Epidemiology of postoperative visual loss for non-ocular surgery in a cohort of inpatients

Perioperative Vision Loss Following Prone Spine Surgery: A Case-Control Study

PURPOSE

Perioperative vision loss (POVL) is a rare and devastating complication following prone spine surgery. Due to the rare nature of this complication, there is limited research available about patient and surgical risk factors that increase the risk of POVL. The objective of this study was to investigate associated risk factors for POVL with use of the National Surgical Quality Improvement Program (NSQIP) database.

DESIGN

This study used a case-control secondary data analysis methodology that included five cases of POVL and 250 controls from the American College of Surgeons National Surgical Quality Improvement Program database who all underwent prone spine surgery between 2010 and 2020.

METHODS

Each POVL case was matched to 50 randomly selected controls (n = 250) based on type and year of surgery. Demographics and variables of interest were compared among the POVL cases, among POVL cases and the aggregate control group (n = 250), and POVL cases against their matched control group. Univariate and multivariate conditional logistic regression were then used to estimate the odds of developing POVL in relation to potential patient and surgical risk factors.

FINDINGS

When POVL cases were compared to the 250 control cases using univariate analysis, patients who developed POVL were more likely to have received a blood transfusion within 72 hours of surgery (P < .0001). and have longer operative times (odds ratio = 1.01, 95% CI [1.003, 1.017], P = .003).

CONCLUSIONS

Two surgical risk factors were determined to be statistically significant, including the need for perioperative blood transfusion and prolonged operative time. These findings support previous research on POVL which often identified blood loss and prolonged operative times as surgical risk factors. The narrow patient population used in this project may have limited the ability to perform a more robust study on POVL. Therefore, further research on POVL using the National Surgical Quality Improvement Program database is strongly encouraged.

Sudden transient blindness following ureteroscopy: an uncommon complication of a common procedure (a case report)

Perioperative vision loss following non-ophthalmic surgical procedures represents a rare but potentially serious complication. Although its occurrence in urology is infrequent, the consequences for patients and legal implications are significant. We present the case of a 53-year-old woman with no notable medical history, treated for renal lithiasis. Following the ureteroscopy, the patient experienced a sudden reduction in visual acuity. The diagnosis made was that of posterior ischemic optic neuropathy. This case illustrates a rare complication associated with ureteroscopy, highlighting the importance of increased awareness and rigorous postoperative monitoring, especially in patients with risk factors such as anemia or hypertension. Fortunately, the patient's rapid and complete recovery is encouraging, suggesting that early identification and appropriate management can lead to a favorable prognosis.

[Small tidal volume hyperventilation relieves intraocular and intracranial pressure elevation in prone spinal surgery: a randomized controlled trial]

OBJECTIVE

To investigate the effects of different ventilation strategies on intraocular pressure (IOP) and intracranial pressure in patients undergoing spinal surgery in the prone position under general anesthesia.

METHODS

Seventy-two patients undergoing prone spinal surgery under general anesthesia between November, 2022 and June, 2023 were equally randomized into two groups to receive routine ventilation (with Vt of 8mL/kg, Fr of 12-15/min, and etCO2 maintained at 35-40 mmHg) or small tidal volume hyperventilation (Vt of 6 mL/kg, Fr of18-20/min, and etCO2 maintained at 30-35 mmHg) during the surgery. IOP of both eyes (measured with a handheld tonometer), optic nerve sheath diameter (ONSD; measured at 3 mm behind the eyeball with bedside real-time ultrasound), circulatory and respiratory parameters of the patients were recorded before anesthesia (T0), immediately after anesthesia induction (T1), immediately after prone positioning (T2), at 2 h during operation (T3), immediately after supine positioning after surgery (T4) and 30 min after the operation (T5).

RESULTS

Compared with those at T1, IOP and ONSD in both groups increased significantly at T3 and T4(P < 0.05). IOP was significantly lower in hyperventilation group than in routine ventilation group at T3 and T4(P < 0.05), and ONSD was significantly lower in hyperventilation group at T4(P < 0.05). IOP was positively correlated with the length of operative time (r=0.779, P < 0.001) and inversely with intraoperative etCO2 at T3(r=-0.248, P < 0.001) and T4(r=-0.251, P < 0.001).ONSD was correlated only with operation time (r=0.561, P < 0.05) and not with IOP (r=0.178, P>0.05 at T3; r=0.165, P>0.05 at T4).

CONCLUSION

Small tidal volume hyperventilation can relieve the increase of IOP and ONSD during prone spinal surgery under general anesthesia.

[Perioperative visual loss : Rare, unknown, relevant?]

Perioperative visual loss (POVL) is a rare but severe complication following non-ophthalmological surgery under general anesthesia. A POVL can be caused by lesions in any part of the optical system. The predominant causes include corneal injuries and particularly ischemic damage. The symptoms of POVL substantially vary ranging from reduced vision to complete blindness. The risks involve factors related to the surgery as well as patient-specific factors. In general, the prognosis in cases of mechanical damage is better than for ischemic lesions. The treatment measures depend on the underlying pathomechanism and due to the limited evidence only a few treatment options are available. Therefore, preventive measures and meticulous documentation play a crucial role.

Decoding the Neurological Sequelae of General Anesthesia: A Review

General anesthesia is an integral part of modern surgical practice, but it is associated with a number of complications, including neurological ones. This article provides a thorough analysis of these complications, taking into account the most common ones like drug complications, through delirium, postoperative cognitive impairment (POCD), to the rarest ones like perioperative stroke (POS), spinal cord ischemia (SCI), and postoperative visual loss (POVL). Its main goal is to familiarize healthcare professionals, especially those involved in anesthesiology, with the intricacies of neurological complications. Given their specificity and frequency of occurrence, it is well known that the diagnosis and management of these complications can sometimes cause problems for physicians without advanced neurological knowledge. Also, in addition to complex diagnostics, the pathomechanism of non-pharmacological complications is often not fully understood due to their multifactoriality and sometimes paucity of research. For this reason, an increasing amount of work is being done in the medical community to better understand this group of conditions, enabling faster diagnosis and more effective treatment, as well as perioperative prevention. This paper aims to increase awareness and vigilance among physicians across the spectrum of surgical patient care, from premedication to postoperative follow-up. Drawing on the authors' experience and the extensive medical literature, this paper includes 39 selected articles from 1994 to 2023, seeking the latest insights in the constantly evolving field of neurology and anesthesiology. This article aims to review the neurological complications of general anesthesia.