Perioperative visual loss in ocular and nonocular surgery

Abstract

Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period. Method of literature reviewWe searched the National Library of Medicine's PubMed database with a subsequent review of the accompanying references (last accessed February 8, 2010). The major search words and word combinations included: posterior ischemic optic neuropathy; anterior ischemic optic neuropathy; central retinal artery occlusion; pituitary apoplexy; cortical blindness; optic nerve trauma; postoperative vision loss; postoperative blindness; perioperative vision loss; perioperative blindness; and ocular surgery. In addition, the citations from the above searches were also included. Cases from the non-English literature and cases prior to 1970 were not included. Cases with documented direct surgical trauma to orbital structures other than the optic nerve were not included.

Perioperative visual loss with non-ocular surgery: Case report and review of literature

“…The incidence of POVL is estimated to be around 0.013% for all surgeriesand up to 0.2% followingspine surgery. [ 2 ] Cardiac, spinal as well as head and neck surgeries have been associated with POVL. The main reported causes are ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness.…”

“…The pre-operative factors often associatedare anemia, hypertension, glaucoma, carotid artery disease, smoking, obesity, and diabetes. [ 2 ] Intraoperatively, many factors have been proposed which include long duration in the prone position, decreased oxygen perfusion pressure, excessive blood loss and anemia, hypotension, hypoxia, excessive fluid replacement, elevated venous pressure, head positioning, and patient-specific vascular susceptibility which may be anatomic or physiologic. However, the risk factors for any given patient or procedure may vary.…”

Surgical errors and risks – the head and neck cancer patient

“…A dramatic but rare complication after radical neck dissection is visual loss and just 12 cases are reported in the literature [ 97 ]. Underlying cause is an anterior or posterior ischemic optic neuropathy with assumed distension of the ophthalmic vein with compression of the orbital apex followed by reduction of perfusion of the eye bulb [ 98 ].…”

Posterior ischemic optic neuropathy: Perioperative risk factors

“…[ 3 ] Visual loss has been reported following various nonocular surgeries such as spinal procedures,[ 4 5 6 7 8 9 10 11 12 ] radical neck dissection,[ 13 14 15 16 17 18 19 20 21 ] venous graft in extremities,[ 22 23 ] cardiopulmonary bypass,[ 24 25 26 ] hip surgery,[ 24 ] other orthopedic surgery,[ 27 ] nasal surgery,[ 28 ] thoracotomy for hemothorax,[ 19 ] laparoscopic nephrectomy,[ 29 ] prostatectomy,[ 30 ] breast augmentation and abdominal liposuction,[ 31 ] and penetrating thoracoabdominal injury. [ 32 ] It has also been reported as a rare occurrence following ocular or periocular sinus surgeries[ 33 34 35 36 ] though these, not being remote, probably reflect a different pathophysiology. Spine surgery is the most frequently associated procedure, comprising 72% of patients in the American Society of Anesthesiologists (ASA) postoperative visual loss (POVL) registry,[ 37 ] and 60% of these cases were PION.…”