Ischemic Optic Neuropathy in Cardiac Surgery

Abstract

Background Ischemic optic neuropathy is the most common form of perioperative visual loss, with highest incidence in cardiac and spinal fusion surgery. To date, potential risk factors have been identified in cardiac surgery by only small, single-institution studies. To determine the preoperative risk factors for ischemic optic neuropathy, the authors used the National Inpatient Sample, a database of inpatient discharges for nonfederal hospitals in the United States. Methods Adults aged 18 yr or older admitted for coronary artery bypass grafting, heart valve repair or replacement surgery, or left ventricular assist device insertion in National Inpatient Sample from 1998 to 2013 were included. Risk of ischemic optic neuropathy was evaluated by multivariable logistic regression. Results A total of 5,559,395 discharges met inclusion criteria with 794 (0.014%) cases of ischemic optic neuropathy. The average yearly incidence was 1.43 of 10,000 cardiac procedures, with no change during the study period (P = 0.57). Conditions increasing risk were carotid artery stenosis (odds ratio, 2.70), stroke (odds ratio, 3.43), diabetic retinopathy (odds ratio, 3.83), hypertensive retinopathy (odds ratio, 30.09), macular degeneration (odds ratio, 4.50), glaucoma (odds ratio, 2.68), and cataract (odds ratio, 5.62). Female sex (odds ratio, 0.59) and uncomplicated diabetes mellitus type 2 (odds ratio, 0.51) decreased risk. Conclusions The incidence of ischemic optic neuropathy in cardiac surgery did not change during the study period. Development of ischemic optic neuropathy after cardiac surgery is associated with carotid artery stenosis, stroke, and degenerative eye conditions.

Modern Aspects of Hypertensive Angioretinopathy

“…В 2017 году американские исследователи Rubin и соавт. [18] представили результаты многолетнего исследования, проводившегося в течение 15 лет (c 1998 по 2013). Авторы наблюдали пациентов после хирургических операций на сердце (шунтирование коронарной артерии, операции по восстановлению и замене клапанов сердца) и выявили риск развития ишемической оптической нейропатии.…”

“…Авторы наблюдали пациентов после хирургических операций на сердце (шунтирование коронарной артерии, операции по восстановлению и замене клапанов сердца) и выявили риск развития ишемической оптической нейропатии. Исследование показало, что развитие ишемической оптической нейропатии после сердечно-сосудистых хирургических вмешательств связано со стенозом сонных артерий, инсультом, дегенеративными состояниями глаз, но главное -с гипертонической ретинопатией [18]. Гипертоническую ретинопатию часто изучают при сочетанных патологиях.…”

Update on Perioperative Ischemic Optic Neuropathy Associated With Non-ophthalmic Surgery

“…Explanations may include greater utilization of minimally invasive spine surgery and surgical staging, and changes in anesthesia practice such as higher blood pressure levels and lower fluid administration ( 7 , 9 ). Often not appreciated is that poION occurs with cardiac surgery at a rate of 0.06–0.113%, 6-fold greater vs. spinal fusion ( 6 , 10 , 11 ). poION has also been reported after head and neck surgery ( 12 , 13 ), joint replacement ( 14 ), nasal and sinus surgery ( 15 ), vascular and general surgery, radical prostatectomy, gynecologic surgery, and liposuction ( 16 ).…”

“…Therefore, demonstration of positive associations in the models that adjust for cataract increases confidence that other eye diseases are true associations. Intriguingly, this suggests that degenerative eye diseases are associated with poION, raising the possibility of a role of local pre-existing disease in the ON, and the possibility of constructing risk models based on these conditions ( 6 ). Limitations are, in addition to those for claims data in general, that type of poION was not identified.…”

“…The most common surgical procedures complicated by ION are cardiac surgery and spinal fusion. Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative ION (poION), with cohort and case-control studies helping to identify candidate risk factors ( 6 , 7 ). Animal models have provided insight regarding mechanisms ( 8 ).…”