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Şimdivar GHN, İncekalan TK, Gündüz A. Evaluation of retinal and peripapillary vessel density and subfoveal choroidal thickness changes in patients undergoing cardiopulmonary bypass: An OCTA study. Indian J Ophthalmol 2024; 72:S119-S124. [PMID: 38131553 PMCID: PMC10833158 DOI: 10.4103/ijo.ijo_2800_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 09/22/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE We aimed to investigate hemodynamic changes in the retina, peripapillary area, and choroid in patients undergoing coronary artery bypass grafting (CABG). METHODS This prospective case series included 35 eyes of 35 patients. Vessel density (VD) of superficial capillary plexus, deep capillary plexus, radial peripapillary capillary, foveal avascular zone area, and subfoveal choroidal thickness changes were evaluated using optical coherence tomography angiography (OCTA) 1 day before and 2 weeks after surgery. The correlation of these parameters with aortic cross-clamp (ACC) duration and cardiopulmonary bypass (CPB) duration was evaluated. RESULTS There were no differences in the OCTA measurements of the patients after CABG compared to before surgery (P > 0.05). Inside-disc VD showed a negative correlation with both ACC (P = 0.036) and CPB duration (P = 0.048); peripapillary inferior hernia showed a negative correlation with both ACC (P = 0.042) and CPB duration (P = 0.027). Another negative correlation was observed between mean peripapillary VD and CPB duration (P = 0.039). CONCLUSION The CPB procedure had no permanent effect on retinal choroid and optic disc blood flow postoperatively. Prolonged ACC and CPB times seem to be important in terms of optic nerve blood flow. Clinicians should be alert for postoperative ocular complications after long surgeries.
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Affiliation(s)
- Göksu Hande Naz Şimdivar
- Department of Ophthalmology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Tuğba Kurumoğlu İncekalan
- Department of Ophthalmology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Akif Gündüz
- Department of Cardiovascular Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Shahriari M, Nikkhah H, Mahjoob MP, Behnaz N, Barkhordari S, Cheraqpour K. Impact of coronary artery bypass grafting surgery on the chorioretinal biomicroscopic characteristics. World J Clin Cases 2023; 11:6754-6762. [PMID: 37901009 PMCID: PMC10600861 DOI: 10.12998/wjcc.v11.i28.6754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Most patients with cardiovascular disorders suffer from coronary artery diseases, which can be treated successfully using coronary artery bypass grafting (CABG). One of the unpleasant events following CABG is postoperative vision loss (POVL). Vulnerability of retinal vessels to hemodynamic changes, an expectable event following CABG, may contribute to the development of POVL, which might be associated with the changes in the choroidal and retinal structures. AIM To investigate postoperative changes in chorioretinal and peripapillary nerve fiber layer (NFL) thickness, and progression of diabetic and hypertensive retinopathy after CABG. METHODS In this prospective, cross-sectional study, 49 eyes in 25 candidates for CABG underwent both ophthalmic and cardiovascular examinations within 6 mo prior to and 9 mo after surgery. RESULTS Among the study participants, 56% were male with a mean age of 62.84 years ± 10.49 years (range 33-80 years). Diabetes mellitus was observed in eight participants (32%). None of the patients suffered from postoperative anterior or posterior ischemic optic neuropathy, central retinal artery occlusion, and cortical blindness. The mean value of the preoperative best corrected visual acuity was 0.11 ± 0.10 logMAR (range, 0-0.4), which worsened to 0.15 ± 0.08 logMAR (range, 0-0.4) after CABG (P = 0.031). No significant difference was observed between the pre- and postsurgical choroidal (P = 0.853) and macular (P = 0.507) thickness, NFL thickness in the subfoveal (P > 0.999) and peripapillary areas (P = 0.659), as well as the severity of diabetic and hypertensive retinopathy. CONCLUSION CABG may reduce visual acuity without affecting ocular structures. Postoperative vision reduction might be attributable to molecular or cellular variations, changes in visual pathway function, or central nervous system.
