An Analysis of 71 Spine Cases With Ischemic Optic Neuropathy From The ASA Postoperative Visual Loss Registry

2005 ◽  
Vol 17 (4) ◽  
pp. 251-252 ◽  
Author(s):  
Lee LA ◽  
Roth S ◽  
Posner KL ◽  
Cheney FW ◽  
Domino KB
Keyword(s):  
Optic Neuropathy ◽  
Visual Loss ◽  
Ischemic Optic Neuropathy ◽  
Postoperative Visual Loss

The American Society of Anesthesiologists Postoperative Visual Loss Registry

2006 ◽  
Vol 105 (4) ◽  
pp. 652-659 ◽  
Author(s):  
Lorri A. Lee ◽  
Steven Roth ◽  
Karen L. Posner ◽  
Frederick W. Cheney ◽  
Robert A. Caplan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spine Surgery ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Ischemic Optic Neuropathy ◽  
Bilateral Disease ◽  
The Mean ◽  
American Society ◽  
American Society Of Anesthesiologists ◽  
Postoperative Visual Loss

Background Postoperative visual loss after prone spine surgery is increasingly reported in association with ischemic optic neuropathy, but its etiology is unknown. Methods To describe the clinical characteristics of these patients, the authors analyzed a retrospectively collected series of 93 spine surgery cases voluntarily submitted to the American Society of Anesthesiologists Postoperative Visual Loss Registry on standardized data forms. Results Ischemic optic neuropathy was associated with 83 of 93 spine surgery cases. The mean age of the patients was 50 +/- 14 yr, and most patients were relatively healthy. Mayfield pins supported the head in 16 of 83 cases. The mean anesthetic duration was 9.8 +/- 3.1 h, and the median estimated blood loss was 2.0 l (range, 0.1-25 l). Bilateral disease was present in 55 patients, with complete visual loss in the affected eye(s) in 47. Ischemic optic neuropathy cases had significantly higher anesthetic duration, blood loss, percentage of patients in Mayfield pins, and percentage of patients with bilateral disease compared with the remaining 10 cases of visual loss diagnosed with central retinal artery occlusion (P < 0.05), suggesting they are of different etiology. Conclusions Ischemic optic neuropathy was the most common cause of visual loss after spine surgery in the Registry, and most patients were relatively healthy. Blood loss of 1,000 ml or greater or anesthetic duration of 6 h or longer was present in 96% of these cases. For patients undergoing lengthy spine surgery in the prone position, the risk of visual loss should be considered in the preoperative discussion with patients.

Nonarteritic Anterior Ischemic Optic Neuropathy

2020 ◽  
pp. 46-52
Keyword(s):  
Optic Nerve ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Clinical Findings ◽  
Common Type ◽  
Diagnosis And Treatment ◽  
Anterior Ischemic Optic Neuropathy ◽  
Ischemic Optic Neuropathy ◽  
Factors Affecting ◽  
Optic Nerve Involvement

Nonarteritic anterior ischemic optic neuropathy (NAION) is the most common ischemic optic neuropathy and the most common type of optic neuropathy after glaucoma. It is a vascular optic neuropathy that is not related to inflammation, demyelinization, and compression and it is the most common visual loss due to optic nerve involvement. While incidence between the ages of 55-65 is increasing; factors affecting the etiopathogenesis and development of NAION and its treatment have not been clarified yet. This article summarizes the literature on the pathogenesis, clinical findings, diagnosis, and treatment of NAION.

Acquired Optic Nerve Diseases

Visual Fields ◽  
2010 ◽  
Author(s):  
Peter A. Quiros ◽  
Alfredo A. Sadun
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Optic Nerve ◽  
Visual Field ◽  
Optic Neuritis ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Mass Effect ◽  
Ischemic Optic Neuropathy ◽  
Optic Nerve Diseases

