Der Anaesthesist

, Volume 55, Issue 4, pp 457–464

Erblindung nach nichtophthalmologischen Eingriffen

Systematische Literaturübersicht zu Inzidenz, Pathogenese, Behandlung und Prävention
  • A. Torossian
  • J. Schmidt
  • W. Schaffartzik
  • H. Wulf
Fehler und Gefahren

Zusammenfassung

Hintergrund

Die postoperative Erblindung ist eine sehr seltene, aber gravierende Komplikation nach nichtophthalmologischen Eingriffen. Der Visusverlust kann partiell oder total sein und ein- oder beidseitig auftreten. Da die Ätiologie bislang nicht geklärt werden konnte, war es das Ziel dieser Recherche, aus den publizierten Fallsammlungen potenzielle Ursachen zu identifizieren, um Ansätze zur Prophylaxe erarbeiten zu können.

Methodik

Es wurde eine Literatursuche in der PubMed-Datenbank der US National Library of Medicine durchgeführt. Die MeSH-Begriffe und Kombinationen lauteten: „blindness, postoperative complications, ischemic optic neuropathy, not ophthalmological surgical procedures, not neurosurgical procedures“. Weiterhin wurden die Ergebnisse einer Zwischenanalyse der „Postoperative-visual-loss-(POVL-)Registratur der American Society of Anesthesiologists (ASA)“ berücksichtigt.

Erkenntnisse

Die Inzidenz einer Erblindung nach nichtophthalmologischen Eingriffen beträgt nur 0,0008%. Sie ist aber auf 0,11% nach Kardiochirurgie und 0,08% nach Wirbelsäulenchirurgie in Bauchlagerung erhöht. Als Risikofaktoren werden dabei eine perioperative Anämie, arterielle Hypotension und Bauchlagerung, aber auch arteriosklerotische Vorerkrankungen des Patienten angesehen. Folglich kann die Korrektur einer Anämie oder hämodynamische Stabilisierung erfolgreich in der Behandlung sein.

Fazit

Der Patient mit arteriosklerotischer Vorerkrankung sollte für Eingriffe unter der Herz-Lungen-Maschine (HLM), bei Wirbelsäuleneingriffen, aber auch bei beidseitiger „neck dissection“ über die, wenn auch seltene, Möglichkeit einer postoperativen Erblindung aufgeklärt werden. Postoperative Veränderungen des Sehvermögens sollten ohne Zeitverlust ophthalmologisch geklärt und ggf. behandelt werden.

Schlüsselwörter

Postoperative Erblindung Nichtophthalmologische Chirurgie Anästhesie Ischämische Optikusneuropathie 

Loss of vision after non-ophthalmic surgery

Systematic review of the literature on incidence, pathogenesis, treatment and prevention

Abstract

Background and goal

Postoperative loss of vision is a rare, but devastating complication after non-ocular surgery. It can occur partially or completely and may involve one or both eyes. Since its etiology has not yet been solved, the purpose of this review was to extract potential causes from the case collections reported to propose prophylactic measures.

Methods

A literature search was performed using the “Pubmed” database of the US National Library of Medicine. MeSH terms and combinations used were: blindness, postoperative complications, ischemic optic neuropathy, not ophthalmological surgical procedures, not neurosurgical procedures. Additionally, the results of the interim analysis of the postoperative visual loss (POVL) registry of the ASA were considered.

Results

The incidence of permanent loss of vision after non-ophthalmologic surgery is reported to be 0.0008%. However, it is elevated up to 0.11% after cardiac and 0.08% after spine surgery. Risk factors seem to be perioperative anemia, arterial hypotension and prone position, but also pre-existing diseases such as arteriosclerosis. Thus hemodynamic stabilization or correction of anemia may be successful in therapy.

Conclusion

Patients with pre-existing arteriosclerotic disease scheduled for spine or cardiac surgery, but also for bilateral neck dissection should be informed preoperatively about the rare possibility of POVL. Postoperatively any visual changes should be immediately referred to an ophthalmologist and treated accordingly.

Keywords

Postoperative blindness Non-ophthalmologic surgery Anesthesia Ischemic optic neuropathy 

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • A. Torossian
    • 1
    • 4
  • J. Schmidt
    • 2
  • W. Schaffartzik
    • 3
  • H. Wulf
    • 1
  1. 1.Klinik für Anästhesie und IntensivtherapieUniversitätsklinikum Gießen und Marburg, Standort Marburg
  2. 2.Klinik für AugenheilkundeUniversitätsklinikum Gießen und Marburg, Standort Marburg
  3. 3.Klinik für Anästhesiologie, Intensivmedizin und SchmerztherapieUnfallkrankenhausBerlin
  4. 4.Klinik für Anästhesie und IntensivtherapieUniversitätsklinikum Gießen und Marburg, Standort MarburgMarburg/Lahn

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