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Transient corneal depression after open heart surgery with cardiopulmonary bypass

Ocular complications following cardiopulmonary bypass (CPB) are rare. Unilateral corneal depression, also known as ocular hypotony, occurs when there is a decrease in intraocular pressure (IOP) from the normal range of 10-20 mmHg to <5mmHg. Anesthetic agents, CPB, and hypotonic solutions, such as mannitol, may all contribute to ocular hypotony. The corneal depression usually resolves as the IOP is normalized. Sugammadex (Bridion, MSD, Seoul, South Korea), a neuromuscular blocking agent, had been used to promote more rapid recovery of IOP. We present images of two patients who developed transient unilateral corneal depression following cardiac surgery on CPB. Patient #1–A 79-year-old male with aortic and mitral valve regurgitation and persistent atrial fibrillation underwent bioprosthetic aortic valve replacement, a mitral valve ring annuloplasty, and a MAZE procedure with CPB and crossclamp times of 136 and 119min. Nine hours following surgery, he suddenly developed corneal depression of the right eye (Figure 1A). He received 200mg of IV Sugammadex and the corneal depression resolved within 4 h (Figure 1B). A follow-up ophthalmic examination was normal with an IOP of 12-14mmHg. The remainder of his postoperative course was unremarkable. Patient #2–A 87-year-old female underwent emergent replacement of the ascending aorta for an acute type A dissection during a