Postoperative visual loss (POVL) is a rare but devastating complication that has been reported following a wide range of procedures including robotic urological surgery. Visual loss following elective non-ocular surgery is a catastrophic event for the patient, surgeon and anaesthetist. Despite being a rare entity, perioperative ocular complications in non-ophthalmic surgery have become a focus for surgical, anaesthetic and neuro-ophthalmological literature and a contentious medicolegal issue.
Ocular injuries associated with a degree of postoperative visual loss include a broad spectrum of conditions each with distinct aetiologies, risk factors, patterns of visual loss, treatment and prognoses. Injuries are categorized as corneal abrasion, retinal ischaemia, ischaemic optic neuropathy (ION), cortical blindness or acute glaucoma.
Procedures complicated with prolonged steep Trendelenburg positioning, significant blood loss, haemodynamic perturbations and prolonged pneumoperitoneum should be recognized as higher risk for POVL and visual assessment part of the postoperative assessment. When a patient reports any visual symptoms following surgery, an urgent ophthalmologic consultation should be obtained to determine its cause.
Perioperative visual loss POVL Ischaemic optic neuropathy ION Cortical blindness Postoperative blindness
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