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Catastrophic Perioperative Complications and Management pp 19–29Cite as

Postoperative Visual Loss: Anatomy, Pathogenesis, and Anesthesia Considerations

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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.

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References

  1. Slocum HC, O’neal KC, Allen CR. Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet. 1948;86(6):729–34. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18915944.

    CAS  PubMed  Google Scholar 

  2. Givner I, Jaffe N. Occlusion of the central retinal artery following anesthesia. Arch Ophthalmol. 1950;43(2):197–201. https://doi.org/10.1001/archopht.1950.00910010204001.

    Article  CAS  Google Scholar 

  3. Hollenhorst RW, Svien HJ, Benoitt CF. Unilateral blindness occurring during anesthesia for neurosurgical operations. AMA Arch Ophthalmol. 1954;52(6):819–30. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/13217529.

    Article  CAS  Google Scholar 

  4. Williams EL. Postoperative blindness. Anesthesiol Clin North Am. 2002;20(3):605–22, viii. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12298309.

  5. American Society of Anesthesiologists Task Force on Perioperative Visual Loss. 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(2):274–85.

    Article  Google Scholar 

  6. Kels BD, Grzybowski A, Grant-Kels JM. Human ocular anatomy. Clin Dermatol. 2015;33(2):140–6. https://doi.org/10.1016/j.clindermatol.2014.10.006.

    Article  PubMed  Google Scholar 

  7. 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(5):1534–45. https://doi.org/10.1213/ane.0b013e3181b0500b.

    Article  PubMed  Google Scholar 

  8. Hayreh SS. Ischemic optic neuropathy. Prog Retin Eye Res. 2009;28(1):34–62.

    Article  Google Scholar 

  9. Berg KT, Harrison AR, Lee MS. Perioperative visual loss in ocular and nonocular surgery. Clin Ophthalmol. 2010;4:531–46.

    PubMed  PubMed Central  Google Scholar 

  10. Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthod. 2014;5(2):100–6.

    Article  Google Scholar 

  11. Beck RW, Servais GE, Hayreh SS. Anterior ischemic optic neuropathy, IX: cup-to-disc ratio and its role in pathogenesis. Ophthalmology. 1989;94:1503–8.

    Article  Google Scholar 

  12. Hayreh SS, Podhajsky PA, Zimmerman B. Nonarteritic anterior ischemic optic neuropathy: time of onset of visual loss. Am J Ophthalmol. 1997;124(5):641–7.

    Article  CAS  Google Scholar 

  13. Hayreh SS, Bridget Zimmerman M. Nonarteritic anterior ischemic optic neuropathy: natural history of visual outcome. Ophthalmology. 2008;115(2):298.

    Article  Google Scholar 

  14. Rizzo JF 3rd, Andreoli CM, Rabinov JD. Use of magnetic resonance imaging to differentiate optic neuritis and nonarteritic anterior ischemic optic neuropathy. Ophthalmology. 2002;109(9):1679–84.

    Article  Google Scholar 

  15. Atkins EJ, Bruce BB, Newman NJ, Biousse V. Treatment of nonarteritic anterior ischemic optic neuropathy. Surv Ophthalmol. 2010;55(1):47–63.

    Article  Google Scholar 

  16. Dunker S, Hsu HY, Sebag J, Sadun AA. Perioperative risk factors for posterior ischemic optic neuropathy. J Am Coll Surg. 2002;194(6):705–10.

    Article  Google Scholar 

  17. Roth S. Postoperative blindness. In:Miller’s anesthesia. 7th ed. Philadelphia: Churchill Livingstone/Elsevier; 2010.

    Google Scholar 

  18. Lee MS, Grossman D, Arnold AC, Sloan FA. Incidence of nonarteritic anterior ischemic optic neuropathy: increased risk among diabetic patients. Ophthalmology. 2001;118:959–63.

    Article  Google Scholar 

  19. Buono LM, Foroozan R. Perioperative posterior ischemic optic neuropathy: review of the literature. Surv Ophthalmol. 2005;50(1):15–26.

    Article  Google Scholar 

  20. Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008;145(4):604–10.

    Article  Google Scholar 

  21. Calway T, Rubin DS, Moss HE, Joslin CE, Beckmann K, Roth S. Perioperative retinal artery occlusion. Ophthalmology. 2017;124(2):189–96. https://doi.org/10.1016/j.ophtha.2016.10.025.

    Article  PubMed  Google Scholar 

  22. Varma DD, Cugati S, Lee AW, Chen CS. A review of central retinal artery occlusion: clinical presentation and management. Eye. 2013;27(6):688–97. https://doi.org/10.1038/eye.2013.25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Roth S. Perioperative visual loss: what do we know, what can we do? Br J Anaesth. 2009;103(Suppl 1):i31–40. https://doi.org/10.1093/bja/aep295.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stern WH, Archer DB. Retinal vascular occlusion. Annu Rev Med. 1981;32(1):101–6. https://doi.org/10.1146/annurev.me.32.020181.000533.

    Article  CAS  PubMed  Google Scholar 

  25. Fraser SG, Adams W. Interventions for acute non-arteritic central retinal artery occlusion. In: Fraser SG, editor. Cochrane Database of Systematic Reviews. Chichester: Wiley; 2009. p. CD001989. https://doi.org/10.1002/14651858.CD001989.pub2.

  26. Incandela L, Cesarone MR, Belcaro G, Steigerwalt R, De Sanctis MT, Nicolaides AN, Griffin M, Geroulakos G, Ramaswami G. Treatment of vascular retinal disease with pentoxifylline: a controlled, randomized trial. Angiology. n.d. 2002;53(Suppl 1):S31–4. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11865833.

