Perioperative visual loss and anesthetic management

Abstract

Perioperative visual loss (POVL) is an uncommon complication primarily associated with cardiac, spine, and head and neck surgery that can have a potentially severe impact on quality of life. The largest multicenter case control study to date on POVL recently identified risk factors associated with ischemic optic neuropathy and prone spinal fusion surgery. This review will summarize these findings and the updated American Society of Anesthesiologists practice advisory on POVL to provide guidance on identification and management of high-risk patients undergoing prone spine surgery. Epidemiology data on POVL from national databases, POVL in robotic surgery, and posterior reversible encephalopathy syndrome as a newer cause of POVL will also be discussed. Risk factors associated with prone spinal fusion surgery and ischemic optic neuropathy identified in a large multicenter case-control study include male sex, obesity, use of the Wilson spinal frame, longer anesthetic duration, greater blood loss, and a lower percentage of colloid in the nonblood fluid administration. Strategies aimed at modifying risk factors for ischemic optic neuropathy associated with prone spinal fusion surgery that are extrinsic to the patient may decrease its incidence. Further research is needed to validate this concept.