Perioperative vision loss after sequential lower extremity fracture surgery: a case report

Abstract

Perioperative vision loss (POVL) is a rare but serious complication, most frequently reported after cardiac and prone spinal surgeries. POVL following lower extremity surgery is uncommon. We herein report a case of POVL in a man in his mid-thirties after a third surgery to repair a lower extremity fracture. The patient developed vision loss 3 hours postoperatively following sequential surgeries for a lower extremity fracture. Before the third surgery, he was in a hypercoagulable state, and tranexamic acid was administered to reduce intraoperative blood loss. After POVL occurred, anticoagulant and antithrombotic agents, as well as high-dose steroid pulse therapy, were promptly administered. The patient’s vision recovered 3 days later, with no abnormalities found during follow-up visits over the next 6 months. For patients at high risk of thrombosis, POVL warrants careful attention. The coagulation system should be kept as stable as possible, and medications that may promote thrombosis, such as tranexamic acid, should be used cautiously.