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Posterior ischemic optic neuropathy during general surgery.

J F Rizzo, S Lessell

    American Journal of Ophthalmology
    |June 15, 1987
    PubMed
    Summary
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    Two patients experienced severe vision loss after surgery due to intraoperative optic nerve damage, a condition known as posterior ischemic optic neuropathy. Factors like low blood pressure and anemia may contribute to this rare complication.

    Area of Science:

    • Ophthalmology
    • Neurology
    • Anesthesiology

    Background:

    • Postoperative visual loss is a rare but serious complication following general anesthesia.
    • Understanding the mechanisms behind intraoperative visual disturbances is crucial for patient safety.

    Observation:

    • Two patients presented with sudden, profound bilateral visual loss immediately after surgical procedures under general anesthesia.
    • Ophthalmoscopic examination revealed normal fundi initially, progressing to bilateral optic atrophy in both cases.

    Findings:

    • The patients likely experienced intraoperative infarction of the retrobulbar optic nerve segments, leading to posterior ischemic optic neuropathy.
    • One patient had radiological evidence of a small deep white matter cerebral infarction.
    • Potential contributing factors identified include profound systemic hypotension, use of a pump-oxygenator, and anemia.

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    Implications:

    • This case series highlights posterior ischemic optic neuropathy as a potential cause of profound vision loss after surgery.
    • Identifying and mitigating risk factors such as hypotension and anemia during surgery is essential to prevent optic nerve damage.
    • Further research is needed to elucidate the precise mechanisms and develop preventative strategies for intraoperative optic neuropathy.