Bilateral visual impairment in a middle-aged female after bariatric surgery, A case report

Abstract

Background: Nutritional optic neuropathy (NON) is a rare eye disease, similar to toxic optic neuropathy and hereditary optic neuropathy, meaning that it is easily misdiagnosed at early-stage. This report described a rare case of optic neuropathy due to nutritional deficiency following bariatric surgery. Case presentation: A 44-year-old female patient presented to our department complaining for blurred vision in the left eye for 2 years, accompanied by blurred vision in the right eye for 6 months, who performed bariatric surgery in 2007. Upon examination, her best corrected visual acuity (BCVA) was 20/50 in the right eye and 20/200 in the left eye. Intraocular pressure (IOP) was 17 mmHg in the right eye and 16 mmHg in the left eye. Anterior segment examination of both eyes was unremarkable, and a intraocular lens (IOL) was observed with a left relative afferent pupillary defect (RAPD). Color fundus photography showed the optic disc structure of both eyes was basically normal. However, the OCT-macula showed diffuse thinning of the ganglion cell layer. Visual field testing demonstrated a noticeable central scotoma in both eyes. Laboratory findings included abnormal blood potassium, vitamin D2, vitamin D3, and vitamin B7. Other parameterssuch as vitamin B12 and folate showed basical normalities. Computed tomography and magnetic resonance imaging of brain and orbits revealed no apparent abnormalities. In addition, visual evoked potentials of both eyes was basically normal. The medical history included nutritional disorders, anaemia and electrolyte disturbance, and her BMI was 16.0 kg/m²at present. Therefore, a clinical diagnosis of NON was made. After 6 weeks of treatment with nutrition supplements, the BCVA was 20/20 in the right eye and 20/25 in the left eye, and the central scotoma in both eyes also improved significantly. Conclusions: NON was a rare eye disease in clinical practice, but the medical history along with systemic and fundus examinations could help establish the diagnosis. Timely treatment is crucial for maximizing visual outcomes.