Abstract
Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries. Ischemic optic neuropathy (ION), and retinal arterial occlusion (RAO) are the main causes (1, 2). Less frequent are cortical blindness (3), acute glaucoma (4), and choroidal and vitreous hemorrhage (5). ION is the most common cause for which the neurologist or neuro-ophthalmologist is consulted as it is associated either with a normal ophthalmic exam (posterior ION, PION), or less often, with optic nerve (ON) head swelling (anterior ION, AION). The presumed cause is impaired blood supply to the optic nerve (Figure 1). The most common surgical procedures complicated by ION are cardiac surgery and spinal fusion. Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative ION (poION), with cohort and case-control studies helping to identify candidate risk factors (6, 7). Animal models have provided insight regarding mechanisms (8). This mini-review is an update on the latest advancements regarding poION in non-ophthalmic surgeries in epidemiological, clinical, and animal studies.
Highlights
Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries
Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative Ischemic optic neuropathy (ION), with cohort and case-control studies helping to identify candidate risk factors [6, 7]
Often not appreciated is that peri-operative ION (poION) occurs with cardiac surgery at a rate of 0.06–0.113%, 6-fold greater vs. spinal fusion [6, 10, 11]. poION has been reported after head and neck surgery [12, 13], joint replacement [14], nasal and sinus surgery [15], vascular and general surgery, radical prostatectomy, gynecologic surgery, and liposuction [16]
Summary
395 Lumbar spine 600,000 lumbar fusion ( studied cervical spine) 2.5M lumbar fusion. 83 *Mean hemoglobin 9.5 g/dl *Mean blood loss 3.7 L *Mean operative duration 8.7 h *Mean lowest SBP 77 mm Hg. 83 *Lowest mean hematocrit 26% *Mean blood loss 2.0 L. *Operative duration mostly > 6 h *33%, lowest SBP was > 90 mm Hg *20%, lowest recorded SBP was ≤ 80 mm Hg. *57% had SBP or MAP 20–39% below baseline *25% SBP or MAP 40–49% below baseline. *Hypertension 41%, diabetes 16%, and coronary artery disease 10%. 22 *Age, lowest hematocrit and lowest blood pressure no different in cases vs controls *
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