Postoperative Visual Loss Following Spine Surgery: A Case Report
Sabin Bhandari1, Krishna Pokharel1, Birendra Prasad Sah2
1Department of Anaesthesia and Intensive Care, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal.
JNMA; Journal of the Nepal Medical Association
|April 24, 2020
Summary
Postoperative visual loss is a rare complication of non-ophthalmic surgery. A case report highlights potential contributing factors like hypotension, anemia, and prone positioning during spine surgery.
Area of Science:
- Ophthalmology
- Neurology
- Anesthesiology
Background:
- Postoperative visual loss (POVL) is a rare but severe complication following non-ophthalmic surgical procedures.
- The exact etiology of POVL remains poorly understood, with several contributing factors proposed in the literature.
Observation:
- A 33-year-old female patient experienced irreversible vision loss in her right eye after undergoing general anesthesia.
- The surgery involved pedicle screw fixation for vertebral fractures and hip plating in the prone position, followed by calcaneal fracture screw placement in the supine position.
Findings:
- The patient was diagnosed with non-arteritic-posterior-ischemic-optic-neuropathy, resulting in severe visual impairment (counting fingers at a close distance).
- Vision did not improve at the one-year follow-up.
- Potential contributing factors identified include mild intraoperative hypotension, anemia, prolonged surgery duration, prone positioning, and general anesthesia.
Implications:
- This case underscores the importance of recognizing potential risk factors for POVL in patients undergoing lengthy surgeries, especially those involving prone positioning.
- Anesthesiologists and surgeons should be vigilant about managing intraoperative hemodynamics and hematological parameters to mitigate risks.
- Further research is needed to elucidate the precise mechanisms and establish preventative strategies for POVL in non-ophthalmic surgery.
