Post-operative vision loss (POVL) following surgical procedures

Abstract

Backgound: Postoperative vision loss (POVL), with a prevalence of 0.1% of cardiopulmonary bypass cases and 0.02% - 0.2% of spine surgery cases, is a rare but devastating complication that can occur in patients undergoing surgery in the prone position. Although the primary cause of this complication is unknown, POVL has been associated with anemia, hypotension (induced or due to hemorrhage), duration of surgery and over hydration. This author reviews the available evidence on the guidelines and management of these patients. Methods: A database search of MEDLINE, Academic Search Complete, Google Scholar, the Cochrane library, PubMed Central, and Embase was done using the key terms and phrases; postoperative vision loss, vision, ischemic optic neuropathy, prone position, perfusion, intraocular pressure, surgery, spinal surgery, scoliosis, blood flow and visual evoked potentials. Non-English language articles were excluded. The majority of the evidence retrieved included case studies, retrospective cohort studies and other literature reviews from dates ranging from 1995-2011. Results: There are no definitive guidelines for the management of patients undergoing spine surgery in the prone position. Conclusion: A synthesis of the literature revealed there is an increased risk of POVL in the presence of both preoperative and intraoperative risk factors. A medical history of diabetes, smoking and vascular disease can all contribute to the development of POVL. Intraoperative risk factors include, but are not limited to, pressure on the orbit, anemia, length of surgery, patient position and amount of volume infused. © 2012 Kendrick H.