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Postoperative Visual Loss: Anatomy, Pathogenesis, and Anesthesia Considerations

  • Andrew J. Brunk
  • Ken P. EhrhardtJr
  • Jeremy B. Green
  • Susie M. Mothersele
  • Alan David Kaye
Chapter

Abstract

Visual loss after surgery is a poorly understood phenomenon with risk factors similarly found in vascular pathogenesis. Outcomes vary, ranging from full recovery to permanent blindness. Because the incidence is so rare, it has been difficult to identify best practice risk prevention strategies and management to minimize or even eliminate visual loss after surgery. This review, therefore, summarizes understanding of anatomy, pathogenesis, and anesthesia considerations related to visual loss after surgery. To facilitate further exploration of the subject, the American Society of Anesthesiology (ASA) Committee on Professional Liability established the ASA Postoperative Visual Loss (POVL) Registry in 1999, which is a database that includes detailed patient and surgical information on related cases. The findings from this task force are also summarized in this manuscript and conclude that there are no specific patient characteristics that would identify a patient as high risk; however, risk is deemed higher when procedures are prolonged and involve an anticipated large volume of blood loss. In summary, patients who are to undergo higher-risk procedures should be kept at a neutral spine with the head kept at or above the level of the heart. Serial hematocrits should be checked, and central venous pressure monitoring can be used to monitor volume status. Volume resuscitation can be done with colloids, crystalloids, and blood products to maintain euvolemic states. Since there is a large medicolegal consideration with vision loss, surveyed patients have overwhelmingly preferred to have the risk of POVL discussed with them face-to-face prior to the day of surgery. In this regard, the more severe injury to the visual pathway correlates with increase in payment when injury is brought to suit.

Keywords

Vision loss after anesthesia Ophthalmologic injuries Anterior and posterior ischemic optic neuropathy Cortical blindness 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Andrew J. Brunk
    • 1
  • Ken P. EhrhardtJr
    • 1
  • Jeremy B. Green
    • 1
  • Susie M. Mothersele
    • 1
  • Alan David Kaye
    • 1
  1. 1.Department of AnesthesiologyLouisiana State University School of MedicineNew OrleansUSA

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