Postoperative Visual Loss Following Spinal Surgery

Abstract

Postoperative visual loss (POVL) is a catastrophic perioperative complication that has come to the forefront of anesthesiologists’ attention in the last 10–15 years. The extent of visual loss from POVL can be minimal unilateral visual field loss loss to complete blindness in both eyes. The incidence of symptomatic POVL varies from 0 to 4.5% depending on the institution and the type of cases studied. The highest reported incidence of symptomatic visual loss is 4.5% in cardiac cases and 0.2% in spine surgery. The most common types of surgical procedures associated with POVL include prone spine surgery, cardiopulmonary bypass procedures, head and neck procedures, and major vascular procedures. Radical prostatectomy is emerging as a new high-risk procedure for ischemic optic neuropathy (ION), particularly with the robotic prostatectomies that utilize an exaggerated steep Trendelenburg position. A wide variety of miscellaneous procedures have been associated with POVL including cholecystectomy, liposuction, supine spine surgery, nephrectomy, thoracotomy, and many others.