Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations

Mendel, Ehud; Stoicea, Nicoleta; Rao, R; Niermeyer, Weston; Revilla, Stephen; Cluse, Marcus; Sandhu, Gurneet; Todaro, Gerald J.; Bergese, Sergio D.

doi:10.3389/fsurg.2017.00034

Cited by 24 publications

(38 citation statements)

References 38 publications

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“…12,16,43 This part may be prone to ischemic optic nerve neuropathy. 31 The blood supplies from the arteries and arterioles in the optic nerve decrease in the order of chiasm, intracranial optic nerve, and intracanalicular optic nerve. 12 The optic nerve has poor blood flow at the exit of the optic canal, and local microscopic blood flow disturbance may be likely due to strong bending and compression by the edge of the optic canal bony margin and local nerve stretching.…”

Section: Figmentioning

confidence: 99%

Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions

Yamaguchi¹,

Tosaka²,

Miyagishima³

et al. 2021

Journal of Neurosurgery

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OBJECTIVEVisual acuity impairment due to sellar and suprasellar tumors is not fully understood. The relationship between these tumors and disturbance of visual function was examined using preoperative MRI.METHODSThis study reviewed 93 consecutive patients with sellar and suprasellar tumors. Best-corrected visual acuity (BCVA) and visual impairment score (VIS) were used for estimation of visual impairments. Preoperative MR images were examined to obtain several values for estimation of chiasmatic compression. Additionally, the optic nerve–canal bending angle (ONCBA) was newly defined as the external angle formed by the optic nerve in the optic canal and the optic nerve in the intracranial subarachnoid space at the junction, using preoperative sagittal T2-weighted MR images.RESULTSThe mean ONCBA was about the same on the right (44° ± 25°) and the left (44° ± 24°). Sagittal ONCBA was defined as large (> 45°) and moderate (≤ 45°) on each side. Preoperative VIS was found to be significantly worse if the right or left ONCBA (or both) was large (right side: ONCBA large [median 20, IQR 8–30] > ONCBA moderate [median 10, IQR 3–17], p = 0.003, Mann-Whitney U-test; left side: ONCBA large [median 22, IQR 9–30] > ONCBA moderate [median 10, IQR 2–16], p = 0.001). A large ONCBA showed a significant relationship with unfavorable ipsilateral BCVA (> logMAR, 0; right side, p = 0.001, left side, p = 0.001, chi-square test). The ONCBA had a positive correlation with ipsilateral BCVA (right: r = 0.297, p = 0.031; left: r = 0.451, p = 0.000, Pearson’s correlation coefficient). Preoperative BCVA was significantly lower on the same side in the large ONCBA group compared with the moderate ONCBA group (right side: large ONCBA 0.169 ± 0.333 [logMAR, mean ± standard deviation] vs moderate ONCBA 0.045 ± 0.359, p = 0.026, Student t-test; left side: large ONCBA 0.245 ± 0.346 vs moderate ONCBA 0.025 ± 0.333, p = 0.000). This visual acuity impairment improved after resection of the tumors.CONCLUSIONSSagittal bending of the optic nerve at the entrance from the intracranial subarachnoid space to the optic canal may be related to ipsilateral deterioration of visual acuity in sellar and suprasellar lesions. Sagittal T2-weighted MRI is recommended for preoperative estimation of the optic nerve bending.

