pars plana vitrectomy ( ppv ) is a proven and basically safe procedure with a low incidence of complications [ 1 , 2 ] . however , serious adverse events can and do occur , the most serious complications being endophthalmitis , hemorrhages and nonarteritic anterior ischemic optic neuropathy ( naion ) , a potentially blinding condition . an investigation in a random sample of 5% of the american medicare beneficiaries   over a period of 12 years ( 19942005 ) yielded an incidence of approximately 7% for postprocedural blindness after ppv without an appreciable trend over time . whereas endophthalmitis is widely considered and investigated in the literature concerning post - ppv complications [ 1 , 2 , 3 ] , the incidence of postprocedural loss of vision due to naion appears to be somewhat underreported . following the concept of vascular occlusion as a key factor in sudden blindness , the conventional mainstay for the treatment of postsurgical loss of vision is the systemic administration of corticosteroids and anticoagulants , e.g. acetylsalicylic acid [ 6 , 7 , 8 ] . however , there is no generally accepted , well - proven treatment for naion currently . in the past decade , a number of novel protein - based direct thrombin inhibitors became available for the treatment of diseases associated with undesired blood clotting . one of those agents is dabigatran etexilate , presently approved for the prophylaxis of venous thrombosis after hip or knee arthroplasty and stroke in patients with atrial fibrillation . after all conventional methods of reversing the visual loss in our patient had failed , we resorted to a therapeutic trial of dabigatran etexilate , and the results are reported here . a 46-year - old caucasian female underwent ppv of the right eye with endolaser treatment and c2f6 ( hexafluoroethane ) gas tamponade as per the current guidelines   for retinal detachment . after the procedure , the vision of the treated eye was practically lost , and the patient was only able to distinguish hand movements . the afferent pupillary defect ( apd ) was positive , and perimetry revealed a severe loss of the visual field ( fig . the administration of a conventional therapeutic regimen [ consisting of prednisolone ( 100 mg / day for 3 days , 80 mg / day for 3 days , 60 mg / day for 3 days , 40 mg / day for 3 days , and 20 mg / day for 3 days ) and acetylsalicylic acid ( 100 mg ) ] improved visual acuity only marginally to logmar 1,4 ( fig . 3 ) with positive apd . since pronounced corticosteroid side effects ( sleeplessness , facial edema , restlessness , sweating and tachycardia ) burdened the patient and the treatment showed practically no effect , we decided to try to improve her vision with the administration of dabigatran etexilate ( 2  110 mg ) , a novel direct thrombin inhibitor , 24 days after the initiation of the prednisolone / acetylsalicylic acid treatment . promptly after the first administration , visual acuity improved to logmar 1,0 and continued to improve to logmar 0,4 ( fig . perimetry done 26 days afterwards showed a marked improvement in central sensitivity from 7 to 25 and 21 db , respectively ; the nasal part of the visual field also showed an increase in sensitivity ( fig . strictly speaking , the diagnosis of naion requires the exclusion of arteritic alterations , usually by temporal artery biopsy . however , a sudden loss of vision after ocular surgery without signs of retinal detachment or other intraocular alterations strongly suggest ischemic neuropathy , and tentative diagnosis and treatment are warranted . since naion is not a disease as such but rather the common endpoint of a large number of local and systemic conditions , there is no established standard therapy . however , systemic corticosteroids in combination with anticoagulation to reduce swelling and improve venous blood flow are basically accepted modalities . when this approach failed in the present case , we resorted to the off - label administration of a novel direct thrombin inhibitor , resulting in a dramatic recovery of visual function . naion is known to show spontaneous remission in approximately 40% of the cases , but this assumption notwithstanding , improvement of blood flow is an accepted measure whose indication to preserve or restore vision is undisputed . therefore , the striking improvement of vision after the administration of dabigatran etexilate in the present case may warrant a systematic clinical trial of a combination of corticosteroids and dabigatran etexilate in comparison with ( for instance ) warfarin as is common practice under different indications for anticoagulation [ 12 , 13 , 14 ] . however , when ophthalmologists consider the administration of dabigatran etexilate for naion , certain peculiarities and disadvantages of the drug ( such as the lack of an antidote [ 12 , 15 ] ) need to be borne in mind to avoid potential hazards .
a 46-year - old caucasian female underwent pars plana vitrectomy ( ppv ) for retinal detachment . 
 after the procedure , the patient could only distinguish hand movements ; the condition was tentatively diagnosed as nonarteritic anterior ischemic optic neuropathy . 
 conventional treatment with systemic corticosteroids and acetylsalicylic acid was ineffective and yielded substantial steroid - related side effects . 
 additional administration of 2  110 mg dabigatran etexilate ( pradaxa ) , a novel direct thrombin inhibitor , resulted in a prompt and marked improvement of visual acuity , which indicated improved blood flow in the central vessels of the optic nerve . 
 dabigatran etexilate may provide a promising alternative for the treatment of postprocedural vision loss after ppv .