Bilateral Posterior Ischemic Optic Neuropathy Following Midface Advancement Surgery in a Pediatric Patient With Pfeiffer Syndrome

This article presents the first reported case of bilateral posterior ischemic optic neuropathy in a pediatric patient following major craniofacial surgery. A 13-year-old male patient developed bilateral vision loss with dilated and nonreactive pupils after extubation on postoperative day 5 following Le Fort II midface advancement. During the procedure, he had permissive hypotension and an estimated blood loss of 800 mL. It was determined on institutional review that his vision loss was attributed to the tightness of the bicoronal flap due to scarring from past Le Fort III procedures in combination with permissive hypotension and anemia. This case demonstrates the only documented episode of bilateral posterior ischemic optic neuropathy in a pediatric patient and describes a rarely documented risk factor.