Central Retinal Artery Occlusion after Cervical Spine Surgery in Prone Position under General Anesthesia: A case report

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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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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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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