Sequential Episodes of Perioperative Ischemic Optic Neuropathy After Hip Surgery

Abstract

Perioperative ischemic optic neuropathy (ION) after nonocular surgery is a rare complication leading to permanent and often severe vision loss. Due in part to the low prevalence of this complication, there remains no reliable way to predict which patients will develop ION. We present a patient with sequential episodes of unilateral perioperative ION, both occurring after otherwise uncomplicated hip operations. Patients and physicians should be aware that perioperative ION after one surgery may increase the risk of ION after subsequent surgeries.

Corneal Abrasions in Total Joint Arthroplasty

“…23 Patients and physicians should be aware that perioperative ION after one surgery may increase the chance of ION after subsequent surgeries. 23…”

“…One study reported sequential episodes of right AION following uncomplicated hip operations performed in the lateral decubitus position. 23 Patients and physicians should be aware that perioperative ION after one surgery may increase the chance of ION after subsequent surgeries. 23 Central retinal artery occlusion is a commonly reported cause of postoperative blindness that generally manifests unilaterally.…”

“…23 Patients and physicians should be aware that perioperative ION after one surgery may increase the chance of ION after subsequent surgeries. 23 Central retinal artery occlusion is a commonly reported cause of postoperative blindness that generally manifests unilaterally. 24 CRAO is frequently associated with spine surgery, and complete recovery is unusual.…”

“…Corneal abrasion during total joint arthroplasty is a rare complication and is infrequently addressed in the literature. 5,11,[20][21][22][23][24] CA is mostly self-limiting, however, but may lead to patient dissatisfaction and to delays if sameday discharge is attempted. Preventative measures and attentive care may help reduce the incidence of CA in patients undergoing total joint arthroplasty.…”

“…ION, thought to arise from hypoperfusion of the posterior ciliary arteries supplying the optic nerve, has been previously reported in TJA. 19,23 Prone and Trendelenburg positioning during surgery can increase intraocular pressure, causing ophthalmic vein congestion leading to ION. 24 Additionally, hypotension, blood loss, lengthy surgery, and patient-specific factors may predispose to decreased oxygen delivery to the optic nerve leading to ischemic injury.…”