Unilateral postoperative visual loss due to central retinal artery occlusion following cervical spine surgery in prone position

Background: Blindness after spinal surgery is a rare complication, but it is serious, irreversible and incurable. Central retinal artery occlusion (CRAO) is rare after spinal surgery and ophthalmoplegia is even rarer. Case: A 52-year-old male patient complained of loss of vision in right eye immediately after cervical spine surgery. On examination, the patient’s visual acuity in right eye was absent perception of light. Right eye pupil was dialated and relative afferent pupillary defect (RAPD) was present. Extraocular movements were absent in all gazes in right eye. Intra-ocular pressure (IOP) was 26 mmHg in right eye and 16 mmHg in the left. Posterior segment examination revealed blurred disc margin with ischemic whitening of retina, thin and attenuated retinal arterioles and a central cherry red spot in right eye. Left eye was essentially normal. Observations: The causal factors of blindness in the patient were likely ischemia of the retina after venous congestion or temporary arterial occlusion resulting from changes in pressure to the tissues of the orbit. Factors including prolonged prone positioning with head end dependent position and possibility of orbital compression by the headrest could have contributed to impaired venous drainage, increase in IOP and reduction in perfusion pressure. Conclusion: Loss of vision post spinal surgery is a rarest of complication yet grave and irreversible. Because the problem involves mainly prone positioning of the patient, an appropriate position should be found so that facial and ocular compression can be avoided.

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

10.21203/rs.3.rs-17927/v1 ◽

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.

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

Journal of International Medical Research ◽

10.1177/0300060520952279 ◽

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.

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Perioperative Visual Deficit in a Patient Undergoing Dorsolumbar Spine Surgery

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0038-1667211 ◽

2018 ◽

Vol 05 (03) ◽

pp. 195-197 ◽

Cited By ~ 1

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.

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A Cardiac Pseudoaneurysm as a Thromboembolic Source: Acute Visual Loss due to Cardiac Emboli

Case Reports in Cardiology ◽

10.1155/2020/3192957 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Fernando Montenegro Sá ◽

Sara I. L. Fernandes ◽

Rita J. R. Carvalho ◽

Luís M. G. Santos ◽

José A. S. Antunes ◽

...

Keyword(s):

Aortic Valve ◽

Visual Loss ◽

Central Retinal Artery Occlusion ◽

Transoesophageal Echocardiography ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Acute Visual Loss ◽

History Of ◽

Retinal Artery

Acute visual loss is rarely caused by a heart condition. This manuscript transcribes a case report of a 36-year-old patient with a 2-year history of aortic valve replacement due to bicuspid aortic valve endocarditis that presents to the emergency department with an acute right eye visual loss. After ophthalmologic investigation identified a central retinal artery occlusion, a transthoracic echocardiography was performed to search for a possible cardiac embolus, despite the patient presenting INR values of 2-2.5 for the last year. A mitral-aortic intervalvular fibrosa pseudoaneurysm was identified. A transoesophageal echocardiography was then performed, identifying a small clot logged inside the pseudoaneurysm that protruded to the left ventricle outflow tract. After INR-adjusted warfarin treatment to levels between 3 and 4, the pseudoaneurysm was surgically closed. This is a rare case since the likely source of embolism to the central retinal artery was the thrombus logged inside the pseudoaneurysm despite a standardly accepted therapeutic INR.

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Monocular Blindness due to Central Retinal Artery Occlusion Post Spine Surgery

The Journal of Spinal Surgery ◽

10.5005/jp-journals-10039-1028 ◽

2014 ◽

Vol 1 (3) ◽

pp. 126-127

Author(s):

Jay Shah ◽

Vinod Agrawal ◽

Himanshu Parmar ◽

Munjal Satishkumar Shah ◽

Saurav N Nanda

Keyword(s):

Spine Surgery ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Retinal Artery

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Central Retinal Artery Occlusion Associated with Sildenafil Overdose

Case Reports in Ophthalmological Medicine ◽

10.1155/2021/2006271 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Mojtaba Abrishami ◽

Seyedeh Maryam Hosseini ◽

Hamid Mohseni ◽

Majid Razavi ◽

Amir Ghaffarian Mashhadi Nejad ◽

...

Keyword(s):

Visual Loss ◽

Central Retinal Artery Occlusion ◽

Retinal Artery Occlusion ◽

Artery Occlusion ◽

Central Retinal Artery ◽

Limited Area ◽

Predisposing Factor ◽

Cherry Red Spot ◽

Retinal Artery ◽

The Right

Background. To report a patient with central retinal artery occlusion (CRAO) associated with sildenafil overdose. Case Presentation. A forty-two-year-old male presented three hours after sudden painless visual loss in the right eye. BCVA was counting finger in two meters, and relative afferent pupillary defect was positive. Fundus examination revealed retinal whiteness except in a limited area of papillomacular bundle and cherry red spot. He consumed two 100 mg film-coated sildenafil tablet (Vizarsin, Krka, d.d., Novo mesto, Slovenia) twelve hours apart, and the last one was six hours before visual loss. He was diagnosed with CRAO with cilioretinal artery sparing. Although we did not find any emboli, anterior chamber paracentesis was done. Four weeks later, BCVA improved to 20/80, with resolving of retinal edema. Cardiovascular, carotid arteries, and neurologic evaluations were negative for any predisposing factor. Conclusion. CRAO is a vision threatening condition that might be associated with the overdose of sildenafil.

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