Perioperative visual loss: what do we know, what can we do?

Perioperative visual loss (POVL), a rare, but devastating complication, can follow non-ocular surgery. Highest rates of visual loss are with cardiac and spine surgery. The main causes of visual loss after non-ocular surgery are retinal vascular occlusion and ischaemic optic neuropathy. This review updates readers on the incidence, suspected risk factors, diagnosis, and treatment of POVL due to these conditions.

[1]  P. Puri,et al.  Anterior ischemic optic neuropathy after emergency caesarean section under epidural anesthesia , 2002, Acta Anaesthesiologica Scandinavica.

[2]  Ronald D. Miller Miller's Anesthesia , 2005 .

[3]  D. Schroeder,et al.  Risk Factors for Ischemic Optic Neuropathy After Cardiopulmonary Bypass: A Matched Case/Control Study , 2001, Anesthesia and analgesia.

[4]  L. Levin,et al.  Treatment of ischemic optic neuropathy , 2002, Seminars in ophthalmology.

[5]  J. Carter,et al.  Anterior Ischemic Optic Neuropathy Is Not Associated With Carotid Artery Atherosclerosis , 1993, Stroke.

[6]  M. Vaphiades Optic nerve enhancement in hypotensive ischemic optic neuropathy. , 2004, Journal of neuro-ophthalmology.

[7]  A. Minagar,et al.  Liposuction and ischemic optic neuropathy Case report and review of literature , 2000, Journal of the Neurological Sciences.

[8]  D. Buus,et al.  Ophthalmic complications of sinus surgery. , 1990, Ophthalmology.

[9]  R. Foroozan,et al.  Perioperative posterior ischemic optic neuropathy: review of the literature , 2005 .

[10]  Sibu P Saha,et al.  Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline. , 2007, The Annals of thoracic surgery.

[11]  W. Mann,et al.  The management of acute visual loss after sinus surgery--two cases of rhinogenic optic neuropathy. , 2006, Rhinology.

[12]  R. McAllister,et al.  Perioperative Ischemic Optic Neuropathy: A Case Control Analysis of 126,666 Surgical Procedures at a Single Institution , 2009, Anesthesiology.

[13]  D. Little INDUCED HYPOTENSION DURING ANESTHESIA AND SURGERY , 1955, Anesthesiology.

[14]  R. P. Cochran,et al.  Angiographic and histological evaluation of porcine retinal vascular damage and protection with perfluorocarbons after massive air embolism. , 1998, Stroke.

[15]  Nishant Kumar,et al.  Blindness and rectus muscle damage following spinal surgery. , 2004, American journal of ophthalmology.

[16]  R. Casson,et al.  Ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position. , 2006, Ophthalmology.

[17]  G. Herzon,et al.  Intraoperative Monitoring of the Visual Evoked Potential during Endoscopic Sinus Surgery , 1994 .

[18]  W. Baumgartner,et al.  Incidence of and risk factors for perioperative optic neuropathy after cardiac surgery. , 2004, The Annals of thoracic surgery.

[19]  S. Roth,et al.  Blood flow after retinal ischemia in cats. , 1994, Investigative ophthalmology & visual science.

[20]  M. Slavin,et al.  Ischemic optic neuropathy after cardiac arrest. , 1987, American journal of ophthalmology.

[21]  S. Hayreh Comment re: multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications , 2007, Graefe's Archive for Clinical and Experimental Ophthalmology.

[22]  S. Roth,et al.  The effects of isovolumic hemodilution on ocular blood flow. , 1992, Experimental eye research.

[23]  D. Bradford,et al.  Ophthalmic Complications After Spinal Surgery , 1997, Spine.

[24]  Influence of oxygenator type on the prevalence and extent of microembolic retinal ischemia during cardiopulmonary bypass. Assessment by digital image analysis. , 1990 .

[25]  T. Kansu,et al.  A case of unilateral posterior ischemic optic neuropathy after radical neck dissection. , 1990, Annals of ophthalmology.

