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

Pandey, Nidhi; Chandrakar, A K; Garg, M L

doi:10.4103/0301-4738.116464

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…Arterial occlusions have been reported after nonophthalmic invasive procedures such as spine, cardiac, and head-neck surgeries; hip/femur fracture repair; knee replacement; appendectomy; colorectal resection; and cholecystectomy. 8 In our 4 cases, RAOs were noted after cardiac surgery and neurosurgeries. Warner et al found hypercoagulability, perioperative hypotension, sickle cell disease, diabetes mellitus, embolic sources, prone positioning, ocular compression, increased intraocular pressure, and anemia to be risk factors for perioperative visual loss, but we did not identify these factors in any of our patients.…”

Section: Discussionmentioning

confidence: 61%

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Xia

Zarbin

Bhagat

2019

Journal of VitreoRetinal Diseases

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Purpose:This article describes the characteristics, management, and etiology of retinal artery occlusions (RAOs) in young patients.Methods:A retrospective chart review of patients <50 years of age with ophthalmic and RAOs was conducted. Data were collected on demographics, clinical presentation, laboratory and imaging evaluation, management, and outcome.Results:Seventeen eyes of 15 patients younger than 50 (mean age, 34±8 years; 71% male, 29% female) with RAOs were identified. AOs included: 8 (47%) central RAOs (CRAOs), 5 (29%) branch RAOs (BRAOs), 3 (18%) ophthalmic AOs (OAOs), and 1 (6%) combined CRAO and vein occlusion (CRAO/CRVO). Logarithm of the minimum angle of resolution visual acuity (VA) at presentation was 2.6±4 (Snellen range 20/15 to no light perception). Systemic diseases in patients with BRAO included Susac disease (n = 1), sickle cell disease (n = 2), patent foramen ovale (PFO) (n = 1), and HIV (n = 1). CRAO was diagnosed in 4 patients after invasive surgery (3 after neurosurgery and 1 after cardiac surgery). Other patients had hypertension (n = 3), hypercoagulability due to uterine cancer (n = 1), and PFO (n = 1). OAOs were noted in 1 patient with Saturday night retinopathy and in 1 with ruptured internal carotid aneurysm at the level of the ophthalmic artery. Two eyes with CRAO were treated with tissue plasminogen activator (1 intraophthalmic artery through catheterization and 1 intravenously) without any change in final VA. In these patients, VA remained poor (VA hand motions – counting fingers) at 6 months or greater follow-up visits.Conclusion:RAO in young patients is uncommon. In this series, one-fourth of occlusions were seen during the perioperative period. A significant number of patients had concurrent uncontrolled hypertension. Other associated systemic findings included PFO, hypercoagulability, sickle cell disease, Susac disease, and HIV.

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Section: Discussionmentioning

confidence: 61%

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Xia

Zarbin

Bhagat

2019

Journal of VitreoRetinal Diseases

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“…PION diagnosis requires imaging, because there are no visible structures to be evaluated with clinical examination. [14][15][16][17] Generally, CRAO is caused by direct pressure over the eye, augmenting intraocular pressure and compromising perfusion. In prone position, which is the most common position for the patients in spine surgery, the head should be at the same level as the heart.…”

Section: Discussionmentioning

confidence: 99%

Visual loss after spine surgery: Case report

Cobar-Bustamante

Cahueque

Hernández

2016

Journal of Orthopaedics

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The presence of postoperative visual loss is a well-known complication, and described in various reports, its low incidence (0.028-0.2%) makes it extremely rare. Two main causes have been determined: Posterior Ischemic Optic Neuropathy and central Retinal Artery Oclusion. The following is a case report of a 52-year-old patient that presented visual loss after elective spine surgery that had no complications that could initially explain this complication. Studies were performed and evaluations by ophthalmologists determined that the cause of Posterior Ischemic Optic Neuropathy due to multiple risk factors that the patient had previously and during the surgery. After 3 year follow-up the patient still has total visual loss and no other complications were reported.

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“…discussed in 2014 various etiologies of POVL following prone spine surgery; this included ION, CRAO or branch retinal artery occlusion, and CB largely due to microvascular pathology and/or intraoperative hypotension [Tables 3 and 4 ]. [ 28 ] This study uniquely presented POVL following a cesarean section.…”

Section: Review Articles On Postoperative Visual Loss With Prone Spinmentioning

confidence: 99%

Perioperative visual loss following prone spinal surgery: A review

Epstein

2016

Surg Neurol Int

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Background:Postoperative visual loss (POVL) following prone spine surgery occurs in from 0.013% to 1% of cases and is variously attributed to ischemic optic neuropathy (ION: anterior ION or posterior ION [reported in 1.9/10,000 cases: constitutes 89% of all POVL cases], central retinal artery occlusion [CRAO], central retinal vein occlusion [CRVO], cortical blindness [CB], direct compression [horseshoe, prone pillows, and eye protectors Dupaco Opti-Gard]), and acute angle closure glaucoma (AACG).Methods:Risk factors for ION include prolonged operative times, long-segment spinal instrumentation, anemia, intraoperative hypotension, diabetes, obesity, male sex, using the Wilson frame, microvascular pathology, decreased the percent of colloid administration, and extensive intraoperative blood loss. Risk factors for CRAO more typically include improper positioning during the surgery (e.g., cervical rotation), while those for CB included prone positioning and obesity.Results:POVL may be avoided by greater utilization of crystalloids versus colloids, administration of α-2 agonists (e.g., decreases intraocular pressure), avoidance of catecholamines (e.g., avoid vasoconstrictors), avoiding intraoperative hypotension, and averting anemia. Patients with glaucoma or glaucoma suspects may undergo preoperative evaluation by ophthalmologists to determine whether they require prophylactic treatment prior to prone spinal surgery and whether and if prophylactic treatment is warranted.Conclusions:The best way to avoid POVL is to recognize its multiple etiologies and limit the various risk factors that contribute to this devastating complication of prone spinal surgery. Furthermore, routinely utilizing a 3-pin head holder will completely avoid ophthalmic compression, while maintaining the neck in a neutral posture, largely avoiding the risk of jugular vein and/or carotid artery compromise and thus avoiding increasing IOP.

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

Cited by 6 publications

References 6 publications

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Retinal Artery Occlusion in Young Patients: A 6-Year Review

Visual loss after spine surgery: Case report

Perioperative visual loss following prone spinal surgery: A review

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