Perioperative visual loss and anesthetic management

Area of Science:

• Anesthesiology
• Ophthalmology
• Neurosurgery

Background:

• Perioperative visual loss (POVL) is an infrequent but serious complication impacting patient quality of life.
• Cardiac, spine, and head and neck surgeries are most commonly associated with POVL.
• Recent large-scale studies have identified specific risk factors for POVL, particularly in prone spinal fusion procedures.

Purpose of the Study:

• To review findings from the largest multicenter case-control study on POVL.
• To summarize updated American Society of Anesthesiologists practice guidelines for POVL.
• To provide guidance on identifying and managing patients at high risk for POVL during prone spine surgery.

Main Methods:

• Review of a large multicenter case-control study on POVL.
• Analysis of epidemiology data from national databases.
• Discussion of POVL in robotic surgery and posterior reversible encephalopathy syndrome.

Main Results:

• Key risk factors for POVL in prone spinal fusion include male sex, obesity, Wilson spinal frame use, prolonged anesthesia, significant blood loss, and low colloid administration.
• These factors are associated with ischemic optic neuropathy.

Conclusions:

• Modifying patient-extrinsic risk factors may lower the incidence of ischemic optic neuropathy in prone spinal fusion.
• Further research is necessary to confirm the efficacy of these preventative strategies.