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Lost vision after by-pass surgery
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Lost vision after by-pass surgery

I have already posted this problem in the Heart section of this forum. But since the end result of the problem is affecting the eye, I decided to post it here too to increase my chances of getting some information. The patient to doctor forums were locked down.

My 76 year old father had quadruple by-pass surgery and heart valve replacement 6 months ago (Dec '06). Everything went well and he recovered quickly. The only on-going side effect he had was an occasional dizzy spell, especially if he got hot out in the sun. Then suddenly, without any warning signs at all, he totally lost vision in his left eye. The same day an opthamologist took one look into his eye and bluntly said he'll never see out of that eye again. A CAT scan of his head and neck showed no signs of a blockage or hemorrhaging. Blood work showed inflammation. They didn't say where. His doctor put him on prednisone for that.

I have heard that clots are not uncommon after by-pass surgery. Is it possible that a clot blocked blood flow to his eye causing lose off vision, and then went away before the CAT scan was done? I heard of this same situation happening to someone else after by-pass surgery. He went back to the hospital that did the surgery and got most of his vision back. I was not able to get the details of what actually caused the loss of site or what was done to get it back.

Obviously, this is very devastating to my Dad and everyone who loves him. If anyone thinks they have ANY information that might help my Dad get his vision back, PLEASE don't hesitate to let me know.

Thanks, Kent
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6 Comments Post a Comment
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Avatar_dr_m_tn
Vision loss immediately following heart or vascular surgery is not at all unsual and is a well recognized risk of these types of surgery, even when performed at the highest level of skill and experience.  This type of visual loss is usually in one eye (often the left) and occurs very soon after the surgery.

From your question I cannot determine how long it was after your father's heart surgery that his visual loss occured. If it was longer than a week after the heart surgery then the surgery was not the cause.

Sudden vision loss in one eye, especially in an older patient, a smoker, someone with diabetes, high cholesterol, high blood pressure or a family history of stroke or heart attack is often central retinal artery occlusion (CRAO). The cause is usually a small clot (emboli) that came from the heart or blood vessels and traveled to the eye. The prognosis for recovery of vision is not good and there is no established method of treating this problem (there are some heroic experimental techniques under testing now for treating CRVO and CRAO immediately after they occur).

A second cause can be central retinal vein occlusion (CRVO). This has a better prognosis than CRAO and complete loss of vision is less frequent. Again there is no clearly established treatment of CRVO.

Both CRVO and CRAO need careful follow up with an ophthalmologist (Eye-MD) looking for delayed complications such as bleeding in the eye, a certain type of glaucoma and to try and protect and save the other eye.

From your description of "inflammation" and "prednisone" treatment I suspect your father was diagnosed with giant cell arteritis (GCA) or as it is sometimes called "temporal arteritis". Note this is an inflammation of the medium sized arteries of the head. It is NOT ARTHERITIS.  This diagnosis is made on the medical history, tests for inflammation [sedimentation rate and C-reactive protein]. It may be necessary to stay on prednisone for a long time (years) while monitoring the amount of inflammation in the eye with these two tests. This is extremely important as GCA has a bad tendency to affect and blind both eyes. Often a biopsy of the temple artery of the head is done to establish a diagnosis).

If the amount of time since your father lost his vision is over several months and the vision has not gotten better it is not likley to return to normal (poor prognosis).  It is highly unlikely that anyone anywhere can fix this as the optic nerve does not regenerate when damaged.  Best concentrate on keeping what vision he has left and his other eye healthy by seeing an ophthalmologist (Eye MD) on a regular basis.

Computed axial tomography (CAT scans) do not show CRVO, CRAO or giant cell arteritis.

Sorry, some things are just not likely to be able to be fixed.

JCH MD
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Avatar_n_tn
Thank you so very much for your reply. I can't thank you enough. It is very helpful.

To clarify the time frame from by-pass surgery to vision loss; the by-pass surgery was Dec '06, the vision loss was this past Friday, June 15th '07, almost 6 months later. He had absolutely no vision problems until then. Without any warning, is left eye went blind. He was having a dizzy spell at the time of his vision loss, but he had them before. He says he can see his hand a little if he holds it out to the side, but nothing directly in front. He thinks his side vision has gotten a little better over the weekend; hoping maybe the prednisone is helping.

He is taking medication for high blood pressure and his doctor told him that that may be causing his dizzy spells and not get too hot.

With this additional information, any more information you can give me will be greatly appreciated.

Thank you again very much for your reply,

Kent



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Avatar_dr_m_tn
Well with this additional information we can say that the heart surgery was not a causative factor.

The most helpful thing will be for you to be sure you understand your father's physicians' "working diagnosis".  The most likely is GCA, then CRAO, then least likely (but best prognosis) is CRVO.

Don't forget to ask about the health of the "other" (and most important) eye. What you can do to keep that eye healthy and the risk of the same problem happening in the good eye.

I would be interested in what the diagnosis is, please post.

It will probably be 4-6 weeks to tell if the treatment is helping.

Good luck.

JCH Board certified ophthalmologist Eye MD
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Avatar_n_tn
Thank you again for your reply. I just saw my Dad and he is going to his ophthalmologist in a few hours. Now he's saying he is starting to see a little more directly in front of his eye. The clarity is in spots or in very limited certain areas. He held his hand at a certain spot and he could actually distinguish his fingernails. He said he could see me a little where I was sitting about 5 ft. from him at about a 45 degree angle.

I will check this board often and will post the developments. If you have any more suggestions, please let me know.

Thank you again for your time, concern, and kindness.

May God bless you,

Kent

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Avatar_f_tn
My wife just had aortic valve replacement (pig valve).  She has blurred vision in both eyes.  Individually sh can see well if she covers 1 eye, but she can't focus unless the object is close.  Ct scan and ct scan with contrast showed nothing.  We are doing MRI today.  Opthamologist did yet tests and he is not color blind, but has trouble with up and down movements of the eyes and focusing.  Any ideas here?
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233488_tn?1310696703
Could be a number of things from a small stroke due to blood clot to trouble with eyes due to severe post op weakness or pain medication. Best hope is that it clears as strength comes back.

JCH MD
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