscopic hysterectomy, bilateral salpingectomy, and excision of deeply infiltrating endometriosis from the right pelvic sidewall. She was in the dorsal lithotomy position with both arms tucked. Operating time was 174 minutes and EBL was 75mL. Upon arrival to the surgical floor, approximately 4 hours postoperative, she became increasingly distressed, reporting complete absence of vision. A stroke code was called. No focal neurologic deficits were found. Pupils were equally reactive to light, but vision was reported as no light perception. No cerebral hemorrhage or ischemia were detected on CT/MRI. Funduscopic exam revealed no structural abnormalities. Tonometry demonstrated a normal intraocular pressure of 18mmHg in the left eye and 13mmHg in the right. The lens was clear, macula flat, and periphery was within normal limits bilaterally. Over the following days, her vision remained unchanged. She continued to describe a white wall, and unable to notice motion or light. Otherwise, she met all appropriate post-operative milestones from a gynecologic perspective. On postoperative day 7 the decision was made to start an IV methylprednisolone taper. The following morning she noticed mild light perception. Later that night, she reported a spontaneous partial return of visual acuity. She was discharged home the next day after completing the steroid taper. At her 2 week postoperative visit, uncorrected Snellen eye exam was 20/63 for her left eye and 20/50 for her right, which was consistent with her baseline. Conclusion POVL should be treated as an emergency, and managed in a multidisciplinary fashion.