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Affiliation(s)
- Mansoor Shahriari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Homayoun Nikkhah
- Department of Ophthalmology, Torfe Medical Center, Tehran 1149847514, Iran
| | | | - Nazanin Behnaz
- Department of Ophthalmology, Shahid Beheshti University of Medical Sciences, Tehran 1617763141, Iran
| | - Shahriar Barkhordari
- Department of Ophthalmology, Imam Hossein Educational Hospital, Tehran 1617763141, Iran
| | - Kasra Cheraqpour
- Department of Ophthalmology, Farabi Eye Hospital, Tehran 1336616351, Iran
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Güneş A, Konuk ŞG, Demir HD, Kurt S, Naseri E, Erkorkmaz Ü. Evaluation of VEP parameters in patients before and after cardiopulmonary by-pass surgery. Int Ophthalmol 2023; 43:397-402. [PMID: 35864286 DOI: 10.1007/s10792-022-02435-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Coronary bypass surgery is emphasized in aetiology of ischemic optic neuropathy. Our aim in this study was to investigate the pattern visual evoked potentials (PVEP) in patients before and after coronary bypass surgery. METHODS Thirty-one patients were included in the study. After a full ophthalmological evaluation, PVEP was assesed in the pre and postoperative periods. Operative times, hematological parameters, blood pressures, number of transfusions, body temperatures, anaesthetic drugs and systemic illnesses were recorded for each patient. RESULTS The mean age of the patients were 59 ± 10.4 years. There was 22 men and 9 women in the study. Only 3 of them needed transfusion during the surgery. The mean duration of the surgery was 3.2 ± 0.7 h. None of the patients had a history of visual disturbance or postoperative ischemic optic neuropathy. The mean VEP P100 amplitude was not statistically significantly different but the mean VEP P100 latency showed statistically significant difference between the preoperative and postoperative periods. (p = 0.014) This significance was more appereant in patients with systemic illnesses. (p = 0.023) There was a positive correlation between the age and VEP P100 latency (r = 0.402, p < 0.05). CONCLUSIONS Although surgical techniques and equipments are developing each day in the field of cardiopulmonary bypass surgery, the contributing factors such as hypothermia, anemia and diabetes still seem to affect neurophysiological functions even after a noncomplicated surgery.
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Affiliation(s)
- Alper Güneş
- School of Medicine, Department of Ophthalmology, Gaziosmanpaşa University, Tokat, Turkey.
| | - Şerife Gülhan Konuk
- School of Medicine, Department of Ophthalmology, Gaziosmanpaşa University, Tokat, Turkey
| | - Helin Deniz Demir
- School of Medicine, Department of Ophthalmology, Gaziosmanpaşa University, Tokat, Turkey
| | - Semiha Kurt
- School of Medicine, Department of Neurology, Gaziosmanpaşa University, Tokat, Turkey
| | | | - Ünal Erkorkmaz
- School of Medicine, Department of Biostatistics, Sakarya University, Sakarya, Turkey
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Criado GG, Paiva ADCM, Britto VSD, Michelini IV, Simões KMP, Motta MMDS. Retinal vascular occlusions after nonocular surgeries. REVISTA BRASILEIRA DE OFTALMOLOGIA 2022. [DOI: 10.37039/1982.8551.20220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Complete Vision Loss after Laparoscopic Hysterectomy. Case Rep Obstet Gynecol 2021; 2021:6643703. [PMID: 33728078 PMCID: PMC7937478 DOI: 10.1155/2021/6643703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Postoperative vision loss (POVL) is a rare but devastating complication that has only recently been reported following laparoscopic surgery. We present the case of a 34-year-old gravida 6 para 4 female who experienced POVL following an uncomplicated laparoscopic hysterectomy. Operating time was 174 minutes, and EBL was 75 mL. After surgery, she complained of complete vision loss with no light perception. No cerebral hemorrhage or ischemia was detected on imaging. Funduscopic exam revealed no structural abnormalities. On postoperative day 7, she received an IV methylprednisolone taper. The following morning, she reported mild light perception. Later that night, she reported a partial return of visual acuity and was discharged home. At her 2-week postoperative visit, her vision had returned to baseline. POVL is an emergency and prompt evaluation should be initiated to optimize outcome.
