Erblindung nach nichtophthalmologischen Eingriffen

Abstract

Perioperative visual loss (POVL) after nonocular surgery is a rare but unexpected event and represents a devastating complication. It is most often associated with cardiac, spinal as well as head and neck surgery. The etiology of POVL remains incompletely understood. Any portion of the visual system may be involved, from the cornea to the occipital lobe. The most common site of permanent injury is, however, the optic nerve itself and ischemia is the most often presumed mechanism. Multiple factors have been proposed as risk factors for POVL, including long duration in the prone position, decreased ocular perfusion pressure, excessive blood loss and anemia, hypotension, hypoxia, excessive fluid replacement, elevated venous pressure, head positioning and a patient-specific vascular susceptibility which may be anatomic or physiologic. However, the risk factors for any given patient or procedure may vary. The underlying specific pathogenesis of these neuro-ophthalmic complications remains unknown and physicians should be alert to the potential for loss of vision in the postoperative period. This review updates readers on the incidence, suspected risk factors, diagnosis and treatment of POVL in the setting of nonocular surgery.

Perioperative visual loss with non-ocular surgery: Case report and review of literature

“…However, the risk factors for any given patient or procedure may vary. [5] Our patient had a pre-operative anemia, and intraoperatively, suffered significant blood loss as is evident by furtherdecrease inhemoglobin level post-operatively. She also received significant quantities of fluids intraoperatively.…”

Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…Eine direkte Evidenz zur Frage von Lagerungsschäden in der Endoskopie liegt nicht vor. Die Empfehlung stützt sich daher auf die gemeinsame Empfehlung des Berufsverbandes Deutscher Anästhesisten und des Berufsverbandes des Chirurgen 48 und Aktualisierung BDA von 2016.…”

“…Entsprechend den Empfehlungen von nationalen und internationalen Fachgesellschaften 5 22 23 24 25 26 27 28 29 30 31 44 47 48 49 281 361 372 wird eine pulsoxymetrische Überwachung bei allen Untersuchungen gefordert. Bei sedierten Patienten und Risikopatienten werden ergänzend noch eine kontinuierliche Blutdruckkontrolle und eine EKG-Ableitung gefordert.…”

“…Ein Auskühlen der Patienten und eine Austrocknung der Augen sind durch geeignete Maßnahmen zu verhindern. In Bauchlagerung ist auch auf die kompressionsfreie Lagerung des untenliegenden Auges zu achten, um Augenschäden zu vermeiden [48].…”

Updated S3 Guideline “Sedation for Gastrointestinal Endoscopy” of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – June 2023 – AWMF-Register-No. 021/014

“…There is no direct evidence of positional damage in endoscopy. The recommendation is, therefore, based on the joint recommendation of the Professional Association of German Anesthesiologists and the Professional Association of Surgeons [48] and Update BDA from 2016.…”