[26]  W. Feuer,et al.  Autoregulation of human optic nerve head circulation in response to increased intraocular pressure. , 1997, Experimental eye research.

[27]  M. Goldbaum,et al.  Ischemia of ciliary arterial circulation from ocular compression. , 1975, Archives of ophthalmology.

[28]  S. Hayreh,et al.  Experimental occlusion of the central artery of the retina. IV: Retinal tolerance time to acute ischaemia. , 1980 .

[29]  S. Gelman,et al.  Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. , 2004, Anesthesiology.

[30]  R. Tempelhoff,et al.  The Effect of Prone Positioning on Intraocular Pressure in Anesthetized Patients , 2001, Anesthesiology.

[31]  Joseph F Rizzo,et al.  Use of magnetic resonance imaging to differentiate optic neuritis and nonarteritic anterior ischemic optic neuropathy. , 2002, Ophthalmology.

[32]  J. Silverstein,et al.  In-hospital Complications and Mortality After Elective Spinal Fusion Surgery in the United States: A Study of the Nationwide Inpatient Sample From 2001 to 2005 , 2009, Journal of neurosurgical anesthesiology.

[33]  D. Shahian,et al.  Anterior ischemic optic neuropathy after open heart operations. , 1996, The Annals of thoracic surgery.

[34]  R. Carr,et al.  Unilateral retinitis pigmentosa. , 1973, Archives of ophthalmology.

[35]  R. Flower,et al.  Functional and cellular responses in a novel rodent model of anterior ischemic optic neuropathy. , 2003, Investigative ophthalmology & visual science.

[36]  L. Kline,et al.  Ischemic Optic Neuropathy After Lumbar Spine Surgery , 1994 .

[37]  S. Lessell Anterior ischaemic optic neuropathy. II. Fundus on ophthalmoscopy and fluorescein angiography. , 1974, The British journal of ophthalmology.

[38]  N. Newman,et al.  Clinical spectrum of posterior ischemic optic neuropathy. , 2001, American journal of ophthalmology.

[39]  C. Pournaras,et al.  Effect of isovolumic hemodilution on oxygen delivery to the optic nerve head. , 2002, Klinische Monatsblätter für Augenheilkunde.

[40]  P. Savino,et al.  Optic disc structure and shock-induced anterior ischemic optic neuropathy. , 2003, Ophthalmology.

[41]  K. Lauer Visual loss after spine surgery. , 2004, Journal of neurosurgical anesthesiology.

[42]  R. W. Hollenhorst,et al.  Unilateral blindness occurring during anesthesia for neurosurgical operations. , 1954, A.M.A. archives of ophthalmology.

[43]  M. Murphy Bilateral posterior ischemic optic neuropathy after lumbar spine surgery. , 2003, Ophthalmology.

[44]  J. Morris,et al.  Anterior ischemic optic neuropathy: a complication after systemic inflammatory response syndrome. , 2000, Journal of Trauma.

[45]  A. Tung,et al.  Visual loss in a prone-positioned spine surgery patient with the head on a foam headrest and goggles covering the eyes: an old complication with a new mechanism. , 2007, Anesthesia and analgesia.

[46]  L. Levin,et al.  Erectile dysfunction drugs and risk of anterior ischaemic optic neuropathy: casual or causal association? , 2007, British Journal of Ophthalmology.

[47]  S. Roth Postoperative Visual Loss , 2010 .

[48]  S S Hayreh,et al.  Anterior ischaemic optic neuropathy. III. Treatment, prophylaxis, and differential diagnosis. , 1974, The British journal of ophthalmology.

[49]  D. Heimbach,et al.  Elevated orbital pressure: another untoward effect of massive resuscitation after burn injury. , 2006, The Journal of trauma.

[50]  S. Hayreh Anterior ischemic optic neuropathy. VIII. Clinical features and pathogenesis of post-hemorrhagic amaurosis. , 1987, Ophthalmology.

[51]  B. Byers Blindness secondary to steroid injections into the nasal turbinates. , 1979, Archives of ophthalmology.

