Postoperative Visual Loss and Ischemic Optic Neuropathy

Abstract

Chapter 11 covers partial or complete loss of vision in the perioperative period, which is a devastating iatrogenic complication that can leave patients with significant physical disability and loss of quality of life. Postoperative visual loss (POVL) with nonocular surgery most often occurs in association with cardiac surgery, spine surgery in the prone position, and head and neck surgery. POVL has also been reported in other operations, including nonspine orthopedic surgery, major vascular surgery, prostatectomies (open or laparoscopic/robotic), abdominal compartment syndrome, liposuction, thoracotomies, liver transplantation, and other miscellaneous cases. The four most common POVL diagnoses are central retinal artery occlusion (CRAO), cortical blindness, anterior ischemic optic neuropathy (AION), and posterior ischemic optic neuropathy (PION). Less common POVL diagnoses include glycine toxicity during transurethral resection of the prostate (TURP), acute angle closure glaucoma, expansion of intraocular gas perfluoropropane (C3F8) and sulfur hexafluoride (SF6) with administration of nitrous oxide containing anesthetics, and posterior reversible encephalopathic syndrome (PRES). This chapter will focus on the more common types of POVL, with an emphasis on AION and PION.