Perioperative Risk Factors for Posterior Ischemic Optic Neuropathy1

Dunker, Stephan; Hsu, Hui-Tsung; Sebag, J.; Sadun, Alfredo A.

doi:10.1016/s1072-7515(02)01210-3

Cited by 99 publications

(44 citation statements)

References 19 publications

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“…Some have speculated that facial oedema indicates ION risk after spine surgery. 27 However, facial oedema is often seen after spinal surgery in many patients who do not develop ION, and therefore, its relevance remains unclear, and the notion that facial oedema is a risk factor is unproven.…”

Section: Haemodilutionmentioning

confidence: 99%

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

Roth¹

2009

British Journal of Anaesthesia

253

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: Haemodilutionmentioning

confidence: 99%

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

Roth¹

2009

British Journal of Anaesthesia

253

116

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“…Nonarteritic PION was seen in 17 women and 11 men (nine right, 12 left, and seven both eyes), arteritic PION in 10 women and two men (three right, seven left, and two both eyes), and surgical PION in 2 women and one man (one right, one left, and one both eyes). Age range was 20-90 (median 61.5, interquartile [52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70] …”

Section: Demographic Characteristicsmentioning

confidence: 99%

“…Surgical PION usually tends to cause bilateral massive visual loss or even complete blindness, which is usually permanent; therefore, it has great medicolegal importance. A large number (mostly anecdotal) of surgical PION cases have been reported in the literature, almost invariably associated with prolonged systemic surgical procedures, for a variety of conditions, including spinal and other orthopaedic surgical procedures, 46-51 radical neck dissection, [30][31][32][52][53][54][55][56][57] venous graft in extremities, 58,59 coronary artery bypass, 60 hip surgery, 60 nasal surgery, 61 thoracotomy for haemothorax, 55 penetrating thoracoabdominal injury, 62 cataract surgery, 63 and strabismus surgery. 64 Sadda et al 9 reported 28 patients following a variety of procedures.…”

Section: Surgical Pionmentioning

confidence: 99%

Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management

Hayreh

2004

Eye

202

159

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“…However, the CSF leak during the incidental durotomy should have had a 'protective' effect on this-it has been suggested that intracranial pressure is decreased in patients with ocular hypotension and vice versa [17]. The resolving nature of our patient's POVL is only the third case reported [4,18] and the only documented case to resolve completely within 48 h.…”

Section: Discussionmentioning

confidence: 69%

Transient bilateral post-operative visual loss in spinal surgery

2011

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Background Post-operative visual loss (POVL) following spinal surgery is a rare but devastating complication. Although a number of intra-operative and post-operative factors have been implicated, the exact etiology may still remain unclear. Purpose To report a unique case of transient bilateral POVL in a patient who had undergone lumbar surgery in the prone position. Study design/setting This patient was followed up prospectively for 1 year. Methods Prospective follow-up of a single patient following spinal surgery, who developed transient bilateral POVL. Results This patient's visual loss improved within 48 h. Conclusion This is the only documented case of POVL to have resolved completely within 48 h.

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Perioperative Risk Factors for Posterior Ischemic Optic Neuropathy1

Cited by 99 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?

Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management

Transient bilateral post-operative visual loss in spinal surgery

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