To report a rare case of post-operative Posterior Ischemic Optic Neuropathyimmediately after bilateral lung transplant.

Posterior Ischemic Optic Neuropathy (PION) is a very rare condition, which is usually seen in association with giant cell arteritis. It has been rarely reported in patients who underwent prolonged surgeries in a prone operative position, for example spinal surgeries. It has never been reported as a complication of bilateral lung transplant. 

We performed a retrospective chart review on a patient who became blind after bilateral lung transplant due to PION. 

A 51 year old female with hyperlipidemia underwent bilateral lung retransplantation at The Ohio State University. Her lung retransplant was complicated by hypovolemic shock, requiring massive transfusion. She required 12 units of packed red blood cells, 6 units of fresh frozen plasma, 5 units of platelets, and 4 units of cryoprecipitate after coming out of surgery. She was sedated post surgery for the next three days on propofol. On postoperative Day 3 she was found to have anisocoria. On neurological exam she had no light perception in both eyes and no other focal deficits upon initial assessment. She was essentially blind and remained so long term. This was attributed to prolonged operative time, hypotensive and hypovolemic shock requiring massive transfusion of blood products and pressor support. MRI brain showed scattered cardioembolic strokes in several vascular territories that did not account for her visual loss. 

PION is a rare condition, which may be associated with surgical procedures where the patient is positioned prone for surgery. These usually include spinal surgeries. It has not been reported in patients undergoing lung transplant who are positioned in the supine position during surgery. However, hypovolemic shock and pressor support during lung transplant surgery may be risk factors for PION.