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Perioperative visual loss after nonocular surgeries
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA. ophtnjn@emory.edu
American Journal of Ophthalmology
|March 25, 2008
Summary
Persistent visual loss after nonocular surgery is rare but serious, often affecting the optic nerves due to ischemia. Risk factors are multifactorial, and causes remain unclear, necessitating neuroimaging if no obvious ocular cause is found.
Area of Science:
- Ophthalmology
- Neurology
- Anesthesiology
Background:
- Persistent visual loss following nonocular surgeries under general anesthesia is a recognized complication.
- The incidence varies, with higher rates in cardiac and spine surgeries.
Purpose of the Study:
- To review current knowledge on persistent visual loss after nonocular surgeries.
- To understand the incidence, mechanisms, risk factors, and management of perioperative visual loss.
Main Methods:
- Literature review.
- Perspective analysis of existing data.
Main Results:
- Visual loss can affect any part of the visual pathway, most commonly the optic nerves, presumed to be ischemic.
- Anterior ischemic optic neuropathy (AION) is linked to cardiac surgery, while posterior ischemic optic neuropathy (PION) is associated with spine/neck procedures.
- Risk factors are multifactorial, including surgery duration, blood loss, hypotension, anemia, hypoxia, and patient-specific vascular factors.
Conclusions:
- Urgent neuroimaging is recommended if no obvious ocular cause for visual loss is found post-surgery.
- Anterior and posterior ischemic optic neuropathy should be considered in the differential diagnosis.
- The pathogenesis of perioperative visual loss remains unclear, with elusive preventive and therapeutic measures.
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