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Mendel E, Stoicea N, Rao R, Niermeyer W, Revilla S, Cluse M, Sandhu G, Todaro GJ, Bergese SD. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations. Front Surg 2017; 4:34. [PMID: 28695122 PMCID: PMC5483430 DOI: 10.3389/fsurg.2017.00034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/08/2017] [Indexed: 11/15/2022] Open
Abstract
Postoperative vision loss (POVL) following non-ocular surgery is a serious complication where the causes are not fully understood. Studies have identified several causes of POVL as well as risk factors and prevention strategies. POVL research is made difficult by the fact that cases are often subject to malpractice claims, resulting in a lack of public access to case reports. This literature review was conducted in order to identify legal issues as a major barrier to studying POVL and address how this affects current knowledge. Informed consent provides an opportunity to overcome legal challenges by reducing malpractice litigation through educating the patient on this outcome. Providing pertinent information regarding POVL during the informed consent process has potential to reduce malpractice claims and increase available clinical information.
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Affiliation(s)
- Ehud Mendel
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Rahul Rao
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, United States
| | - Weston Niermeyer
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Stephen Revilla
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Marcus Cluse
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Gurneet Sandhu
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | | | - Sergio D Bergese
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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Storey C, Menger R, Hefner M, Keating P, Ahmed O, Guthikonda B. Unilateral Acute Closed-Angle Glaucoma After Elective Lumbar Surgery Reveals Multiple Intracranial Aneurysms. A Case Report and Discussion on Workup of Differential Diagnoses. World Neurosurg 2015; 84:1493.e15-8. [DOI: 10.1016/j.wneu.2015.04.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/17/2015] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
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Hassani V, