The Frequency of Perioperative Vision Loss

Warner, Matt; Warner, Mark A.; Garrity, James A.; MacKenzie, Robert; Warner, David O.

doi:10.1097/00000539-200112000-00013

Cited by 133 publications

(80 citation statements)

References 13 publications

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“…Two large retrospective studies determined that the incidence of POVL is approximately 1/60000 to 1/125000 of all general anesthetics [6,7] . However, the risk of POVL is believed to be significantly greater following cardiac and spine surgeries.…”

Section: Epidemiologymentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

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Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. According to the American Society of Anesthesiologists Postoperative Visual Loss Registry, the most common causes of POVL in spine procedures are the two different forms of ischemic optic neuropathy: anterior ischemic optic neuropathy and posterior ischemic optic neuropathy, accounting for 89% of the cases. Retinal ischemia, cortical blindness, and posterior reversible encephalopathy are also observed, but in a small minority of cases. A recent multicenter case control study has identified risk factors associated with ischemic optic neuropathy for patients undergoing prone spinal fusion surgery. These include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. These risk factors are thought to contribute to the elevation of venous pressure and interstitial edema, resulting in damage to the optic nerve by compression of the vessels that feed the optic nerve, venous infarction or direct mechanical compression. This review will expand on these findings as well as the recently updated American Society of Anesthesiologists practice advisory on POVL. There are no effective treatment options for POVL and the diagnosis is often irreversible, so efforts must focus on prevention and risk factor modification. The role of crystalloids versus colloids and the use of α-2 agonists to decrease intraocular pressure during prone spine surgery will also be discussed as a potential preventative strategy. Core tip: Perioperative visual loss (POVL) is an uncommon, but devastating complication that remains primarily associated with spine and cardiac surgery. The incidence and mechanisms of visual loss after surgery remain difficult to determine. Ischemic optic neuropathy accounts for the vast majority of these cases, with retinal ischemia, cortical blindness, and posterior reversible encephalopathy observed with low incidence. Recently identified risk factors include obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration. POVL is often permanent and untreatable, so prevention is key to limiting its impact. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop 2014; 5(2): 100-106 Available from:

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Section: Epidemiologymentioning

confidence: 99%

Perioperative visual loss after spine surgery

Nickels¹,

Manlapaz²,

Farag³

2014

WJO

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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

200

159

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“…Post-operative visual loss following non-ocular surgery is an infrequent but disastrous complication with an estimated incidence ranging from 0.001 to 1 % depending on the type of surgery [20,25,26]. Direct pressure on the eye, especially as a result of patient malpositioning, has been cited as a factor contributing to visual loss [2,3,19].…”

Section: Discussionmentioning

confidence: 99%

Modified prone position using lateral brace attachments for cervico-dorsal spine surgeries

2013

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Purpose The purpose of the study was to propose a method of prone positioning for posterior cervico-dorsal spine surgeries that is easy to achieve without additional equipment and may reduce complications associated with prone positioning in patients. Methods 41 patients underwent posterior spine surgeries using our method of prone positioning on a fluoroscopy compatible conventional operation table, and the technical difficulties and complications associated were noted. After induction under general anaesthesia in supine position, cervical tongs were applied. An assembly of two adequately padded cylindrical bolsters and two lateral brace attachments was set on a conventional operating table. The patient was then positioned prone so that the tongs as well as insertion pins of the tongs rest on the lateral brace attachments, with the face and head suspended freely in between. A neutralisation weight was then applied suspended from the tongs to stabilize the head. Results The time required for patient positioning was noted and was found to be nearly the same as that required for traditional prone positioning. No problems were noted during patient positioning and with anaesthesia tubing management. All surgeries went well without position related complications except for one patient who developed post-operative macroglossia. All cervical tong pin sites healed without any complications. The fluoroscope easily gained access to the operative areas.Conclusions Our modification appears simple, versatile and reproducible for posterior approach procedures of the cervical and upper dorsal spine in prone position. Also, the method can be easily implemented in most conventional operating room facilities with minimal surgeon effort and without the need for any additional inventory.

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The Frequency of Perioperative Vision Loss

Abstract: Vision loss and blindness after surgery and anesthesia is a very rare event. In this study, only one per 125,234 patients undergoing noncardiac surgery developed vision loss persisting for longer than 30 days.

Cited by 133 publications

References 13 publications

Perioperative visual loss after spine surgery

Perioperative visual loss after spine surgery

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

Modified prone position using lateral brace attachments for cervico-dorsal spine surgeries

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