Anterior ischemic optic neuropathy after open heart operations

Shapira, Oz M.; Kimmel, Wendy A.; Lindsey, Peggy S.; Shahian, David M.

doi:10.1016/0003-4975(95)01108-0

Cited by 82 publications

(94 citation statements)

References 30 publications

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“…89 90 In a retrospective single-institution case -control study of 602 open-heart surgery patients over 2 yr, lowest systemic perfusion pressure intraoperatively was no different between affected and normal patients. 88 A more recent series by Holy and colleagues 50 showed similar results, but their series included other surgical procedures which complicates interpretation of the specific results with cardiac surgery. Nuttall and colleagues 72 in a case -control study did not report arterial pressures during cardiopulmonary bypass.…”

Section: Possible Pathogenic Factorsmentioning

confidence: 91%

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Perioperative visual loss: what do we know, what can we do?

Roth¹

2009

British Journal of Anaesthesia

255

116

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Perioperative visual loss (POVL), a rare, but devastating complication, can follow non-ocular surgery. Highest rates of visual loss are with cardiac and spine surgery. The main causes of visual loss after non-ocular surgery are retinal vascular occlusion and ischaemic optic neuropathy. This review updates readers on the incidence, suspected risk factors, diagnosis, and treatment of POVL due to these conditions. Br J Anaesth 2009; 103 (Suppl. 1): i31-i40Keywords: complications, neurological; complications, neuropathy; eye, intraocular pressure; eye, pupil; surgery, spinal Visual loss after anaesthesia and surgery is a rare, unexpected, and devastating complication. Clinicians have suspected that incidence is increasing, particularly with spinal fusion surgery; however, recent data suggest that this may not be the case. This review will update readers on the incidence, suspected risk factors, diagnosis, and treatment of perioperative visual loss (POVL), in the setting of non-ocular surgery. The causes of POVL are primarily retinal vascular occlusion (RVO) and ischaemic optic neuropathy (ION). The relevant anatomy of the ocular circulation has been reviewed elsewhere and is summarized in Figure 1. 80 Other sources are glycine toxicity during transurethral resection of the prostate, acute angle closure glaucoma, cortical blindness, and expansion of an intraocular sulphur hexafluoride vitrectomy bubble by administration of nitrous oxide. As these are less common, the reader is referred for details to a recent more inclusive review. 80

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Section: Possible Pathogenic Factorsmentioning

confidence: 91%

“…81 Chang and Miller 19 reviewed 14 102 spine surgery procedures in one hospital, identifying four ION cases (0.028%). After cardiac surgery, incidence was estimated as high as 1.3% in one study, 88 but 0.06% and 0.113% in two more recent larger retrospective studies. 52 72 Types of POVL…”

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confidence: 88%

Perioperative visual loss: what do we know, what can we do?

Roth¹

2009

British Journal of Anaesthesia

255

116

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“…ll In addition to hypotension, anaemia and diabetes mellims, other risk factors which would apply in the postoperative period include excessive weight gain from fluid replacement, microembolism and the use ofinotropes, such as epinephrine and amrinone. 12 In conclusion, we feel that prone positioning, on a Relton-Hall frame, of an obese patient for a long spinal surgery contributed to the development of ION. The Relton-Hall frame may not be the best choice for obese patients scheduled for prone procedures of long anticipated duration, and a frame that allows for the increased abdominal girth may be a better choice.…”

Section: Discussionmentioning

confidence: 80%

Ischaemic optic neuropathy after spinal fusion

et al. 1998

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Purpose: We report a case of ischaemic optic neuropathy which occurred after prolonged spine surgery in the prone position in an obese, diabetic patient. Clinical features: The patient was a 44-yr-old, 123 kg, 183 cm man for decompressive laminectomy and instrumented fusion of the lumbar spine. Anaesthesia was induced with thiopentone, fentanyl and succinylcholine and maintained with nitrous oxide, oxygen, isoflurane and a fentanyl infusion. He was positioned prone on the Relton-Hall frame and had an uneventful intraoperative course. Estimated blood loss was 3,000 ml. l-le was taken to the surgical intensive care unit (SICU) and the trachea was extubated 3.5 hr later. He had no pulmonary or haemodynamic problems and went to a regular nursing floor in the morning. He was discharged home on postoperative day #S. He telephoned his surgeon on postoperative day #7 to say that his vision had been blurry since surgery. His visual acuity was decreased, and on examination, he had a bilateral papillary defect, optic swelling and a splinter haemorrhage in the right eye. Magnetic resonance imaging (MRI) scan of the head and orbits detected no other abnormality. Based on this examination, he was felt to have bilateral ischaemic optic neuropathy and treated conservatively. By postoperative day #47, his visual acuity was greatly improved and near normal. Careful review of possible contributing factors suggests that the cause of the ischaemic optic neuropathy was venous engorgement. Conclusion: This patient developed ischaemic optic neuropathy from a prolonged interval in the prone position of the Relton-Hall frame, which may. be related to venous engorgement.Objectif : Nous rapportons un cas de neuropathie optique ischEmique consecutive ~ une chirurgie rachidienne prolongEe en dEcubitus ventral chez un obese diab&ique. l~,l&nents cliniques : Un patient de 44 ans, pesant 123 kg et mesurant 183 cm &ait opErE pour une laminectomie d&ompressive avec ostEosynthEse instrumentale de la colonne Iombaire. Le thiopental associE ~ du fentanyl et de la succinylcholine a servi h induire I'anesth&ie, qui a EtE entretenue avec du protoxyde d'azote, de I'oxygEne, de I'isoflurane et une perfusion de fentanyl. II Etait immobilisE en d&ubitus ventral sur un cadre de Relton-Hall et l'op&ation s'est dEroulEe sans incident. On a estimE la perte sanguine ,~ 3 000 ml. II a EtE transfEtE ~ l'unitE des soins intensifs (USI) et extub6 3,5 h plus tard. II ne prEsentait aucun problEme respiratoire et hEmodynamique et on l'a ramenE dans son unite de soins le lendemain matin. II &ait libErE le cinquiEme jour. Par tElEphone, il avisait son chirurgien le septiEme jour que sa vision Etait embrouillEe depuis l'intervention. Son acuitE visuelle avait diminuE et ~ l'examen, il pr&entait une lesion papillaire bilatErale, de l'oedEme du ned optique et une hEmorragie linEaire de l'oeil droit, l'imagerie par resonance magnEtique de la tEte et des orbites ne montrait aucune autre anomalie. Cet examen sugg&ait une neuropathie optique isch6mique bilat&ale qui fut traitE...

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“…The authors 11 found postoperative anaemia to be significantly associated with AION after CABG. 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.…”

Section: Discussionmentioning

confidence: 92%

“…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%