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.

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.

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.

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.

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.

scholarly journals Risk Factors Associated with Ischemic Optic Neuropathy after Spinal Fusion Surgery

2012 ◽  
Vol 116 (1) ◽  
pp. 15-24 ◽  
Author(s):  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Spinal Fusion ◽  
Visual Loss ◽  
Case Control ◽  
Ischemic Optic Neuropathy ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Estimated Blood Loss ◽  
Male Sex

Background Perioperative visual loss, a rare but dreaded complication of spinal fusion surgery, is most commonly caused by ischemic optic neuropathy (ION). The authors sought to determine risk factors for ION in this setting. Methods Using a multicenter case-control design, the authors compared 80 adult patients with ION from the American Society of Anesthesiologists Postoperative Visual Loss Registry with 315 adult control subjects without ION after spinal fusion surgery, randomly selected from 17 institutions, and matched by year of surgery. Preexisting medical conditions and perioperative factors were compared between patients and control subjects using stepwise multivariate analysis to assess factors that might predict ION. Results After multivariate analysis, risk factors for ION after spinal fusion surgery included male sex (odds ratio [OR] 2.53, 95% CI 1.35-4.91, P = 0.005), obesity (OR 2.83, 95% CI 1.52-5.39, P = 0.001), Wilson frame use (OR 4.30, 95% CI 2.13-8.75, P < 0.001), anesthesia duration (OR per 1 h = 1.39, 95% CI 1.22-1.58, P < 0.001), estimated blood loss (OR per 1 l = 1.34, 95% CI 1.13-1.61, P = 0.001), and colloid as percent of nonblood replacement (OR per 5% = 0.67, 95% CI 0.52-0.82, P < 0.001). After cross-validation, area under the curve = 0.85, sensitivity = 0.79, and specificity = 0.82. Conclusions This is the first study to assess ION risk factors in a large, multicenter case-control fashion with detailed perioperative data. Obesity, male sex, Wilson frame use, longer anesthetic duration, greater estimated blood loss, and decreased percent colloid administration were significantly and independently associated with ION after spinal fusion surgery.

Retinal Vascular Occlusive Disorders - Risk Factors

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Shivcharan Lal Chandravanshi, Sunil Kumar Shrivastava, Priyanka Agnihotri, Smriti Gupta
Keyword(s):  
Risk Factors ◽  
Retinal Vein Occlusion ◽  
Central Retinal Vein Occlusion ◽  
Branch Retinal Vein Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Vein Occlusion ◽  
Department Of Ophthalmology ◽  
Retinal Artery ◽  
Central Retinal Vein

Aims and Objective - The aim of the present study is to identify risk factors associated with different retinal vascular occlusive diseases (RVOD), such as central retinal artery occlusion (CRAO), hemi-retinal artery occlusion (HRAO), branch retinal artery occlusion (BRAO), cilioretinal artery occlusion (Cilio-RAO), central retinal vein occlusion (CRVO), branch retinal vein occlusion (BRVO), and hemi-retinal vein occlusion (HRVO). Patients and Method - A cross-sectional study on 114 consecutive subjects, aged 24-96 years who have attended at the outpatient department of ophthalmology at Shyam Shah Medical College, Rewa, MP, were included in the study. The Duration of study was January 2016 to December 2017. Only patients with CRAO, BRAO, HRAO, Cilio-RAO, CRVO, BRVO, and HRVO were included in the study. Other retinal vascular disorders such as diabetic vaso-occlusive disease, anterior and posterior ischemic and non-ischemic neuropathy, hypertensive retinopathy, sickle cell retinopathy, retinal telangiectasia, retinopathy of prematurity, were excluded from study. Results - We have included 114 patients, 64 cases (56.14%) males, 50 (43.85%) females, aged 56+/-8 years (range 24-96 years).  Bilateral retinal vascular occlusive disorders were seen in only 4 cases (3.5%). Two patients have bilateral CRVO followed by one case of bilateral BRVO and one case of bilateral CRAO.  Out of 114 patients, branch retinal vein occlusion was seen in 62 cases (54.38%), followed by central retinal vein occlusion in 36 cases (31.57%), CRAO in 8 cases (7.01%), and hemi- retinal vein occlusion in 4 cases (3.50%). Hypertension was the most common, (40 cases, 35.08%) risk factor identified for retinal vascular occlusive disorders followed by diabetes 24 cases (21.05%), combined diabetes and hypertension in 22 cases (19.29%), and atherosclerosis in 18 cases (15.78%). Conclusions - Retinal vascular occlusive diseases have systemic as well as ocular risk factors. Understanding of these risk factors is essential for proper treatment of RVOD. Timely identification of risk factors for RVOD may helpful in decreasing ocular and systemic morbidity in these patients.

Central Retinal Artery Occlusion Following Prone Transcranial Surgery for Craniosynostosis and Discussion of Risk Factors

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Grayson Roumeliotis ◽  
Stewart Campbell ◽  
Sumit Das ◽  
Goran Darius Hildebrand ◽  
Peter Charbel Issa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Retinal Artery ◽  
Transcranial Surgery

scholarly journals Transocular sonography in acute arterial occlusions of the eye in elderly patients: Diagnostic value of the spot sign

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247072
Author(s):  
Michael Czihal ◽  
Christian Lottspeich ◽  
Anton Köhler ◽  
Ilaria Prearo ◽  
Ulrich Hoffmann ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Interobserver Agreement ◽  
Diagnostic Yield ◽  
Central Retinal Artery Occlusion ◽  
Retinal Artery Occlusion ◽  
Diagnostic Value ◽  
Artery Occlusion ◽  
Ischemic Optic Neuropathy ◽  
Spot Sign ◽  
Retinal Artery

Purpose To characterize the diagnostic yield of the spot sign in the diagnostic workup of acute arterial occlusions of the eye in elderly patients. Methods Clinical characteristics of consecutive patients aged ≥ 50 years with acute central retinal artery occlusion (CRAO), branch retinal artery occlusion (BRAO) or anterior ischemic optic neuropathy (AION) were recorded. Videos of transocular sonography were assessed for the presence of the spot sign by two blinded readers. Group comparisons were made between CRAO-patients with and without the spot sign. Two experienced cardiovascular physicians allocated CRAO-cases to a presumed aetiology, without and with knowledge on the presence/absence of the spot sign. Results One-hundred-twenty-three patients were included, 46 of whom suffered from CRAO. A spot sign was seen in 32 of 46 of patients with CRAO and in 7 of 23 patients with BRAO. Interobserver agreement was excellent (Cohen`s kappa 0.98). CRAO-patients with the spot sign significantly more frequently had a medical history of cardiovascular disease (62.8 vs. 21.4%, p = 0.03) and left heart valve pathologies (51.9 vs. 10%, p = 0.03). The spot sign was not found in any of the three patients with CRAO secondary to cranial giant cell arteritis. The assumed CRAO aetiology differed in 37% of cases between two cardiovascular physicians, regardless whether transocular sonography findings were known or not. Conclusion The spot sign is a simple sonographic finding with excellent interobserver agreement, which proofs the embolic nature of CRAO, but does not allow exact attribution of the underlying aetiology.

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