Posterior Ischemic Optic Neuropathy (Pion) After Complicated Cataract Surgery As The First Clinical Manifestation Of Carotid Artery Stenosis: A Case Report

To present a case where Posterior Ischemic Optic Neuropathy (PION) after complicated cataract surgery serves as the initial clinical manifestation of Carotid Artery Stenosis (CAS).

Case report, General Hospital of Athens ‘’Georgios Gennimatas’’

Α 69-year-old male presented to the outpatient department with pseudoexfoliation syndrome and nuclear cataract. His best corrected visual acuity was 20/70 in the right eye and 20/40 in the left eye, with no notable medical and ocular history. He underwent a complicated cataract surgery for the right eye with a postoperative period of increased Intraocular pressure likely due to inflammation and retained viscoelastic materials. In the follow-up assessment, he had not regained the expected visual acuity. Visual field examination revealed amaurosis of the right eye. Clinical suspicion for PION arose as optic discs looked healthy in terms of rim appearance and cupping. He referred for a comprehensive laboratory examination and cardiac/carotid ultrasound. Surprisingly, a 90% blockage was identified in the right carotid artery and an 80% blockage in the left carotid artery, confirming the diagnosis of PION and establishing it as the initial clinical manifestation of CAS.

This case underscores the potential association between PION after complicated cataract surgery and CAS, emphasizing the necessity of close postoperative monitoring and a comprehensive vascular evaluation, even to individuals with few high-risk factors for CAS. Early recognition of such cases can guide appropriate interventions, preventing potentially life- or even sight-threatening consequences.