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Purpose: To report two rare cases of cortical blindness resulting from posterior cerebral artery (PCA) occlusion after laminectomy and laparoscopic gastrectomy under general anesthesia. Case summary: (Case 1) A 65-year-old man presented with visual loss after a bone graft and total laminectomy for spinal stenosis under general anesthesia. His best-corrected visual acuity (BCVA) was hand motion in both eyes. The pupillary light reflex was normal, and a relative afferent pupillary defect (RAPD) was not observed. Slit-lamp microscopy and fundus examination were normal. Using brain computed tomography, magnetic resonance imaging (MRI), and angiography, a PCA infarction was detected. His left 2b PCA was reperfused after intra-arterial thrombolysis. However. he still had left homonymous hemianopia and right homonymous superior quadrantanopia. (Case 2) A 64-year-old man was referred for visual loss in the recovery room after laparoscopic distal gastrectomy under general anesthesia. His BCVA was finger counting for the right eye and hand motion for the left eye. His pupillary light reflex was normal. A RAPD was not observed. Slit-lamp microscopy and a fundus examination were normal. Using a brain MRI and angiography, PCA infarctions were detected. Echocardiography showed an atherosclerotic change with a mobile plaque. Anticoagulation therapy was started, but he still had left homonymous hemianopia and right homonymous inferior quadrantanopia. Conclusions: Cortical blindness caused by non-ophthalmological surgery under general anesthesia is known for severe complications and poor prognoses. Therefore, it is crucial to identify patients with high risks of complications to prevent ophthalmic complications resulting in visual losses before surgery. J Korean Ophthalmol Soc 2020;61(5):582-586

Two Cases of Cortical Blindness from Both Posterior Cerebral Artery Occlusion Following General Anesthesia Surgery