Background: We report a case of transient loss of vision post percutaneous nephrolithotomy (PCNL) which is very rare to our knowledge.

Case presentation: A 39-year-old man with a history of right femoro-popliteal by-pass on antiplatelet drugs preoperatively underwent left percutaneous nephrolithotomy to treat nephrolithiasis. Intraoperative ECG changes suggesting inferior myocardial infarction and painless visual loss in both eyes two hours after the procedure. Visual acuity was bilateral hand movement. However, ophthalmologic examinations were unremarkable, neuroimaging was normal. Within one month, visual acuity and visual fields improved dramatically.

Conclusion: This is a rare reported case of posterior ischemic optic neuropathy (PION) following percutaneous nephrolithotomy. Posterior ischemic optic neuropathy is a rare cause of severe visual loss following surgery. Vascular diseases, severe blood loss, hypotension, anemia, and body position during surgery are the most important risk factors. Ophthalmologists, urologists, and anesthesiologists should be aware of this condition, and this rare possibility should be considered before surgery.