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Related Experiment Videos

Bilateral posterior ischemic optic neuropathy after spinal surgery.

G Alexandrakis1, B L Lam

  • 1Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida 33136, USA.

American Journal of Ophthalmology
|March 24, 1999
PubMed
Summary

Spinal surgery can lead to vision loss due to optic nerve hypoperfusion. This case report highlights the risk of bilateral posterior ischemic optic neuropathy following prolonged prone-position surgery.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Neurosurgery

Background:

  • Posterior ischemic optic neuropathy (PION) is a rare condition causing vision loss.
  • Spinal surgery, particularly in the prone position, presents unique physiological challenges.

Observation:

  • A 68-year-old woman developed sudden, complete bilateral blindness after an 8-hour prone-position spinal surgery.
  • Clinical examination revealed periorbital edema and conjunctival chemosis, with initial optic nerve appearance normal except for pre-existing optic nerve drusen.

Findings:

  • Neuroimaging and electrophysiological tests, including cerebral arteriography, MRI, and electroretinography, were initially normal.
  • Visual-evoked response was undetectable, and optic nerve head pallor developed within 7 weeks, confirming bilateral optic neuropathy.

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Implications:

  • This case suggests a potential association between spinal surgery and bilateral posterior ischemic optic neuropathy.
  • Hypoperfusion of the retrobulbar optic nerves, possibly exacerbated by periorbital pressure, is a likely mechanism.
  • Awareness of this risk is crucial for surgeons and ophthalmologists managing patients undergoing prolonged spinal procedures.