Anemia and Hypotension as Contributors to Perioperative Loss of Vision

Brown, Robert H.; Schauble, James F.; Miller, N. R.

doi:10.1097/00000542-199401000-00033

Cited by 149 publications

(64 citation statements)

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“…In another study, 15 prolonged cardiopulmonary bypass time, low postoperative haematocrit, excessive perioperative body weight gain, and use of epinephrine or amrinone were also found to be associated with AION. Moster, 10 Jaben, 8 Brown, 4 and Jarrell 27 found postoperative anaemia to be a predisposing cause for AION. Anaemia can conceivably result in a reduction of oxygen-carrying capacity and subsequent ischaemia in the watershed zones.…”

Section: Discussionmentioning

confidence: 99%

“…In this paper, we report the clinical characteristics of subjects with AION following CABG performed over a 5-year period, and compare them to subjects free from AION during the same period, as well as to cases reported in the literature. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] A better understanding of the factors associated with postoperative AION can aid in the development of preventive and therapeutic measures.…”

Section: Introductionmentioning

confidence: 99%

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Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Mansour

Awwad

Najjar

et al. 2005

Eye

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Mansour

Awwad

Najjar

et al. 2005

Eye

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“…Usually ION presents as selective AION or PION, presumably due to different predisposing factors and differences in the blood supply to those portions of the nerve [141] . Hypertension, diabetes, obesity, hypotension, anemia, prone position, smoking, vascular disease, increased blood viscosity and abnormal anatomy have been associated with ION and perioperative visual loss [139,140,[142][143][144][145][146][147] . Anemia, hypotension, peripheral vascular disease and blood transfusion were associated with ION after spine surgery [90,92] .…”

Section: Ionmentioning

confidence: 99%

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Kamel

Barnette

2014

WJO

103

111

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Positioning patients for spine surgery is pivotal for optimal operating conditions and operative-site exposure. During spine surgery, patients are placed in positions that are not physiologic and may lead to complications. Perioperative peripheral nerve injury (PPNI) and postoperative visual loss (POVL) are rare complications related to patient positioning during spine surgery that result in significant patient disability and functional loss. PPNI is usually due to stretch or compression of the peripheral nerve. PPNI may present as a brachial plexus injury or as an isolated injury of single nerve, most commonly the ulnar nerve. Understanding the etiology, mechanism and pattern of injury with each type of nerve injury is important for the prevention of PPNI. Intraoperative neuromonitoring has been used to detect peripheral nerve conduction abnormalities indicating peripheral nerve stress under general anesthesia and to guide modification of the upper extremity position to prevent PPNI. POVL usually results in permanent visual loss. Most cases are associated with prolonged spine procedures in the prone position under general anesthesia. The most common causes of POVL after spine surgery are ischemic optic neuropathy and central retinal artery occlusion. Posterior ischemic optic neuropathy is the most common cause of POVL after spine surgery. It is important for spine surgeons to be aware of POVL and to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters. Modification of risk factors extrinsic to the patient may help reduce the incidence of PPNI and POVL. It is important for spine surgeons to be aware of PPNI and POVL to participate in safe, collaborative perioperative care of spine patients. Proper education of perioperative staff, combined with clear communication and collaboration while positioning patients in the operating room is the best and safest approach. The prevention of uncommon complications of spine surgery depends primarily on identifying high-risk patients, proper positioning and optimal intraoperative management of physiological parameters.Kamel I, Barnette R. Positioning patients for spine surgery: Avoiding uncommon position-related complications. World J Orthop

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“…44 In addition, AION has been reported in association with systemic hypotension including intraoperative hypotension and severe acute hemorrhage. 7,44 Posterior ischemic optic neuropathy is the most commonly reported cause of vision loss in patients in the prone position during spinal surgery. 32,35,42 Key differences between AION and PION are the location of the insult and finding on the retinal examination.…”

Section: Establishing the Diagnosismentioning

confidence: 99%

Vision loss after spine surgery: review of the literature and recommendations

Baig¹,

Lubow²,

Immesoete³

et al. 2007

Neurosurgical FOCUS

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HE focus of this review was to present the issue of vision loss associated with modern spinal surgery. Vision loss after spinal surgery is a unique complication of optic nerve damage resulting from ION, most often located in the posterior portion of the orbital optic nerve. This is surprising because the posterior area is rarely affected by ischemia. Such "posterior" lesions are designated PION. They have been uncommon until recently, mostly found in association with lumbar spinal surgery. We present the unique factors associated with lumbar surgeries and the patients undergoing them. Vision loss linked to ION and associated with lumbar surgery should be termed LION.Of the many different complications resulting from spinal surgery, POVL is an uncommon but devastating morbidity, with dire consequences. It is estimated that 1 case per 100 spine surgeons annually will have a significant vision complication after surgery.35 Recent studies have shown that spinal surgery is the leading cause of POVL, replacing cardiac surgery. 6,37,42 Postoperative vision loss has been the subject of investigation even before the era of modern spinal instrumentation and fusion techniques. 22,41Although the number of cases reported in the literature is on the rise, many questions remain regarding its origin, risk factors, pathophysiology, and prevention. We attempt to summarize the evidence in literature, highlight the limitations of existing knowledge, and recommend practical guidelines for avoiding this outcome. Summary of Literature Search MethodologyWe searched the National Library of Medicine's PubMed using key words, with subsequent review of the accompanying references and its citations. The key words included a combinations of the following: spine and postoperative visual loss, or spinal postoperative visual loss, spine and postoperative blindness, spine/spinal and posterior ischemic optic neuropathy, spine/spinal and retrobulbar optic neuropathy or spine/spinal and ischemic optic neuropathy. In our review we included articles dealing with visual complications after spinal surgery and excluded non-English language literature and duplicate results.Using these criteria, we identified 166 cases of perioperative vision loss in 21 reports (Table 1) (Fig. 1). 1,3,5,[8][9][10]13,14,17,[25][26][27][28][29][30][31][32][34][35][36]42 Neurosurg. In recent studies spinal surgery has replaced cardiac surgery as a leading cause of postoperative vision loss (POVL). Estimates of the incidence of POVL after spinal surgery range from 0.028 to 0.2%, but with advances in complex spinal instrumentation and the rise in annual spinal operations, POVL may see an ominous increase in its incidence. Postoperative vision loss is an uncommon but devastating complication, with unknown origin and pathogenesis. The authors undertook a literature review and summarize the current understanding of its pathophysiology, highlight the limitations of existing knowledge, and recommend practical guidelines for avoiding this devastating outcome.

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Anemia and Hypotension as Contributors to Perioperative Loss of Vision

Cited by 149 publications

References 0 publications

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Positioning patients for spine surgery: Avoiding uncommon position-related complications

Vision loss after spine surgery: review of the literature and recommendations

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