Zusammenfassung
Die Erblindung nach nichtophthalmologischen Eingriffen („perioperative visual loss“, POVL) ist eine seltene, aber unerwartete und schwerwiegende Komplikation, die am häufigsten bei Herz-, Wirbelsäulen- und Kopf-Hals-Operationen auftritt. Die Ätiologie von POVL bleibt unvollständig erforscht. Jedes Segment des visuellen Systems kann betroffen sein, von der Hornhaut bis zum Okzipitalkortex. Die häufigste Lokalisation der dauerhaften Schädigung aber ist der Sehnerv, und der am häufigsten vermutete Mechanismus ist die Ischämie. Mehrere Faktoren können das Risiko für perioperativen Sehverlust erhöhen, einschließlich lange Operationsdauer in Bauchlage, verminderter okulärer Perfusionsdruck, übermäßiger Blutverlust/Anämie, Hypotonie, Hypoxie, übermäßige Flüssigkeitssubstitution, erhöhter Venendruck, Art der Kopfpositionierung sowie eine patientenspezifische anatomische oder physiologische vaskuläre Prädisposition. Allerdings können die Risikofaktoren für bestimmte Patienten oder Verfahren sehr variabel sein. Die den neuroophthalmologischen Komplikationen zugrunde liegende spezifische Pathogenese bleibt wenig bekannt; dies erfordert besondere Wachsamkeit des Anästhesisten zur Vermeidung von POVL in der perioperativen Phase. Dieser Beitrag gibt einen Überblick über die Häufigkeit, vermutete Risikofaktoren, Diagnose und die Behandlung von POVL nach nichtophthalmologischen Eingriffen.
Abstract
Perioperative visual loss (POVL) after nonocular surgery is a rare but unexpected event and represents a devastating complication. It is most often associated with cardiac, spinal as well as head and neck surgery. The etiology of POVL remains incompletely understood. Any portion of the visual system may be involved, from the cornea to the occipital lobe. The most common site of permanent injury is, however, the optic nerve itself and ischemia is the most often presumed mechanism. Multiple factors have been proposed as risk factors for POVL, including long duration in the prone position, decreased ocular perfusion pressure, excessive blood loss and anemia, hypotension, hypoxia, excessive fluid replacement, elevated venous pressure, head positioning and a patient-specific vascular susceptibility which may be anatomic or physiologic. However, the risk factors for any given patient or procedure may vary. The underlying specific pathogenesis of these neuro-ophthalmic complications remains unknown and physicians should be alert to the potential for loss of vision in the postoperative period. This review updates readers on the incidence, suspected risk factors, diagnosis and treatment of POVL in the setting of nonocular surgery.
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Shmygalev, S., Heller, A. Erblindung nach nichtophthalmologischen Eingriffen. Anaesthesist 60, 683–694 (2011). https://doi.org/10.1007/s00101-011-1908-x
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DOI: https://doi.org/10.1007/s00101-011-1908-x
Schlüsselwörter
- Postoperative Komplikationen
- Ischämische optische Neuropathie
- Blutverlust, chirurgisch
- Positionierung
- Hypotension