Postoperative Visual Loss in Spine Surgery

2018 ◽  
Author(s):  
David E. Traul
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Cortical Blindness ◽  
Ischemic Optic Neuropathy ◽  
Cardiac Procedures ◽  
Postoperative Visual Loss

Postoperative visual loss (POVL) is a rare but devastating condition associated with many types of nonocular surgery. In spine surgery, the most common causes of POVL are ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), and cortical blindness. Although the association of POVL with spine surgery has long been recognized, the low incidence of this complication hinders the identification of patient and perioperative risk factors and limits our understanding of the causes of POVL. In adult spine surgery, POVL is most frequently attributed to ION whereas CRAO is more commonly seen in cardiac procedures. POVL due to cortical blindness has the highest incidence in pediatric spine surgery. While several risk factors for POVL have been identified in spine surgery, there are currently no standardized practice guidelines to eliminate the risk for POVL. Currently, there are no effective treatments for POVL, and recovery from ION and CRAO is limited.

Current intraoperative devices to reduce visual loss after spine surgery

2012 ◽  
Vol 33 (2) ◽  
pp. E14 ◽  
Author(s):  
Alberto A. Uribe ◽  
Mirza N. Baig ◽  
Erika G. Puente ◽  
Adolfo Viloria ◽  
Ehud Mendel ◽  
...  
Keyword(s):  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Critical Factor ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Ocular Injury ◽  
Ischemic Optic Neuropathy ◽  
Advantages And Disadvantages

Postoperative visual loss (POVL) after spine surgery performed with the patient prone is a rare but devastating postoperative complication. The incidence and the mechanisms of visual loss after surgery are difficult to determine. The 4 recognized causes of POVL are ischemic optic neuropathy (approximately 89%), central retinal artery occlusion (approximately 11%), cortical infarction, and external ocular injury. There are very limited guidelines or protocols on the perioperative practice for “prone-position” surgeries. However, new devices have been designed to prevent mechanical ocular compression during prone-position spine surgeries. The authors used PubMed to perform a literature search for devices used in prone-position spine surgeries. A total of 7 devices was found; the authors explored these devices' features, advantages, and disadvantages. The cause of POVL seems to be a multifactorial problem with unclear pathophysiological mechanisms. Therefore, ocular compression is a critical factor, and eliminating any obvious compression to the eye with these devices could possibly prevent this devastating perioperative complication.

Migrainous infarction of the eye: Two cases of monocular ischemic complications associated with retinal migraine

Cephalalgia ◽  
2021 ◽  
pp. 033310242110562
Author(s):  
Nikita Chhabra ◽  
Chia-Chun Chiang ◽  
Marie A Di Nome ◽  
Odette Houghton ◽  
Rachel E Carlin ◽  
...  
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Monocular Vision ◽  
Ischemic Optic Neuropathy ◽  
Migrainous Infarction ◽  
Ischemic Complications ◽  
History Of

Background Retinal migraine is defined by fully reversible monocular visual phenomena. We present two cases that were complicated by permanent monocular vision deficits. Cases A 57-year-old man with history of retinal migraine experienced persistent monocular vision loss after one stereotypical retinal migraine, progressing to finger-count vision over 4 days. He developed paracentral acute middle maculopathy that progressed to central retinal artery occlusion. A 27-year-old man with history of retinal migraine presented with persistent right eye superotemporal scotoma after a retinal migraine. Relative afferent pupillary defect and superotemporal visual field defect were noted, consistent with ischemic optic neuropathy. Conclusion Retinal migraine can complicate with permanent monocular visual loss, suggesting potential migrainous infarction of the retina or optic nerve. A thorough cerebrovascular evaluation must be completed, which was unrevealing in our cases. Acute and preventive migraine therapy may be considered in retinal migraine patients, to mitigate rare but potentially permanent visual loss.

scholarly journals Perioperative Visual Deficit in a Patient Undergoing Dorsolumbar Spine Surgery

