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.
Keywords
perioperative visual loss - spine surgery - prone position - ischemic optic neuropathy
- informed consent - perioperative visual deficit
