# Postoperative Vision Loss Following Bariatric Surgery: Case Report and Literature Review

## TL;DR

A young obese patient developed temporary blindness after bariatric surgery, linked to a neurological condition called PRES, emphasizing the need for careful blood pressure control during and after surgery.

## Contribution

This is the first reported case of total blindness after metabolic surgery, linking it to posterior reversible encephalopathy syndrome (PRES).

## Key findings

- A patient experienced transient total vision loss after laparoscopic sleeve gastrectomy.
- The condition was diagnosed as posterior reversible encephalopathy syndrome (PRES).
- Full visual recovery occurred within three days with appropriate management.

## Abstract

Postoperative blindness following non-ophthalmic surgeries is a rare but devastating complication, most commonly associated with spine and cardiovascular procedures. Thus far, there have been no reports of total blindness after metabolic surgeries in the literature.

We present a case of transient total vision loss after laparoscopic sleeve gastrectomy in a young obese female patient with poorly controlled type 2 diabetes mellitus and hypertension on antihypertensive agent. Following induction of general anesthesia, the patient experienced severe hypertensive episodes lasting approximately five minutes, although the remainder of the intraoperative course was uneventful. She was transferred to the surgical intensive care unit (SICU) for postoperative monitoring. 30 minutes later, she reported sudden complete blindness while remaining hemodynamically stable and alert. During transfer for neuroimaging, she developed a generalized seizure and a decreased Glasgow Coma Scale (GCS) score, necessitating endotracheal intubation and mechanical ventilation. Brain CT and MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES).

Although her GCS improved within 24 hours, visual impairment persisted until gradual recovery commenced on the second postoperative day, with full restoration by day three. The patient was subsequently transferred to the ward and later discharged with close outpatient follow-up. This case highlights PRES as a rare cause of perioperative vision loss and underscores the critical importance of rigorous blood pressure management in the perioperative period to mitigate neurological complications.