Post-Operative Vision Loss (POVL) following Surgical Procedures

Kendrick, Heather

doi:10.4172/2155-6148.1000184

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Various causes of vision loss following non ophthalmic surgeries have been reported in literature. Postoperative vision loss can occur following cardiac and spine surgeries mainly due to ischaemic optic neuropathy 1. In this case the vision loss was due to Purtschers retinopathy following hemicolectomy for carcinoma colon which has not been reported.…”

Section: Descriptionmentioning

confidence: 68%

Sudden visual loss following abdominal surgery

Rodrigues¹,

Sathyanarayan

Mendonca

et al. 2019

BMJ Case Rep

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Section: Descriptionmentioning

confidence: 68%

Sudden visual loss following abdominal surgery

Rodrigues¹,

Sathyanarayan

Mendonca

et al. 2019

BMJ Case Rep

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“…28 When the patient is in the prone position, IOP increases and the extent of this increase is related to the amount of time the patient is in the prone position. 25,[29][30][31][32][33][34] After only a few minutes in the prone position, IOP can increase significantly. 35 According to the American Academy of Ophthalmology, 36 normal IOP is 10 to 21 mm Hg.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Wicklin

2020

Int J Spine Surg

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Background: Patients undergoing surgery in the prone position may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this systematic review and meta-analysis is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients. The research question to be addressed is ''What is the magnitude of the increase in intraocular pressure at specific perioperative time points in adults undergoing surgery in the prone position?''Methods: Comprehensive search strategies were used to identify nine eligible studies (N ¼ 229). Standardized mean difference effect sizes were calculated for two intraoperative time points. Time points for meta-analysis were selected to achieve the greatest number of comparisons for analysis at each time point. Prediction intervals for each time point were also calculated to show the dispersion of true effect sizes around the mean.Results: Meta-analysis showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position (T1: standardized mean difference [d] ¼ 2.55; P , .001) and continued to increase significantly until the end of the prone position (T2: d ¼ 3.44; P ¼ .002).Conclusions: Intraocular pressure increases of this magnitude demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the prone position.Clinical Relevance: Implementing preoperative ophthalmologic examinations for patients undergoing surgery in the prone position may help to reduce the risk for ocular injury. Intraoperative interventions that can be implemented to reduce or mitigate the increase in intraocular pressure include implementing a 5-to 10-degree reverse Trendelenburg prone position, reducing the amount of time the patient is in the prone position, considering staged procedures, monitoring intraocular pressure, providing periodic position changes or rest periods, preventing pressure on the eye, and administering specific medications or anesthetics. ComplicationsKeywords: intraocular pressure, prone position, ischemic optic neuropathy, central retinal artery occlusion Pathogenesis of Postoperative Vision LossPostoperative vision loss in patients undergoing surgery in the prone position is generally related to 1 PurposeAlthough some researchers have studied the quantitative increase of IOP in surgical patients in the prone position, 1,2,14,16,17,34,50 there is a need for systematic review and meta-analyses of these studies to demonstrate the overall effect size and provide high-quality evidence supporting, or negating, the

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“…22 ION has been observed to be the main pathology leading to POVL, with anterior ION being predominantly observed in cardiac surgical cases due to reduced ocular perfusion and posterior ION being described in prone-position spine procedures or laparoscopic surgery in the Trendelenburg position due to reduced venous drainage. 11,17,30 Besides the aforementioned pathomechanisms, some rare cases of POVL are related to mechanical damage, resulting in an injured cornea with support of the development of ION. 23,30 The occurrence of ION is closely related to the blood supply of the eye and especially to the blood supply to the optic nerve.…”

mentioning

confidence: 99%

Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid

Czorlich¹,

Krätzig²,

Kluge³

et al. 2019

Journal of Neurosurgery

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OBJECTIVE Perioperative visual loss (POVL) is a rare but serious complication in surgical disciplines, especially in spine surgery. The exact pathophysiology of POVL remains unclear, but elevated intraocular pressure (IOP) is known to be part of it. As POVL is rarely described in patients undergoing intracranial or intradural surgery, the aim of this study was to investigate the course of IOP during neurosurgical procedures with opening of the dura mater and loss of CSF. METHODS In this prospective, controlled trial, 64 patients fell into one of 4 groups of 16 patients each. Group A included patients undergoing spine surgery in the prone position, group B patients had intracranial procedures in the prone position, and group C patients were treated for intracranial pathologies in a modified lateral position with the head rotated. In groups A-C, the dura was opened during surgery. Group D patients underwent spine surgeries in the prone position with an intact dura. IOP was measured continuously pre-, peri-, and postoperatively. RESULTS In all groups, IOP decreased after induction of anesthesia and increased time dependently after final positioning for the operation. The maximum IOP in group A prior to opening of the dura was 28.6 ± 6.2 mm Hg and decreased to 23.44 ± 4.9 mm Hg directly after dura opening (p < 0.0007). This effect lasted for 30 minutes (23.5 ± 5.6 mm Hg, p = 0.0028); after 60 minutes IOP slowly increased again (24.5 ± 6.3 mm Hg, p = 0.15). In group B, the last measured IOP before CSF loss was 28.1 ± 5.0 mm Hg and decreased to 23.5 ± 6.1 mm Hg (p = 0.0039) after dura opening. A significant IOP decrease in group B lasted at 30 minutes (23.6 ± 6.0 mm Hg, p = 0.0039) and 60 minutes (23.7 ± 6.0 mm Hg, p = 0.0189). In group C, only the lower eye showed a decrease in IOP up to 60 minutes after loss of CSF (opening of dura, p = 0.0007; 30 minutes, p = 0.0477; 60 minutes, p = 0.0243). In group D (control group), IOP remained stable throughout the operation after the patient was prone. CONCLUSIONS This study is the first to demonstrate that opening of the dura with loss of CSF during neurosurgical procedures results in a decrease in IOP. This might explain why POVL predominantly occurs in spinal but rarely in intracranial procedures, offers new insight to the pathophysiology of POVL, and provides the basis for further research and treatment of POVL. German Clinical Trials Register (DRKS) no.: DRKS00007590 (drks.de).

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Post-Operative Vision Loss (POVL) following Surgical Procedures

Cited by 5 publications

References 22 publications

Sudden visual loss following abdominal surgery

Sudden visual loss following abdominal surgery

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

Intraocular pressure during neurosurgical procedures in context of head position and loss of cerebrospinal fluid

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