Ischemic Orbital Compartment Syndrome as a Complication of Spinal Surgery in the Prone Position

Leibovitch, Igal; Casson, Robert J.; Laforest, Caroline; Selva, Dinesh

doi:10.1016/j.ophtha.2005.09.025

Cited by 66 publications

(45 citation statements)

References 9 publications

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“…21 Pressure on the face in prone position is on average 30 mmHg, but can be higher than 50 mmHg in certain areas such as the chin and forehead above the supraorbital ridge. 22 Prolonged pressure on ears, particularly on cartilaginous auricles can result in hematoma, chondritis, ischemia or necrosis. 7 …”

Section: Head and Neck Pressure Soresmentioning

confidence: 99%

“…The rate of this complication is estimated to be between 0.05% and 1%. 3,21,22,31 Ischemic optic neuropathy (ION) and orbital compartment syndrome (OCS) Direct pressure on orbits can cause trauma resulting in conjunctival edema, hemorrhage, chemosis, pain, and vision loss. 7,14 ION is caused by damage to optic nerve by increased intraocular pressure and orbital venous pressure.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…Raised intraocular pressure in combination with raised intra-abdominal pressure reduces venous return in the orbit increasing venous pressure and edema. 14,22,35 Edema can be aggravated by high-volume fluid replacement aggravating intraocular pressure.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…34,22 Decreased perfusion pressure on the optic nerve results in ION. 22,35 ION and OCS are well-established risk even with sufficient supportive facial padding.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

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The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

210

162

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Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.

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Section: Head and Neck Pressure Soresmentioning

confidence: 99%

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

“…34,22 Decreased perfusion pressure on the optic nerve results in ION. 22,35 ION and OCS are well-established risk even with sufficient supportive facial padding.…”

Section: Postoperative Vision Loss (Povl) and Other Ophthalmic Injuriesmentioning

confidence: 99%

See 2 more Smart Citations

The Prone Position During Surgery and its Complications: A Systematic Review and Evidence-Based Guidelines

Kwee

Rozen

2015

International Surgery

210

162

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“…85 Ischaemic ocular compartment syndrome, more typically found with retrobulbar haemorrhage after nasal sinus surgery, 40 47 was reported in a patient undergoing spine surgery in the prone position, believed to be related to positioning with direct pressure on the eye. 62 It is an acute ophthalmological emergency, requiring prompt decompression to relieve the increased IOP. The patient's head had been positioned on a silicone headrest for 8 h during which he received only 1 litre of crystalloids.…”

Section: Central Retinal Artery Occlusionmentioning

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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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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