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Calway T, Rubin DS, Moss HE, Joslin CE, Beckmann K, Roth S. Perioperative Retinal Artery Occlusion: Risk Factors in Cardiac Surgery from the United States National Inpatient Sample 1998-2013. Ophthalmology 2016; 124:189-196. [PMID: 27914836 DOI: 10.1016/j.ophtha.2016.10.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To study the incidence and risk factors for retinal artery occlusion (RAO) in cardiac surgery. DESIGN Retrospective study using the National Inpatient Sample (NIS). METHODS The NIS was searched for cardiac surgery. Retinal artery occlusion was identified by International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Postulated risk factors based on literature review were included in multivariate logistic models. MAIN OUTCOME MEASURES Diagnosis of RAO. RESULTS A total of 5 872 833 cardiac operative procedures were estimated in the United States from 1998 to 2013, with 4564 RAO cases (95% confidence interval [95% CI], 4282-4869). Nationally estimated RAO incidence was 7.77/10 000 cardiac operative procedures from 1998 to 2013 (95% CI, 7.29-8.29). Associated with increased RAO were giant cell arteritis (odds ratio [OR], 7.73; CI, 2.78-21.52; P < 0.001), transient cerebral ischemia (OR, 7.67; CI, 5.31-11.07; P < 0.001), carotid artery stenosis (OR, 7.52; CI, 6.22-9.09; P < 0.001), embolic stroke (OR, 4.43; CI, 3.05-6.42; P < 0.001), hypercoagulability (OR, 2.90; CI, 1.56-5.39; P < 0.001), myxoma (OR, 2.43; CI, 1.39-4.26; P = 0.002), diabetes mellitus (DM) with ophthalmic complications (OR, 1.89; CI, 1.10-3.24; P = 0.02), and aortic insufficiency (OR, 1.85; CI, 1.26-2.71; P = 0.002). Perioperative bleeding, aortic and mitral valve surgery, and septal surgery increased the odds of RAO. Negatively associated with RAO were female gender (OR, 0.77; CI, 0.66-0.89; P < 0.001), thrombocytopenia (OR, 0.79; CI, 0.62-1.00; P = 0.049), acute coronary syndrome (OR, 0.72; CI, 0.58-0.89; P = 0.003), atrial fibrillation (OR, 0.82; CI, 0.70-0.95; P = 0.01), congestive heart failure (OR, 0.73; CI, 0.60-0.88; P < 0.001), DM 2 (OR, 0.74; CI, 0.61-0.89; P = 0.001), and smoking (OR, 0.82; CI, 0.70-0.97; P = 0.02). CONCLUSIONS Risk factors for RAO in cardiac surgery include giant cell arteritis, carotid stenosis, stroke, hypercoagulable state, and DM with ophthalmic complications; associated with lower risk were female gender, thrombocytopenia, acute coronary syndrome, atrial fibrillation, congestive heart failure, DM 2, and smoking. Surgery in which the heart was opened (e.g., septal repair) versus surgery in which it was not (e.g., CABG) and perioperative bleeding increased the risk of RAO.
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Affiliation(s)
- Tyler Calway
- Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Daniel S Rubin
- Department of Anesthesia and Critical Care, the University of Chicago Medicine, Chicago, Illinois
| | - Heather E Moss
- Department of Ophthalmology, Byers Eye Center, Stanford University Medical Center, Palo Alto, California
| | - Charlotte E Joslin
- Department of Ophthalmology and Visual Science, College of Medicine, and School of Epidemiology and Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - Katharina Beckmann
- Department of Anesthesiology, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Steven Roth
- Department of Anesthesiology and Department of Ophthalmology and Visual Sciences, College of Medicine, University of Illinois at Chicago, Chicago, Illinois.
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The prone position during surgery and its complications: a systematic review and evidence-based guidelines. Int Surg 2016; 100:292-303. [PMID: 25692433 DOI: 10.9738/intsurg-d-13-00256.1] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.