2018 ◽  
Vol 05 (03) ◽  
pp. 195-197 ◽  
Author(s):  
Ved Prakash Pandey ◽  
Arnab Dasgupta ◽  
Anurag Aggarwal ◽  
Sachin Jain
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Ischemic Optic Neuropathy ◽  
Long Duration ◽  
Retinal Artery

AbstractPerioperative visual loss (POVL) is a rare but potentially serious complication of long-duration surgeries in prone position under general anesthesia. The mechanism of visual loss after surgery, and its incidence, is difficult to determine. It is primarily associated with cardiothoracic and spine surgeries. The proposed causes include corneal injury, retinal ischemia (central retinal artery occlusion/branch retinal artery occlusion [CRAO/BRAO]), ischemic optic neuropathy (ION), and cortical blindness. A large, recent multicenter case-control study has identified risk factors associated with ION for patients undergoing spinal instrumentation surgery in prone position. These include male sex, obesity, use of Wilson's frame, long duration of anesthesia/surgery, larger estimated blood loss, and larger relative use of crystalloids for compensation of blood loss. This report describes a relatively healthy, 71-year-old female patient who developed significant visual impairment after thoracolumbar spine surgery in prone position under general anesthesia. The case raises dilemmas regarding the preoperative identification of patients who should be informed of the risk of POVL, and by whom.

Transient visual acuity loss after spine surgery in prone position: A case report and literature review

2020 ◽  
Author(s):  
Jun Xiong ◽  
Guiling Liang ◽  
Liang Hu ◽  
Wei Chen ◽  
Jie Deng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Efficacious Treatment ◽  
Retinal Artery ◽  
Visual Acuity Loss

Abstract Background: Visual loss after spine surgery in prone position is disastrous postoperative complication because it is almost irreversible. Meamwhile, there is no optimal treatments and recommended peofessional guidelines. Case presentation: A 43 years old male patient complained visual loss after spine surgery in prone position. Immediate ophthalmic consultation undoubtedly considered central retinal artery occlusion, therefore combined therapies were administered including neurotrophy, anticoagulation, vasodilation and adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment, his visual acuity recovered from postoperative 5 hours gradually. Conclusion: Because there is shortage of efficacious treatment against visual loss after spine surgery in prone position, the best method avoiding this complication is to pay great attention and prevent it.

scholarly journals Transient visual acuity loss after spine surgery in the prone position: a case report and literature review

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052095227
Author(s):  
Jun Xiong ◽  
Guiling Liang ◽  
Liang Hu ◽  
Wei Chen ◽  
Jie Deng ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Prone Position ◽  
Spine Surgery ◽  
Visual Loss ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Retinal Artery ◽  
Visual Acuity Loss ◽  
Professional Guidelines

Visual loss after spine surgery in the prone position is a disastrous postoperative complication because it is almost irreversible. Additionally, the optimal treatments and recommended professional guidelines for visual loss after spine surgery are deficient. A 43-year-old man developed visual loss after spine surgery in the prone position. Immediate ophthalmic consultation confirmed central retinal artery occlusion. Therefore, combined therapies were administered, including neurotrophy, anticoagulation, vasodilation, and adequate fluid infusion, followed by hyperbaric oxygen treatment. After active treatment, his visual acuity gradually recovered from 5 hours postoperatively and continued to improve thereafter. We reviewed the literature on postoperative visual loss with a focus on spine surgery in the prone position. Because the etiology of this complication is complex and has few effective treatments, the best method for its avoidance is to pay close attention to preventing it during surgery.

scholarly journals Perioperative Visual Loss in Spine Fusion Surgery

2016 ◽  
Vol 125 (3) ◽  
pp. 457-464 ◽  
Author(s):  
Daniel S. Rubin ◽  
Isaac Parakati ◽  
Lorri A. Lee ◽  
Heather E. Moss ◽  
Charlotte E. Joslin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Fusion ◽  
Visual Loss ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Spine Fusion ◽  
Ischemic Optic Neuropathy ◽  
Case Control Studies ◽  
Diagnostic Codes ◽  
Statistical Survey

