Visual Loss as a Complication of Spine Surgery

Myers, Mark A.; Hamilton, Steven R.; Bogosian, Armen J.; Smith, Craig H.; Wagner, Theodore A.

doi:10.1097/00007632-199706150-00009

Cited by 267 publications

(155 citation statements)

References 19 publications

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“…20 In a retrospective case -control study of patients undergoing spinal fusion, levels of hypotension and anaemia were equivalent in patients who developed ION after spinal surgery compared with those who did not. 70 Holy and colleagues 50 showed similar results in a mixed patient population in a large single-institution study. ION patients in the ASA Postoperative Visual Loss Registry, the largest series after spine surgery, showed wide variation in arterial pressure decreases intraoperatively; lowest systolic arterial pressures were .90 mm Hg in 33% of the patients, whereas in 20%, lowest systolic arterial pressures were 80 mm Hg.…”

Section: Possible Pathogenic Factorsmentioning

confidence: 78%

“…9 Most knowledge is from individual case reports and case collections; the largest and best described single series is the ASA Postoperative Visual Loss Registry. 61 There has been one case-control study in spine surgery patients, 70 two in cardiac surgery, 72 88 and one that included patients undergoing a variety of surgical procedures. A summary of individual case reports 80 Case series and reviews have been published involving all types of surgery, 33 86 and case-control studies 50 in spine surgery (case series; 20 48 61 case-control study 70 ), cardiac surgery (case series; 52 case-control 72 88 ), and in trauma patients.…”

Section: Ischaemic Optic Neuropathymentioning

confidence: 99%

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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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Section: Possible Pathogenic Factorsmentioning

confidence: 78%

Section: Ischaemic Optic Neuropathymentioning

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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“…Prolonged surgery in the prone position 28 is one risk factor for AION after spine surgery. Katz et al 29 described four cases of AION after lumbar spine surgery and identified three risk factors: prolonged intraoperative hypotension, severe anaemia, and arteriosclerosis (diabetes).…”

Section: Discussionmentioning

confidence: 99%

“…Katz et al 29 described four cases of AION after lumbar spine surgery and identified three risk factors: prolonged intraoperative hypotension, severe anaemia, and arteriosclerosis (diabetes). Visual loss was often irreversible following AION after spine surgery, 28 possibly because AION was not recognized early and was not treated promptly 26 Lee 30 and Stevens et al 26 found that early aggressive correction of anaemia and systemic hypotension allowed reversal of ophthalmic complications of spine surgery with visual recovery.…”

Section: Discussionmentioning

confidence: 99%

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Mansour

Awwad

Najjar

et al. 2005

Eye

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“…Various risk factors have been elucidated by analysis of data available but with a time lag [5][6][7][8][9][10][11] and inadequate preoperative data. In addition there might be bias against reporting these data.…”

Section: Introductionmentioning

confidence: 99%

Ophthalmological changes after posterior spine surgeries: A prospective study

2020

IJCA

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Introduction: Postoperative visual loss (POVL) after posterior approach to spine surgeries is a devastating complication necessitating a prospective study. The primary aim was to identify ophthalmological changes contributing to POVL (visual acuity, anterior segment, intraocular pressure (IOP), fundus, field of vision, external ocular examination). Secondary objectives was to evaluate the relationship between ophthalmological changes and various perioperative data including patient comorbidities, positioning and other intraoperative details. Materials and Methods: After getting necessary approvals and consent, thirty patients posted for the posterior spine surgeries were assessed preoperatively. Ophthalmological examination was conducted preoperatively, the day before surgery and postoperatively twice (first within an hour of completion of surgery and second at twenty four hours). Perioperatively, data including type of surgical frame, headrest used, duration of prone positioning, total blood loss, total intravenous fluids administered, lowest mean arterial pressure for more than ten minutes, blood transfusion details and use of hypotensive anaesthesia were noted. Data were analyzed using chi-square test, paired t test, and correlation coefficient. Results: There were no changes in visual acuity, anterior segment, fundus and field of vision postoperatively. But 12 patients had a rise in IOP and six developed lid edema and chemosis. There was a minimal increase in IOP at one hour post operatively (right eye-2.8 mm Hg (p=0.001, and left eye-3 mmHg(p<0.001). The analysis of perioperative data revealed no relationship with ophthalmological changes noted. Conclusion: There were no clinically significant ophthalmological changes contributing to POVL in spine surgeries in prone position. Observed ophthalmological changes did not have any correlation with patient comorbidities, positioning and other intraoperative details.

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Visual Loss as a Complication of Spine Surgery

Abstract: The authors conclude that blindness after spine surgery is more common than has been recognized previously. Most cases are associated with complex instrumented fusions.

Cited by 267 publications

References 19 publications

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

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

Anterior ischaemic optic neuropathy after coronary artery bypass graft: the role of anaemia in diabetics

Ophthalmological changes after posterior spine surgeries: A prospective study

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