Perioperative posterior ischemic optic neuropathy: review of the literature

Buono, Lawrence M.; Foroozan, Rod

doi:10.1016/j.survophthal.2004.10.005

Cited by 134 publications

(78 citation statements)

References 40 publications

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“…It is interesting that in this case, and many other reports of hypotensive PION [7], the ischaemia was isolated to the posterior portion of the optic nerve, without any accompanying damage to the remainder of the visual pathway or central nervous system. This is most likely explained by the blood supply to the various segments of the optic nerve [4].…”

Section: Discussionsupporting

confidence: 49%

“…Other risk factors for hypotensive PION have been reported including high intraocular pressure, increased orbital venous pressure related to prone positioning during surgery, the use of vasopressors to increase central arterial pressure (at the expense of downstream arterioles and capillaries), and decreased blood oxygen carrying capacity (anaemia/low blood volume/haemodilution) [7]. It is possible that in this case, the patient's mild anaemia (90 g/L), severe metabolic derangement, and the use of inotropic support may have contributed to the development of PION, however we still feel the main causative factor was the prolonged period of systemic hypotension.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Posterior Ischaemic Optic Neuropathy Secondary to Diabetic Ketoacidosis: An Unfortunate Cure for Diabetic Retinopathy

Cunningham¹,

Mason²,

Cain³

et al. 2017

J Clin Exp Ophthalmol

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Purpose: To report a case of bilateral posterior ischaemic optic neuropathy secondary to diabetic ketoacidosis. Methods:Case history with multimodal imaging, including colour fundus photography, fundus fluorescein angiography, optical coherence tomography, and magnetic resonance imaging with high resolution diffusion weighted imaging. Results:We report a 29-year-old female with bilateral posterior ischaemic optic neuropathy following diabetic ketoacidosis resulting in no perception of light vision in both eyes, confirmed on magnetic resonance imaging with high resolution diffusion weighted imaging. We also document the resolution of proliferative diabetic retinopathy following the onset of bilateral optic nerve atrophy. Conclusion:Bilateral posterior ischaemic optic neuropathy can occur following diabetic ketoacidosis, and proliferative diabetic retinopathy can resolve following the onset of optic nerve atrophy. If posterior ischaemic optic neuropathy is suspected, magnetic resonance imaging with high resolution diffusion weighted imaging may aid in confirming the diagnosis.

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Section: Discussionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Bilateral Posterior Ischaemic Optic Neuropathy Secondary to Diabetic Ketoacidosis: An Unfortunate Cure for Diabetic Retinopathy

Cunningham¹,

Mason²,

Cain³

et al. 2017

J Clin Exp Ophthalmol

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“…Anemia and hypotension are almost always observed in patients that develop postoperative PION [26] . The pial vessels that supply the posterior optic nerve lack an autoregulatory mechanism, rendering them susceptible to ischemia during periods of hypotension and when the blood oxygen carrying capacity is decreased [27] .…”

Section: Posterior Ischemic Optic Neuropathymentioning

confidence: 99%

“…Direct orbital pressure, often seen with face pillows/ cushions or other positioning devices, has also been implicated in the pathogenesis of PION. However, with the resultant decreased perfusion pressure to the optic nerve head and central retinal artery, AION or CRAO would be more likely observed [26] . Avoidance of the prone position and direct ocular pressure is insufficient, however, to prevent postoperative PION, as cases have been documented following surgery in the supine position and with the use of head pins [3,9,30] .…”

Section: Posterior Ischemic Optic Neuropathymentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

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Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy. Core tip: Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. Ischemic optic neuropathy accounts for the vast majority of these cases, with retinal ischemia, cortical blindness, and posterior reversible encephalopathy observed with low incidence. Recently identified risk factors include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. POVL is often permanent and untreatable, so prevention is key to limiting its impact. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop 2014; 5(2): 100-106 Available from:

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“…93 However, it is difficult to ascertain if improvement came from treatment because some patients recover vision spontaneously after PION. 14 Acetazolamide lowers IOP and may improve flow to the optic nerve head and retina. 41 Diuretics such as mannitol or furosemide reduce oedema.…”

Section: Haemodilutionmentioning

confidence: 99%

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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Perioperative posterior ischemic optic neuropathy: review of the literature

Cited by 134 publications

References 40 publications

Bilateral Posterior Ischaemic Optic Neuropathy Secondary to Diabetic Ketoacidosis: An Unfortunate Cure for Diabetic Retinopathy

Bilateral Posterior Ischaemic Optic Neuropathy Secondary to Diabetic Ketoacidosis: An Unfortunate Cure for Diabetic Retinopathy

Perioperative visual loss after spine surgery

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

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