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Ocular Surgery in Patients With Severe Atherosclerotic Disease: Anesthetic Considerations and Vascular Risk
Saul J Prado Fonseca1, Fabiana M Araya Padilla1, Nicole Rodríguez2
1Emergency Medicine, Hospital Monseñor Sanabria Martínez, Puntarenas, CRI.
Insights
Ocular surgery in patients with severe atherosclerotic disease poses risks due to compromised vascular health. Comprehensive preoperative evaluation and individualized perioperative management are crucial for optimizing safety and outcomes.
Area of Science:
- Cardiovascular Medicine
- Ophthalmology
- Vascular Surgery
Background:
- Severe atherosclerotic disease presents challenges for ocular surgery due to compromised vascular autoregulation and reduced ocular perfusion.
- Aging populations increase the prevalence of cardiovascular comorbidities, elevating risks for ophthalmic procedures, including cataract surgery.
- Atherosclerosis-related endothelial dysfunction, inflammation, and arterial stiffness heighten susceptibility to perioperative ischemic complications.
Purpose of the Study:
- To outline a comprehensive preoperative evaluation strategy for patients undergoing ocular surgery with severe atherosclerotic disease.
- To detail perioperative management considerations, including anesthetic techniques and hemodynamic monitoring.
- To emphasize the importance of a multidisciplinary approach for optimizing outcomes in this high-risk population.
Main Methods:
- Comprehensive preoperative assessment including cardiovascular history, functional capacity, and frailty evaluation.
- Utilizing risk indices and targeted investigations like ECG, echocardiography, and carotid Doppler imaging.
- Individualized management of antithrombotic therapy and selection of appropriate anesthetic techniques (topical, Sub-Tenon block, or general anesthesia).
Main Results:
- Preoperative evaluation identifies high-risk features and guides perioperative planning.
- Anesthetic technique choice significantly impacts hemodynamic stability.
- Intraoperative strategies focus on maintaining stable mean arterial pressure, avoiding extreme blood pressure variations, and ensuring normocapnia.
- Postoperative care involves monitoring for ischemia, arrhythmias, and neurological events, with timely resumption of antithrombotic therapy.
Conclusions:
- A multidisciplinary and individualized approach is essential for optimizing perioperative safety in patients with severe atherosclerotic disease undergoing ocular surgery.
- Careful preoperative assessment, tailored anesthetic choices, and vigilant intraoperative/postoperative monitoring are key to mitigating risks.
- Effective management balances thrombotic and bleeding risks, particularly concerning antithrombotic therapy, to improve patient outcomes.
Abstract:
Ocular surgery in patients with severe atherosclerotic disease represents a growing clinical challenge due to the increasing prevalence of cardiovascular comorbidities in aging populations. Atherosclerosis, characterized by endothelial dysfunction, inflammation, and arterial stiffness, compromises vascular autoregulation and reduces ocular perfusion, thereby increasing susceptibility to ischemic complications during perioperative hemodynamic fluctuations. In this context, patients undergoing ophthalmic procedures, even those considered low risk, such as cataract surgery, may experience significant cardiovascular and cerebrovascular events. A comprehensive preoperative evaluation is essential and should include detailed cardiovascular history, functional capacity assessment, frailty evaluation, and the use of validated risk indices. Targeted investigations such as electrocardiography, echocardiography, and carotid Doppler imaging allow for the identification of high-risk features and guide perioperative planning. The management of antithrombotic therapy requires an individualized approach that balances thrombotic and bleeding risks, particularly in patients receiving dual antiplatelet therapy or anticoagulation. The choice of anesthetic technique plays a critical role in maintaining hemodynamic stability. Techniques with minimal systemic impact, such as topical anesthesia and Sub-Tenon block, are generally preferred, while general anesthesia should be reserved for selected cases. Intraoperatively, maintaining stable mean arterial pressure, avoiding hypotension and hypertension, and ensuring normocapnia are key strategies to preserve cerebral and ocular perfusion. Postoperative care should focus on early detection of myocardial ischemia, arrhythmias, and neurological complications, as well as timely resumption of antithrombotic therapy. Ultimately, a multidisciplinary and individualized approach is essential to optimize perioperative safety and improve outcomes in this high-risk population.
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