Postoperative vision loss after colorectal laparoscopic surgery.

Area of Science:

• Ophthalmology
• Surgical Oncology
• Anesthesiology

Background:

• Postoperative vision loss is an uncommon but severe complication.
• Ischemic optic neuropathy (ION) is typically associated with cardiac or spinal surgeries.
• Laparoscopic procedures, especially those requiring prolonged steep Trendelenberg positioning, present unique physiological challenges.

Observation:

• A case of a middle-aged male with hypertension and obesity undergoing laparoscopic rectosigmoidal adenocarcinoma resection.
• The patient was maintained in a steep Trendelenberg position for 5 hours with adequate mean blood pressure.
• Postoperative facial and periorbital swelling was noted, followed by immediate decreased visual acuity.

Findings:

• Despite extensive imaging, no structural abnormalities were identified.
• Ophthalmology consultation confirmed the diagnosis of ischemic optic neuropathy.
• This suggests a potential association between laparoscopic surgery in steep Trendelenberg position and ION.

Implications:

• Highlights the risk of vision loss in laparoscopic surgery, particularly with prolonged steep Trendelenberg positioning.
• Emphasizes the need for increased awareness and potential preventative strategies for ION in this surgical context.
• Suggests further investigation into the mechanisms linking laparoscopic surgery, Trendelenberg position, and ischemic optic neuropathy.