Advertisement

Journal of Anesthesia

, Volume 27, Issue 6, pp 919–926 | Cite as

Perioperative visual loss after nonocular surgery

  • Ashfaq Kitaba
  • David P. Martin
  • Senthil Gopalakrishnan
  • Joseph D. TobiasEmail author
Review Article

Abstract

Although rare, a change in visual acuity after surgery for nonocular procedures has devastating consequences. Increased recognition and discussion of this complication is reported in recent literature, most notably following spinal and cardiac surgery. Various pathologies may be responsible for perioperative visual loss (POVL), including ischemic optic neuropathy, retinal vascular occlusion, and cortical blindness. Here we review the incidence of the problem, the anatomy and physiology of the ocular circulation, variants of POVL, and proposed predisposing factors. Potential perioperative methods to prevent this complication are discussed, and suggested treatment modalities are presented.

Keywords

Visual loss Complications Blood loss Hypotension Ischemic optic neuropathy Retinal vascular occlusion 

References

  1. 1.
    Slocum HC, O’Neal KC, Allen CR. Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet. 1948;86:729–34.PubMedGoogle Scholar
  2. 2.
    Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006;104:1319–28.Google Scholar
  3. 3.
    Roth S, Thisted RA, Erickson JP, Black S, Schreider BD. Eye injuries after nonocular surgery. A study of 60,965 anesthetics from 1988 to 1992. Anesthesiology. 1996;85:1020–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Warner ME, Warner MA, Garrity JA, Mackenzie RA, Warner DO. The frequency of perioperative vision loss. Anesth Analg. 2001;93:1417–21.PubMedCrossRefGoogle Scholar
  5. 5.
    Nuttall GA, Garrity JA, Dearani JA, Abel MD, Schroeder DR, Mullany CJ. Risk factors for ischemic optic neuropathy after cardiopulmonary bypass: a matched case/control study. Anesth Analg. 2001;93:1410–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Kalyani SD, Miller NR, Dong LM, Baumgartner WA, Alejo DE, Gilbert TB. Incidence of and risk factors for perioperative optic neuropathy after cardiac surgery. Ann Thorac Surg. 2004;78:34–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Chang SH, Miller NR. The incidence of visual loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital experience. Spine. 2005;30:1299–302.PubMedCrossRefGoogle Scholar
  8. 8.
    Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105:652–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Patil CG, Lad EM, Lad SP, Ho C, Boakye M. Visual loss after spine surgery: a population-based study. Spine. 2008;33:1491–6.PubMedCrossRefGoogle Scholar
  10. 10.
    Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009;109:1534–45.PubMedCrossRefGoogle Scholar
  11. 11.
    Holy SE, Tsai JH, McAllister RK, Smith KH. Perioperative ischemic optic neuropathy: a case control analysis of 126,666 surgical procedures at a single institution. Anesthesiology. 2009;110:246–52.PubMedGoogle Scholar
  12. 12.
    The Postoperative Visual Loss Study Group. Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology. 2012;116:15–24.Google Scholar
  13. 13.
    Williams EL. Postoperative blindness. Anesthesiol Clin North Am. 2002;20:605–22.CrossRefGoogle Scholar
  14. 14.
    Kur J, Newman EA, Chan-Ling T. Cellular and physiological mechanisms underlying blood flow regulation in the retina and choroid in health and disease. Prog Retin Eye Res. 2012;31:377–406.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Hayreh SS. Pathogenesis of visual field defects: role of the ciliary circulation. Br J Ophthalmol. 1970;54:289–311.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Lee LA, Deem S, Glenny RW, Townsend I, Moulding J, An D, Treggiari MM, Lam A. Effects of anemia and hypotension on porcine optic nerve blood flow and oxygen delivery. Anesthesiology. 2008;108:864–72.PubMedCrossRefGoogle Scholar
  17. 17.
    Curley G, Kavanagh BP, Laffey JG. Hypocapnia and the injured brain: more harm than benefit. Crit Care Med. 2010;38:1348–59.PubMedGoogle Scholar
  18. 18.
    Harris A, Arend O, Wolf S, Cantor LB, Martin BJ. CO2 dependence of retinal arterial and capillary blood velocity. Acta Ophthalmol Scand. 1995;73:421–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Ozcan MS, Praetel C, Bhatti MT, Gravenstein N, Mahla ME, Seubert CN. The effect of body inclination during prone positioning on intraocular pressure in awake volunteers: a comparison of two operating tables. Anesth Analg. 2004;99:1152–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Cheng MA, Todorov A, Tempelhoff R, McHugh T, Crowder CM, Lauryssen C. The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology. 2001;95:1351–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Roth S, Barach P. Postoperative visual loss: still no answers—yet. Anesthesiology. 2001;95:575–7.PubMedCrossRefGoogle Scholar
