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Bilateral ischaemic optic neuropathy following laparoscopic proctocolectomy: a case report
H Mizrahi1, C E Hugkulstone, P Vyakarnam
1Department of Colorectal Surgery, Darent Valley Hospital, Dartford, UK. hagarmizrahi@gmail.com
Annals of the Royal College of Surgeons of England
|September 28, 2011
Summary
This case study reports ischemic optic neuropathy (ION) after laparoscopic proctocolectomy. Factors like prolonged surgery, patient positioning, and hypotension may cause this vision loss.
Area of Science:
- Ophthalmology
- Surgical Oncology
- Gastroenterology
Background:
- Perioperative visual loss is a rare but serious complication of non-ocular surgery.
- Ischemic optic neuropathy (ION) has been documented following various surgical procedures.
- Laparoscopic surgery is increasingly common, yet ION associated with it is infrequently reported.
Observation:
- A 58-year-old male developed bilateral ION post-laparoscopic sigmoidectomy and rectal resection.
- The surgery was complex, lasting over six hours due to patient habitus and tumor characteristics.
- Postoperatively, the patient experienced blurred vision, diagnosed as bilateral ION.
Findings:
- This is the first reported case of ION occurring after laparoscopic proctocolectomy.
- Potential contributing factors include relative hypotension and increased intraorbital pressure from patient positioning.
- These factors likely compromised ocular perfusion, leading to severe, permanent visual damage.
Implications:
- Highlights the risk of ION in prolonged laparoscopic procedures, especially with specific patient positioning.
- Suggests careful consideration of patient positioning and hemodynamic monitoring during lengthy laparoscopic surgeries.
- Underscores the need for further research into preventing ION in the context of minimally invasive surgery.