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Section: Figmentioning

confidence: 99%

Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions

Yamaguchi¹,

Tosaka²,

Miyagishima³

et al. 2021

Journal of Neurosurgery

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“…Central retinal artery occlusion (CRAO) accounts for a small percentage of POVL cases, but is the second most common cause associated with spinal surgery, accounting for 11% of all cases, following ION with 89% of cases. 3,4,10 CRAO was also largely attributed to poor prone positioning (direct eye compression and/or rotation of the neck with jugular/carotid compromise) and embolic events. 11 The prognosis is poor mainly because the retina is very sensitive to ischemia being the tissue of the human body with the highest oxygen consumption.…”

Section: Discussionmentioning

confidence: 99%

“…1 There is significant variation in the reported incidence of POVL ranging from 0.056 to 1.3% for all surgeries and up to 0.2% for spine surgery. 2,3 Furthermore, in association with the rising number of spinal fusion surgeries, strong evidence indicates an increasing incidence of POVL. 3,4 The etiology of POVL is not yet entirely understood.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Furthermore, in association with the rising number of spinal fusion surgeries, strong evidence indicates an increasing incidence of POVL. 3,4 The etiology of POVL is not yet entirely understood. 5 Several preoperative and intraoperative risk factors have been identified, including hypertension, diabetes, vascular diseases, intraoperative hypotension, overhydration, and surgical positioning and possible causes include ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), cortical blindness (CB), and corneal abrasion (CA).…”

Section: Introductionmentioning

confidence: 99%

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Hyperbaric oxygenation therapy treatment option in perioperative visual loss in spine surgery

et al. 2021

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<p class="abstract">Perioperative vision loss (POVL) is a catastrophic complication of spine surgery and several risk factors are identified. As spine fusion surgery is rising in number, POVL incidence is increasing. Preventive strategies can decrease the risk of this complication. Prognosis depends on the level of occlusion and how quickly oxygen supply can be restored to retina. We present a 65-year-old female patient with multiple cardiovascular risk factors that who underwent lumbar fusion. Upon waking up from anesthesia, the patient reported total loss of vision in her left eye. An occlusion of the central retinal artery due to a probable embolic cause was diagnosed and the patient promptly started treatment with anti-aggregation therapy and hyperbaric oxygen therapy (HBOT) with good results. The combination of HBOT with anti-aggregation therapy may have had a synergistic effect contributing to the good outcome presented in this case and may be a good option for the treatment of this patients. </p>

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“…Postoperative visual loss (POVL) is a quite rare, but devastating complication of surgeries performed in prone position which pathophysiology is not clearly understood [1]. It occurs in approximately 0.2% of surgeries in prone position [2].…”

Section: Introductionmentioning

confidence: 99%

Influence of Anesthesia Type on Intraocular Pressure During Spine Surgery in Prone Position

et al. 2020

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The aim was to examine intraocular pressure (IOP) during lumbar spine surgery in PP under general vs spinal anesthesia and to compare it with volunteers in PP. Materials and methods: We performed randomized prospective single institutional trial. Patients were operated in PP with fixation of 1-2 spinal segments. Patients of group I (n = 30) were operated under SA, group 2A (n = 25) – under TIVA (total intravenous anesthesia) with 45° head rotation (left eye was located lower, than right eye), group 2B (n=25) – under TIVA with no head rotation (both eyes were located on the same level). IOP was measured with Maklakov method before and after surgery. Volunteers (n = 20) were examined before and 90 minutes after lying in PP with 45° head rotation. Results: In all patients and volunteers after lying in PP, we found that IOP have increased. In SA patients and in TIVA patients with no head rotation there was no difference between eyes. The most significant raise of IOP was found in the dependent eye of IIA group patients: it was higher than in volunteers and I group patients (p < 0.01), and IIB group patients (p < 0.05). In SA patients there was no difference in IOP comparing to volunteers. Conclusions: IOP increased in PP in healthy people and patients under anesthesia (SA and TIVA). IOP in SA patients did not differ from volunteers. IOP increased superiorly in the dependent eye in TIVA patients.

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Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations

Cited by 24 publications

References 38 publications

Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions

Sagittal bending of the optic nerve at the entrance from the intracranial to the optic canal and ipsilateral visual acuity in patients with sellar and suprasellar lesions

Hyperbaric oxygenation therapy treatment option in perioperative visual loss in spine surgery

Influence of Anesthesia Type on Intraocular Pressure During Spine Surgery in Prone Position

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