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. 2010 Jun 24:4:531-46.
doi: 10.2147/opth.s9262.

Perioperative visual loss in ocular and nonocular surgery

Kathleen T Berg  1 , Andrew R Harrison, Michael S Lee
Affiliations

Perioperative visual loss in ocular and nonocular surgery

Kathleen T Berg et al. Clin Ophthalmol. .

Abstract

Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period.

Keywords: nonocular surgery; ocular surgery; perioperative; postoperative; vision loss.

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Figures

Figure 1
Figure 1
Optic disc edema observed in all cases of acute anterior ischemic optic neuropathy.
Figure 2
Figure 2
Normal appearing optic disc is seen in all cases of acute posterior ischemic optic neuropathy.
Figure 3
Figure 3
Positioning in spine surgery typically involves the patient lying prone in the Trendelenburg position. The level of the head is below the level of the feet, which leads to facial edema.
Figure 4
Figure 4
Mayfield headrest used in spine surgery. The edge of the headrest may compress the globe and lead to central retinal artery occlusion.
Figure 5
Figure 5
Funduscopic appearance of central retinal artery occlusion demonstrates a cherry-red spot on the macula, attenuated arterioles, and retinal whitening from edema.
Figure 6
Figure 6
Head computed tomography of a patient with pituitary apoplexy. The hyperdense region represents hemorrhage within a pre-existing pituitary adenoma.
See this image and copyright information in PMC

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