  22. 22.
    Roth S. Perioperative visual loss: what do we know, what can we do? Br J Anaesth. 2009;103 Suppl 1:31–40.CrossRefGoogle Scholar
  23. 23.
    Batra YK, Bali IM. Corneal abrasions during general anesthesia. Anesth Analg. 1977;56:363–5.PubMedGoogle Scholar
  24. 24.
    White E, Crosse MM. The aetiology and prevention of perioperative corneal abrasions. Anaesthesia. 1998;53:157–61.PubMedCrossRefGoogle Scholar
  25. 25.
    Blauth CI, Arnold JV, Schulenberg WE, McCartney AC, Taylor KM. Cerebral microembolism during cardiopulmonary bypass. Retinal microvascular studies in vivo with fluorescein angiography. J Thorac Cardiovasc Surg. 1988;95:668–76.PubMedGoogle Scholar
  26. 26.
    Blauth CI, Smith PL, Arnold JV, Jagoe JR, Wootton R, Taylor KM. Influence of oxygenator type on the prevalence and extent of microembolic retinal ischaemia during cardiopulmonary bypass. Assessment by digital image analysis. J Thorac Cardiovasc Surg. 1990;99:61–9.PubMedGoogle Scholar
  27. 27.
    Kumar N, Jivan S, Topping N, Morrell AJ. Blindness and rectus muscle damage following spine surgery. Am J Ophthalmol. 2004;138:889–991.PubMedCrossRefGoogle Scholar
  28. 28.
    Ettaiche M, Heurteaux C, Blondeau N, Borsotto M, Tinel N, Lazdunski M. ATP-sensitive potassium channels in retina: a key role for delayed ischaemic tolerance. Brain Res. 2001;890:118–29.PubMedCrossRefGoogle Scholar
  29. 29.
    Hayreh SS, Kolder HE, Weingeist TA. Central retinal artery occlusion and retinal tolerance time. Ophthalmology. 1980;87:75–8.PubMedCrossRefGoogle Scholar
  30. 30.
    Wray SH. The management of acute visual failure. J Neurol Neurosurg Psychiatry. 1993;56:234–40.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Feltgen N, Neubauer A, Jurklies B, Schmoor C, Schmidt D, Wanke J, Maier-Lenz H, Schumacher M. Multicenter study of the European Assessment Group for Lysis in the Eye (EAGLE) for the treatment of central retinal artery occlusion: design issues and implications. Graefes Arch Clin Exp Ophthalmol. 2006;244:950–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Hayreh SS. Ischemic optic neuropathy. Prog Retin Eye Res. 2009;28:34–62.PubMedCrossRefGoogle Scholar
  33. 33.
    Buono LM, Foroozan R. Perioperative posterior ischemic optic neuropathy: review of the literature. Surv Ophthalmol. 2005;50:15–26.PubMedCrossRefGoogle Scholar
  34. 34.
    Ho VT, Newman NJ, Song S, Ksiazek S, Roth S. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol. 2005;17:38–44.PubMedCentralPubMedGoogle Scholar
  35. 35.
    Williams EL, Hart WMJ, Tempelhoff R. Postoperative ischaemic optic neuropathy. Anesth Analg. 1995;80:1018–29.PubMedGoogle Scholar
  36. 36.
    Williams EL. Postoperative blindness. Anesthesiol Clin North Am. 2002;20:605–22.CrossRefGoogle Scholar
  37. 37.
    Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology. 2012;116:274–85.Google Scholar
  38. 38.
    Roth S, Nunez R, Schreider BD. Unexplained visual loss after lumbar spinal fusion. J Neurosurg Anesthesiol. 1997;9:346–8.PubMedCrossRefGoogle Scholar
  39. 39.
    Stang-Veldhouse KN, Yeu E, Rothenberg DM, Mizen TR. Unusual presentation of perioperative ischemic optic neuropathy following major spine surgery. J Clin Anesth. 2010;22:52–5.PubMedCrossRefGoogle Scholar
  40. 40.
    Brown RH, Schauble JF, Miller NR. Anaemia and hypotension as contributors to perioperative loss of vision. Anesthesiology. 1994;80:222–2266.PubMedCrossRefGoogle Scholar
  41. 41.
    Myers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA. Visual loss as a complication of spine surgery. A review of 37 cases. Spine. 1997;22:1325–9.PubMedCrossRefGoogle Scholar
  42. 42.
    Practice Guidelines for blood component therapy: a report by the American Society of Anesthesiologists Task Force on Blood Component Therapy. Anesthesiology. 1996;84:732–47.Google Scholar
  43. 43.
    Fodale V, Di Pietro R, Santamaria S. Viagra, surgery and anesthesia: a dangerous cocktail with a risk of blindness. Med Hypotheses. 2007;68:880–2.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Ashfaq Kitaba
    • 1
  • David P. Martin
    • 1
    • 2
  • Senthil Gopalakrishnan
    • 1
    • 2
  • Joseph D. Tobias
    • 1
    • 2
    Email author
  1. 1.Department of Anesthesiology and Pain MedicineNationwide Children’s HospitalColumbusUSA
  2. 2.Department of Anesthesiology and Pain MedicineThe Ohio State UniversityColumbusUSA

Personalised recommendations