  27. Werner D, Michalk F, Harazny J, Hugo C, Daniel WG, Michelson G. Accelerated reperfusion of poorly perfused retinal areas in central retinal artery occlusion and branch retinal artery occlusion after a short treatment with enhanced external counterpulsation. Retina. 2004;24(4):541–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15300074.

    Article  Google Scholar 

  28. Schumacher M, Schmidt D, Jurklies B, Gall C, Wanke I, Schmoor C, Maier-Lenz H, Solymosi L, Brueckmann H, Neubauer AS, Wolf A, Feltgen N, EAGLE-Study Group. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology. 2010;117(7):1367–1375.e1. https://doi.org/10.1016/j.ophtha.2010.03.061.

    Article  PubMed  Google Scholar 

  29. Howard R, Trend P, Russell RW. Clinical features of ischemia in cerebral arterial border zones after periods of reduced cerebral blood flow. Arch Neurol. 1987;44(9):934–40.

    Article  CAS  Google Scholar 

  30. Stoerig P. Functional rehabilitation of partial cortical blindness? Restor Neurol Neurosci. 2008;26(4–5):291–303.

    PubMed  Google Scholar 

  31. Moazami N, Smedira NG, McCarthy PM, Katzan I, Sila CA, Lytle BW, Cosgrove DM 3rd. Safety and efficacy of intraarterial thrombolysis for perioperative stroke after cardiac operation. Ann Thorac Surg. 2001;72(6):1933–7. discussion 1937–9.

    Article  CAS  Google Scholar 

  32. Chalela JA, Katzan I, Liebeskind DS, et al. Safety of intra-arterial thrombolysis in the postoperative period. Stroke. 2001;32:1365–9.

    Article  CAS  Google Scholar 

  33. Selim M. Perioperative stroke. N Engl J Med. 2007;356(7):706–13.

    Article  CAS  Google Scholar 

  34. Cucchiara RF, Black S. Corneal abrasion during anesthesia and surgery. Anesthesiology. 1988;69(6):978–9.

    Article  CAS  Google Scholar 

  35. Mendel E, Stoicea N, Rao R, et al. Revisiting postoperative vision loss following non-ocular surgery: a short review of etiology and legal considerations. Front Surg. 2017;4:34. https://doi.org/10.3389/fsurg.2017.00034.

    Article  PubMed  PubMed Central  Google Scholar 

  36. http://depts.washington.edu/asaccp/projects/postoperative-visual-loss-registry, Postoperative Visual Loss Registry | ASA Closed Claims Project, Postoperative Visual Loss Registry, July 16, 2017.

  37. Uppal M, Posner K, Roth S. Visual loss complicating surgery: review of 21 cases. Anesthesiology. 2000;93:A-1136.

    Google Scholar 

  38. Posner KL. The POVL Study Group: a national sample of variation in blood pressure and anemia severity in spinal fusion surgery. Anesthesiology. 2009;111:A1013.

    Google Scholar 

  39. Lee L, Posner KL, Domino KB. Trends in injuries to the visual pathways and medicolegal payments from the closed claims project database. Anesthesiology. 2013:A2058. https://depts.washington.edu/asaccp/sites/default/files/pdf/Click%20here%20for_2.pdf.

  40. Marcus L. Plant, the decline of “Informed consent”, 35 Wash. & Lee L. Rev. 1978;91:91. http://scholarlycommons.law.wlu.edu/wlulr/vol35/iss1/3.

  41. Marcus L. Plant, the decline of “Informed consent”, 35 Wash. & Lee L. Rev. 1978;91:94. http://scholarlycommons.law.wlu.edu/wlulr/vol35/iss1/3.

  42. Corda DM, Dexter F, Pasternak JJ, Trentman TL, Nottmeier EW, Brull SJ. Patients’ perspective on full disclosure and informed consent regarding postoperative visual loss associated with spinal surgery in the prone position. Mayo Clin Proc. 2011;86(9):865–8. https://doi.org/10.4065/mcp.2011.0279.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Posterior reversible encephalopathy syndrome following a thoracic discectomy–induced dural leak. J Neurosurg Spine, 25(5):586–590. Thejns.org. http://thejns.org/action/showCitFormats?doi=10.3171%2F2016.4.SPINE1623#.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, LA, USA

    Andrew J. Brunk, Ken P. Ehrhardt Jr, Jeremy B. Green, Susie M. Mothersele & Alan David Kaye

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  1. Andrew J. Brunk
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  2. Ken P. Ehrhardt Jr
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  3. Jeremy B. Green
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  4. Susie M. Mothersele
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  5. Alan David Kaye
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Editor information

Editors and Affiliations

  1. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA

    Charles J. Fox, III

  2. Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA

    Elyse M. Cornett

  3. Department of Oral and Maxillofacial Surgery/Head and Neck Surgery, Louisiana State University Health Sciences Center – Shreveport, Shreveport, LA, USA

    G. E. Ghali

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Brunk, A.J., Ehrhardt, K.P., Green, J.B., Mothersele, S.M., Kaye, A.D. (2019). Postoperative Visual Loss: Anatomy, Pathogenesis, and Anesthesia Considerations. In: Fox, III, C., Cornett, E., Ghali, G. (eds) Catastrophic Perioperative Complications and Management. Springer, Cham. https://doi.org/10.1007/978-3-319-96125-5_2

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  • DOI: https://doi.org/10.1007/978-3-319-96125-5_2

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