A Case Report of Late-Onset Leber's Hereditary Optic Neuropathy Diagnosed Following Vision Loss After Cataract Surgery.

Leber's Hereditary Optic Neuropathy (LHON) is a rare mitochondrial disorder characterized by acute to subacute vision loss, predominantly affecting young males. We report a case of a 65-year-old male diagnosed with late-onset LHON after experiencing significant vision decline following cataract surgery. The patient initially presented with decreased vision in the left eye. His best corrected visual acuity (BCVA) was 20/16 in the right eye and 20/600 in the left eye, with normal intraocular pressure. Thinning of the ganglion cell complex (GCC) and a central scotoma were observed in the left eye. As head MRI showed no abnormalities, some form of retinal vasculopathy was suspected. Two months later, he returned complaining of increased glare and visual impairment in the right eye. Since no changes except for cataracts had been detected, cataract surgery was performed on the right eye three and a half months after the initial visit, but the BCVA dropped to 20/63. At this point, thinning of the GCC in the papillomacular bundle area and a central scotoma in the right eye were also observed. Genetic testing confirmed the m.11778 G>A mutation, leading to a diagnosis of LHON. The impact of intraocular surgery on the progression of LHON remains unclear; however, it may negatively influence the disease course.