No significant retinal damage induced by major orthopedic surgery - a pilot study.

Tomas Parizek,Roman Skulec,Vladimir Cerny,Ivana Liehneova,Petr Prasek

doi:10.5507/bp.2021.022

Tomas Parizek, Roman Skulec + Show 3 more

Open Access

https://doi.org/10.5507/bp.2021.022

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Abstract

Perioperative visual loss is one of the rare but devastating complications of anesthesia and surgery. The incidence of less severe or even subclinical postoperative visual dysfunction is unknown. Therefore, we decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT). Adult patients indicated for elective knee replacement surgery with the absence of known retinal or optic nerve disease were included. Each patient underwent baseline OCT examination of the eyes one day before surgery and it was repeated 4-7 days after the surgery. The surgery was done under general and epidural anesthesia. A total of 18 patients (6 men and 12 women) at the age of 70.8±7.1 years were enrolled. We found statistically significant changes in the Macular central thickness and in a few areas of the Retinal Nerve Fiber Layer between the baseline and postoperative measurements. Even though we found significant changes in some parameters, we did not confirm that general anesthesia and/or surgical damage causes significant damage of the retina using OCT measurement. ClinicalTrials.gov (NCT04311801).

Highlights

Perioperative visual loss is one of the rare but devastating complications of surgery under general anesthesia with a reported incidence of 1 case for 60000–125000 anesthesia[1]
Epidural catheter was placed by loss of resistance technique at the level of L2-L3 or L3-L4 disc level and epidural infusion of Bupivacaine Hydrochloride 0.25% solution and sufentanil was maintained during the surgery
General anesthesia was initiated with propofol 2% solution (2 mg/kg) and sufentanil (0.2 ug/kg) and maintained with sevoflurane

Summary

Introduction

Perioperative visual loss is one of the rare but devastating complications of surgery under general anesthesia with a reported incidence of 1 case for 60000–125000 anesthesia[1]. On our best knowledge, the influence of surgery and general anaesthesia on retinas structure has never been investigated. This contrasts with that visual impairment, subclinical, may significantly affect the subsequent quality of life of patients undergoing surgery. We decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT).

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