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Pekel G, Kılıç ID, Alihanoğlu Yİ, Acer S, Yağcı R, Kaya H, Alur İ. Effects of coronary artery bypass grafting surgery on retinal vascular caliber, ocular pulse amplitude and retinal thickness measurements. Perfusion 2014; 30:312-7. [DOI: 10.1177/0267659114547249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The retina and ocular vasculature are vulnerable to alterations in systemic hemodynamics, such as in open heart surgeries. Our aim was to investigate retinal vascular caliber (RVC), ocular pulse amplitude (OPA), peripapillary retinal nerve fiber layer (RNFL) and macular thickness in coronary artery bypass grafting (CABG) surgery patients. Methods: Twenty-six patients who had a history of CABG surgery and 26 age-sex-matched healthy participants were recruited for this prospective, cross-sectional and comparative study. The RVC, peripapillary RNFL and macular thickness measurements were taken with spectral-domain optical coherence tomography. The OPA, a surrogate of pulsatile ocular blood flow, was measured with the Pascal dynamic contour tonometer. Results: There were no statistically significant differences between the CABG surgery patients and the controls with regard to RVC, OPA, peripapillary RNFL thickness and macular thickness measurements (p>0.05). Conclusions: CABG surgery does not affect retinal structures and pulsatile ocular blood flow in the long-term follow-up.
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Affiliation(s)
- G Pekel
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - ID Kılıç
- Cardiology Department, Pamukkale University, Denizli, Turkey
| | - Yİ Alihanoğlu
- Cardiology Department, Pamukkale University, Denizli, Turkey
| | - S Acer
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - R Yağcı
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - H Kaya
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - İ Alur
- Cardiovascular Surgery Department, Pamukkale University, Denizli, Turkey
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Pekel G, Alur I, Alihanoglu YI, Yagci R, Emrecan B. Choroidal changes after cardiopulmonary bypass. Perfusion 2014; 29:560-6. [PMID: 24705571 DOI: 10.1177/0267659114529324] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM Choroid, which is the vascular tissue responsible for blood supply to the outer parts of the retina, might be affected by hemodynamic events. We aimed to reveal choroidal thickness and ocular pulse amplitude changes after cardiopulmonary bypass in which gross hemodynamic alterations occur. METHODS Forty-two eyes of 42 patients who underwent heart surgery with cardiopulmonary bypass were examined in this prospective, cross-sectional case series. The spectral domain optical coherence tomography (Spectralis, Heidelberg, Germany) was used to analyze sub-foveal choroidal thickness. The ocular pulse amplitude, the surrogate of gross choroidal blood flow, was measured with the Pascal dynamic contour tonometer (Pascal DCT, Swiss Microtechnology AG, Port, Switzerland).. The intraocular pressure was also measured with this tonometer. The examinations were performed pre-operatively and post-operatively at the first week and first month. RESULTS The mean age of the patients was 58.8 ± 12.4 years. The mean sub-foveal choroidal thickness and ocular pulse amplitude values did not change statistically significantly after the operations at the follow-up visits (p>0.05). Also, there were no important correlations between cardiopulmonary bypass time and mean sub-foveal choroidal thickness and ocular pulse amplitude changes at the post-operative first week (p>0.05). The intraocular pressure values were decreased markedly at the control visits (p<0.05). CONCLUSIONS Sub-foveal choroidal thickness and ocular pulse amplitude are unchanged, while intraocular pressure decreases one week and one month after cardiopulmonary bypass.
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Affiliation(s)
- G Pekel
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - I Alur
- Cardiovascular Surgery Department, Pamukkale University, Denizli, Turkey
| | - Y I Alihanoglu
- Cardiology Department, Pamukkale University, Denizli, Turkey
| | - R Yagci
- Ophthalmology Department, Pamukkale University, Denizli, Turkey
| | - B Emrecan
- Cardiovascular Surgery Department, Pamukkale University, Denizli, Turkey
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Current world literature. Curr Opin Cardiol 2012; 27:682-95. [PMID: 23075824 DOI: 10.1097/hco.0b013e32835a0ad8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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First reports of serious adverse drug reactions in recent weeks. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kwee MM, Ho YH, Rozen WM. Complications of prolonged prone positioning during reconstructive surgery. Microsurgery 2012; 32:588-9. [DOI: 10.1002/micr.22029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 04/19/2012] [Indexed: 11/11/2022]
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