Bilateral acute angle-closure glaucoma as a complication of facedown spine surgery

Abstract

Background context Multiple studies have reported that facedown positioning can result in elevation of intraocular pressure (IOP) in individuals susceptible to angle-closure glaucoma. Before advances in diagnostic modalities, prone tests were popularly performed in ophthalmology practices as provocative tests for detecting potentially occludable angles. In patients with a positive test result, direct observation shows that the anterior chamber shallows and the angle closes over time, compromising aqueous humor outflow facility. Furthermore, the degree of angle narrowing is proportional to the rise in IOP. A common scenario involving a prone position is spine surgery, which can last several hours with the patient unconscious. Purpose To report a case of a patient who developed bilateral acute angle-closure glaucoma after facedown spine surgery. Study design Case report and literature review. Methods A 68-year-old Caucasian woman presented with persistent low back and left lower extremity pain. History was remarkable for L5 radicular pain, spinal stenosis, and an L3–L4 laminectomy performed 6 months previously. Plain films showed instability at the L4–L5 level and degenerative disc disease and scoliosis at L2–L4. The patient underwent spinal fusion surgery. Results Postoperatively, the patient complained of pain in the left eye accompanied with nausea and vomiting. Ophthalmology consultation confirmed the diagnosis of bilateral acute angle-closure glaucoma, requiring medical therapy initially followed by laser iridotomies in both eyes. Conclusions Bilateral acute angle-closure glaucoma may occur as a complication of facedown spine surgery. It is essential for anesthesiologists and surgeons to be aware of this complication for accurate diagnosis and timely intervention. A preoperative evaluation by an ophthalmologist should be considered for those individuals who are at increased risk of developing angle-closure glaucoma, such as certain ethnicities, including Asians, Canadians, and Eskimos; female gender; hyperopic eyes with a shorter axial length; family history; history of previous attacks in the subject; and so forth. Prophylactic laser iridotomy in eyes with potentially occludable angles is a simple and safe office procedure that can prevent potentially devastating visual outcomes.