Bilateral Ischemic Optic Neuropathy Following Buttock Augmentation in an IIH Suspect

A 51-year-old female was transferred from an outside facility 5 days after buttock augmentation surgery in the prone position. On examination, there was no light perception in the right eye and hand motion vision in the left eye. The nerves were pale and edematous in both eyes. Exam was otherwise unremarkable. Outside MRI/MRA showed distension of the optic nerve sheaths and empty sella. The hemoglobin was 6.5 g/dL at the outside facility, and she had received 1 unit of blood. Hemoglobin was rechecked and found to be 7.5 g/dL with normal MCV suggesting acute blood loss anemia. The provisional diagnosis was perioperative vision loss due to ischemic optic neuropathy. However, given the patient’s risk factors, papilledema, and neuroimaging findings, suspicion remained for underlying IIH. She underwent spinal tap with an opening pressure of 31 mmHg and was started on oral acetazolamide. At post-operative week 7 her vision remained NLP in the right eye but recovered to 20/20 in the left eye with resolution of nerve edema. 

Presentation Date: 10/31/2019

Issue Date: 08/01/2020