[52]  R. Egan,et al.  Ischemic optic neuropathy following spine surgery in a 16-year-old patient and a ten-year-old patient. , 2006, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.

[53]  N. Sarkari,et al.  A Review of 37 Cases , 1970 .

[54]  J. Blice,et al.  Blindness after bilateral neck dissection: case report and review. , 1999, American journal of otolaryngology.

[55]  M. Boakye,et al.  Visual Loss After Spine Surgery: A Population-Based Study , 2008, Spine.

[56]  S. Wray The management of acute visual failure. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[57]  R. Beck,et al.  Anterior ischemic optic neuropathy. IX. Cup-to-disc ratio and its role in pathogenesis. , 1987 .

[58]  E. Stefánsson,et al.  Local hypothermia protects the retina from ischemia. A quantitative study in the rat. , 1989, Investigative ophthalmology & visual science.

[59]  R. Duckrow,et al.  Regional optic nerve blood flow and its autoregulation. , 1983, Investigative ophthalmology & visual science.

[60]  G. Undt,et al.  Posterior ischemic optic neuropathy following bilateral radical neck dissection. , 1995, International journal of oral and maxillofacial surgery.

[61]  A. Bill,et al.  Effects of raised intraocular pressure on retinal, prelaminar, laminar, and retrolaminar optic nerve blood flow in monkeys. , 1979, Investigative ophthalmology & visual science.

[62]  S. Roth,et al.  The Effects of Steep Trendelenburg Positioning on Intraocular Pressure During Robotic Radical Prostatectomy , 2009, Anesthesia and analgesia.

[63]  A. Huber,et al.  Cerebrospinal fluid dynamics between the intracranial and the subarachnoid space of the optic nerve. Is it always bidirectional? , 2007, Brain : a journal of neurology.

[64]  G. Wells,et al.  A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. , 1999, The New England journal of medicine.

[65]  M. Lazdunski,et al.  ATP-sensitive potassium channels (KATP) in retina: a key role for delayed ischemic tolerance , 2001, Brain Research.

[66]  D. Levin,et al.  Ischemic optic neuropathy after hemorrhage from a cornual ectopic gestation. , 1997, American journal of obstetrics and gynecology.

[67]  Craig H. Smith,et al.  Visual Loss as a Complication of Spine Surgery: A Review of 37 Cases , 1997, Spine.

[68]  J. Sebag,et al.  Perioperative risk factors for posterior ischemic optic neuropathy. , 2002, Journal of the American College of Surgeons.

[69]  R. Linsenmeier,et al.  Isovolemic hemodilution increases retinal tissue oxygen tension , 1996, Graefe's Archive for Clinical and Experimental Ophthalmology.

[70]  Lorri A. Lee,et al.  Blindness in the intensive care unit: possible role for vasopressors? , 2005, Anesthesia and analgesia.

[71]  P. Barach,et al.  Postoperative visual loss: still no answers--yet. , 2001, Anesthesiology.

[72]  M. Grocott,et al.  Perioperative Fluid Management and Clinical Outcomes in Adults , 2005, Anesthesia and analgesia.

[73]  A. J. Maniglia Fatal and major complications secondary to nasal and sinus surgery , 1989, The Laryngoscope.

[74]  B. Ehrenberg,et al.  Association between sleep apnea syndrome and nonarteritic anterior ischemic optic neuropathy. , 2002, Archives of ophthalmology.

[75]  Lorri A. Lee,et al.  Unilateral blindness after prone lumbar spine surgery. , 2001, Anesthesiology.

[76]  N. Goldenberg,et al.  Nonarteritic anterior ischemic optic neuropathy: associations with homozygosity for the C677T methylenetetrahydrofolate reductase mutation. , 2004, The Journal of laboratory and clinical medicine.

[77]  J. Tetzlaff,et al.  Ischaemic optic neuropathy after spinal fusion , 1998 .

[78]  A. Arnold Pathogenesis of nonarteritic anterior ischemic optic neuropathy. , 2003, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.