This chapter focuses on the most frequently acquired optic nerve diseases: their signs and symptoms, visual field findings, and the required basic workup and management. Acquired optic nerve diseases are often vision threatening and sometimes even life threatening. There is a need for accurate and timely diagnosis. Therefore, it is incumbent on the clinician to identify optic neuropathies, separate them from chronic congenital and hereditary problems, and aggressively pursue the diagnosis and treatment as necessary. In the workup of optic neuropathies, the visual field is extremely helpful. All patients with suspected optic neuropathies require careful examination of the visual fields for detection, characterization, and monitoring. Acquired optic neuropathies include inflammatory, ischemic, compressive, metabolic, and central nervous system–reflected pathology (papilledema). Inflammatory optic neuropathies include optic neuritis and its various etiologies such as demyelination, infective, immune-mediated (atypical), and slowly progressive/ chronic. Ischemic optic neuropathies include nonarteritic ischemic optic neuropathy (NAION) and arteritic ischemic optic neuropathy (AAION). Metabolic optic neuropathies include nutritional and/or toxic etiologies. Compressive optic neuropathies can occur due to mass effect on the disc optic, gliomas, and perioptic meningiomas. Papilledema may be primary (pseudotumor cerebri) or secondary to central nervous system mass effect. Optic neuritis is defined as a primary inflammation of the optic nerve. It is characterized by central visual loss that worsens over days and usually peaks about 1 to 2 weeks after the onset. It is usually unilateral but may be bilateral, especially in children, following viral infections like measles, mumps, and chickenpox. It occurs most commonly in adults (18-45 years old). Orbital or periocular pain may be present or precede the visual loss and is exacerbated with eye movements. Etiologies include demyelinating diseases/multiple sclerosis;, idiopathic, viral, or bacterial infections (syphilis); contiguous inflammation of the meninges, orbit, or sinuses,; granulomatous inflammation (tuberculosis, sarcoidosis, and cryptococosis); and autoimmune diseases. It is the most common cause of acute visual loss from optic nerve disease in the young and middle-aged adult group.

scholarly journals Postoperative Visual Loss Following Spine Surgery: A Case Report

2019 ◽  
Vol 57 (218) ◽  
Author(s):  
Sabin Bhandari ◽  
Krishna Pokharel ◽  
Birendra Prasad Sah
Keyword(s):  
Visual Loss ◽  
Vision Loss ◽  
Pedicle Screw Fixation ◽  
Ischemic Optic Neuropathy ◽  
Ophthalmic Surgery ◽  
Intraoperative Hypotension ◽  
Posterior Ischemic Optic Neuropathy ◽  
One Year ◽  
The Right ◽  
Postoperative Visual Loss

Postoperative visual loss is a rare but devastating complication of non-ophthalmic surgery. Its aetiology is poorly understood and multiple associated factors have been proposed. We present a report of a 33-year-old female who developed irreversible diminution of vision on the right eye (non-arteritic-posterior-ischemic-optic-neuropathy) following general anaesthesia for pedicle screw fixation and plating for fracture vertebrae and hip in prone position and then screw placement for fracture calcaneum in supine position. The vision loss, limited to finger count close to face on the right eye, did not improve till follow-up at one-year. The combination of mild intraoperative hypotension, anaemia, prone positioning, prolonged surgery and anaesthesia may have contributed to postoperative visual loss in our patient.  

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.

Ischemic optic neuropathy following lumbar spine surgery

1995 ◽  
Vol 83 (2) ◽  
pp. 348-349 ◽  
Author(s):  
Andrew G. LEE
Keyword(s):  
Blood Pressure ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Optic Neuropathy ◽  
Visual Loss ◽  
Lumbar Spine Surgery ◽  
Ischemic Optic Neuropathy ◽  
Content Type ◽  
The Right ◽  
Fine Print

✓ This 48-year-old hypertensive man, a cigarette smoker, awoke in the recovery room with visual loss in the right eye after uncomplicated lumbar spine surgery. His intraoperative blood pressure had been maintained at relatively low levels to reduce bleeding; a loss of 1500 cc of blood was reported. Postoperative hemoglobin was 4.2 g/dl less than the preoperative hemoglobin; however, the patient did not receive a blood transfusion. A postoperative ophthalmological examination revealed decreased visual acuity, color vision, and visual field in the right eye. The right optic nerve and retina were initially normal but the patient eventually developed optic nerve atrophy consistent with the clinical diagnosis of ischemic optic neuropathy. Neurosurgeons should be aware that this condition may follow uncomplicated lumbar spine surgery and should obtain prompt ophthalmological consultation when patients develop postoperative visual loss. Aggressive and rapid correction of blood pressure and hematocrit may be helpful in individuals who develop ischemic optic neuropathy after lumbar spine surgery.

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