CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(03): 195-197
DOI: 10.1055/s-0038-1667211
Case Report
Indian Society of Neuroanaesthesiology and Critical Care

Perioperative Visual Deficit in a Patient Undergoing Dorsolumbar Spine Surgery

Ved Prakash Pandey
1   Department of Neuroanaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India
,
Arnab Dasgupta
1   Department of Neuroanaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India
,
Anurag Aggarwal
1   Department of Neuroanaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India
,
Sachin Jain
1   Department of Neuroanaesthesiology, Fortis Hospital, Noida, Uttar Pradesh, India
› Author Affiliations
Further Information

Publication History

Received: 28 February 2018

Accepted after revision: 11 June 2018

Publication Date:
29 August 2018 (online)

Abstract

Perioperative visual loss (POVL) is a rare but potentially serious complication of long-duration surgeries in prone position under general anesthesia. The mechanism of visual loss after surgery, and its incidence, is difficult to determine. It is primarily associated with cardiothoracic and spine surgeries. The proposed causes include corneal injury, retinal ischemia (central retinal artery occlusion/branch retinal artery occlusion [CRAO/BRAO]), ischemic optic neuropathy (ION), and cortical blindness. A large, recent multicenter case-control study has identified risk factors associated with ION for patients undergoing spinal instrumentation surgery in prone position. These include male sex, obesity, use of Wilson's frame, long duration of anesthesia/surgery, larger estimated blood loss, and larger relative use of crystalloids for compensation of blood loss. This report describes a relatively healthy, 71-year-old female patient who developed significant visual impairment after thoracolumbar spine surgery in prone position under general anesthesia. The case raises dilemmas regarding the preoperative identification of patients who should be informed of the risk of POVL, and by whom.