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Perioperative visual loss after spine surgery.

Travis J Nickels¹, Mariel R Manlapaz¹, Ehab Farag¹

¹Travis J Nickels, Mariel R Manlapaz, Ehab Farag, Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinc, Cleveland, OH 44195, United States.

World Journal of Orthopedics

|May 16, 2014

Summary

Perioperative visual loss (POVL) is a rare but severe complication after spine surgery, often caused by ischemic optic neuropathy. Prevention and risk factor modification are crucial as effective treatments are lacking.

Keywords:

Central retinal artery occlusion Cortical blindness Ischemic optic neuropathy Perioperative visual loss Posterior reversible encephalopathy Prone positioning Spine surgery

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Area of Science:

Ophthalmology
Neurosurgery
Anesthesiology

Background:

Perioperative visual loss (POVL) is an uncommon yet devastating complication, predominantly linked to spine and cardiac surgeries.
The precise incidence and mechanisms underlying POVL remain challenging to ascertain.
Ischemic optic neuropathy (ION) constitutes the leading cause of POVL in spinal procedures, accounting for 89% of cases.

Purpose of the Study:

To review the current understanding of POVL, focusing on its causes, risk factors, and prevention strategies.
To discuss the updated American Society of Anesthesiologists practice advisory on POVL.
To explore potential preventative measures, including fluid management and intraocular pressure reduction.

Main Methods:

Review of literature and data from the American Society of Anesthesiologists Postoperative Visual Loss Registry.
Analysis of a multicenter case-control study identifying risk factors for ION in prone spinal fusion.
Discussion of physiological mechanisms contributing to optic nerve damage.

Main Results:

Anterior and posterior ischemic optic neuropathy are the primary causes of POVL in spine surgery.
Identified risk factors for ION include obesity, male sex, Wilson frame use, prolonged anesthesia, significant blood loss, and reduced colloid administration.
These factors may lead to increased venous pressure, edema, and optic nerve damage via vascular compression or infarction.

Conclusions:

POVL is often irreversible, underscoring the critical importance of prevention and modifying identified risk factors.
Strategies such as optimizing fluid administration (crystalloids vs. colloids) and using alpha-2 agonists to lower intraocular pressure warrant further investigation for prevention.