Ischemic Optic Neuropathy Following Spine Surgery

摘要: Perioperative visual loss (POVL) is a devastating injury that has been reported infrequently after nonocular surgery. The most common cause of POVL ischemic optic neuropathy (ION). Increasing numbers cases ION are being spine surgery, but the etiology postoperative remains poorly understood. After MEDLINE search literature, we reviewed published case reports ION, specifically those surgery performed with patient in prone position. Most involved posterior (PION, n = 17), and remainder anterior (AION, 5). patients had no or few preoperative vascular disease risk factors. All except one PION 2 5 AION symptom onset within first 24 hours Visual was frequently bilateral (40% AION, 47% cases). Mean operative time exceeded 450 minutes. lowest average intraoperative mean arterial blood pressure 64 mm Hg hematocrit 27%. 1.7 L for patients. received an 8 crystalloid solution 2.2 colloid intraoperatively. This compilation suggests combination prolonged position, decreased ocular perfusion pressure, anemia/hemodilution, infusion large quantities intravenous fluids some potential factors ION. However, levels anemia intraoperatively were at considered acceptable anesthesia practice. incompletely Potential strategies to avoid this complication discussed.