[79]  S. Roth,et al.  The Prevalence of Perioperative Visual Loss in the United States: A 10-Year Study from 1996 to 2005 of Spinal, Orthopedic, Cardiac, and General Surgery , 2009, Anesthesia and analgesia.

[80]  C. Schmoor,et al.  Multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. EAGLE Study report no. 1 , 2006, Graefe's Archive for Clinical and Experimental Ophthalmology.

[81]  M. T. Bhatti,et al.  The Effect of Body Inclination During Prone Positioning on Intraocular Pressure in Awake Volunteers: A Comparison of Two Operating Tables , 2004, Anesthesia and analgesia.

[82]  Andrew D. Rosenberg,et al.  Practice Guidelines for Blood Component Therapy: A Report by the American Society of Anesthesiologists Task Force on Blood Component Therapy , 1996, Anesthesiology.

[83]  D. Tice Ischemic optic neuropathy and cardiac surgery. , 1987, The Annals of thoracic surgery.

[84]  P. Scardino,et al.  Bilateral anterior ischemic optic neuropathy and branch retinal artery occlusion after radical prostatectomy. , 1999, The Journal of urology.

[85]  R. Brown,et al.  Anemia and hypotension as contributors to perioperative loss of vision. , 1994, Anesthesiology.

[86]  G. Alexandrakis,et al.  Bilateral posterior ischemic optic neuropathy after spinal surgery. , 1999, American journal of ophthalmology.

[87]  J. Stankiewicz Complications of endoscopic sinus surgery. , 1989, Otolaryngologic clinics of North America.

[88]  P. Gunter Practice Guidelines for Blood Component Therapy , 1996 .

[89]  D. O. Warner,et al.  The Frequency of Perioperative Vision Loss , 2001, Anesthesia and analgesia.

[90]  David G. Birch,et al.  Electrophysiologic Testing in Disorders of the Retina, Optic Nerve and Visual Pathway , 1990 .

[91]  A. Bill,et al.  Effects of high intraocular pressure on the glucose metabolism in the retina and optic nerve in old atherosclerotic monkeys , 1994, Graefe's Archive for Clinical and Experimental Ophthalmology.

[92]  B. Petrig,et al.  Blood flow in the human optic nerve head during isometric exercise. , 1998, Experimental eye research.

[93]  F. Loop,et al.  Cerebral microembolism during cardiopulmonary bypass. Retinal microvascular studies in vivo with fluorescein angiography. , 1988, The Journal of thoracic and cardiovascular surgery.

[94]  Lorri A. Lee,et al.  The American Society of Anesthesiologists Postoperative Visual Loss Registry: Analysis of 93 Spine Surgery Cases with Postoperative Visual Loss , 2006, Anesthesiology.

[95]  N. Miller,et al.  The Incidence of Vision Loss due to Perioperative Ischemic Optic Neuropathy Associated With Spine Surgery: The Johns Hopkins Hospital Experience , 2005, Spine.

[96]  Bang V Bui,et al.  The gradient of retinal functional changes during acute intraocular pressure elevation. , 2005, Investigative ophthalmology & visual science.

[97]  S. Wu,et al.  Adler's Physiology of the Eye , 2002 .

[98]  N. Newman,et al.  Ischemic Optic Neuropathy Following Spine Surgery , 2005, Journal of neurosurgical anesthesiology.

[99]  R. Tempelhoff,et al.  Visual loss after spine surgery: a survey. , 2000, Neurosurgery.

[100]  J. Saunders,et al.  Blindness following bilateral radical neck dissection , 1990, Head & neck.

[101]  S. Roth,et al.  Unexplained visual loss after lumbar spinal fusion. , 1997, Journal of neurosurgical anesthesiology.

[102]  P. Coriat,et al.  Renin angiotensin system antagonists and anesthesia. , 1999, Anesthesia and analgesia.

[103]  E. D. Weber,et al.  Posterior ischemic optic neuropathy after minimally invasive prostatectomy. , 2007, Journal of neuro-ophthalmology : the official journal of the North American Neuro-Ophthalmology Society.