Abstract Background Perioperative ischemic optic neuropathy (ION) causes visual loss in spinal fusion. Previous case–control studies are limited by study size and lack of a random sample. The purpose of this study was to study trends in ION incidence in spinal fusion and risk factors in a large nationwide administrative hospital database. Methods In the Nationwide Inpatient Sample for 1998 to 2012, procedure codes for posterior thoracic, lumbar, or sacral spine fusion and diagnostic codes for ION were identified. ION was studied over five 3-yr periods (1998 to 2000, 2001 to 2003, 2004 to 2006, 2007 to 2009, and 2010 to 2012). National estimates were obtained using trend weights in a statistical survey procedure. Univariate and Poisson logistic regression assessed trends and risk factors. Results The nationally estimated volume of thoracic, lumbar, and sacral spinal fusion from 1998 to 2012 was 2,511,073. ION was estimated to develop in 257 patients (1.02/10,000). The incidence rate ratio (IRR) for ION significantly decreased between 1998 and 2012 (IRR, 0.72 per 3 yr; 95% CI, 0.58 to 0.88; P = 0.002). There was no significant change in the incidence of retinal artery occlusion. Factors significantly associated with ION were age (IRR, 1.24 per 10 yr of age; 95% CI, 1.05 to 1.45; P = 0.009), transfusion (IRR, 2.72; 95% CI, 1.38 to 5.37; P = 0.004), and obesity (IRR, 2.49; 95% CI, 1.09 to 5.66; P = 0.030). Female sex was protective (IRR, 0.30; 95% CI, 0.16 to 0.56; P = 0.0002). Conclusions Perioperative ION in spinal fusion significantly decreased from 1998 to 2012 by about 2.7-fold. Aging, male sex, transfusion, and obesity significantly increased the risk.

scholarly journals OPHTHALMOLOGIC COMPLICATIONS IN SPINAL SURGERIES: LITERATURE REVIEW

2019 ◽  
Vol 18 (2) ◽  
pp. 151-153
Author(s):  
João Thiago Frossard da Cruz Ferreira
Keyword(s):  
Literature Review ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Cortical Blindness ◽  
Direct Compression ◽  
Ischemic Optic Neuropathy ◽  
Level Of Evidence ◽  
Retinal Artery ◽  
Prolonged Surgery

ABSTRACT Literature review using PubMed, relating ophthalmologic complications in spinal surgery. Ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO) and cortical blindness (CB) constitute the majority of cases. These are rare complications and have a poor prognosis. Post-operative visual loss (POVL) occurs most often in surgical procedures performed in the prone position. Being male, anemia, blood transfusion, and prolonged surgery time are related to ION, while malposition and direct compression of the eyeball are related to the development of CRAO. Level of Evidence III; Systematic reviewbof level III studies.

scholarly journals Unilateral Vision Loss without Ophthalmoplegia as a Rare Complication of Spinal Surgery

2017 ◽  
Vol 08 (02) ◽  
pp. 288-290 ◽  
Author(s):  
Elif Akpınar ◽  
Mehmet Sabri Gürbüz ◽  
Gülfidan Bitirgen ◽  
Mehmet Özerk Okutan
Keyword(s):  
Spinal Surgery ◽  
Visual Loss ◽  
Vision Loss ◽  
Rare Complication ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Ischemic Optic Neuropathy ◽  
Acute Visual Loss ◽  
Retinal Artery

ABSTRACTPostoperative visual loss is an extremely rare complication of nonocular surgery. The most common causes are ischemic optic neuropathy, central retinal artery occlusion, and cerebral ischemia. Acute visual loss after spinal surgery is even rarer. The most important risk factors are long-lasting operations, massive bleedings, fluid overload, hypotension, hypothermia, coagulation disorders, direct trauma, embolism, long-term external ocular pressure, and anemia. Here, we present a case of a 54-year-old male who developed acute visual loss in his left eye after a lumbar instrumentation surgery and was diagnosed with retinal artery occlusion.

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