Right-sided complete blindness post-kyphoscoliosis correction surgery - A case report

Visual loss post spine surgery is a rare but serious complication that can occur after elective spine surgeries. Three pathological mechanisms usually cause it: raised intraocular pressure-mediated damage, central retinal artery occlusion, and cortical blindness.

A 13-year-old male developed permanent vision loss after undergoing prone spinal deformity correction surgery (i.e., D3 vertebra excision and overcorrection of the spinal curve) for spastic paraplegia. He developed a complete loss of vision in the right eye on postoperative day 2, which was later diagnosed as central retinal artery thrombosis. Although the authors padded both eyes when using a horseshoe headrest, they now acknowledge that such cases should routinely employ a 3-pin head holder to make sure that the eyes are entirely free.

In this case, the long duration of surgery and intraoperative hypotension likely caused this catastrophic postoperative complication. In the future, an arterial line to avoid hypotension, prophylactically raising the head 20°, and use of the 3-pin head holder should be routinely employed to prevent/limit the risk of intraoperative retinal artery occlusion.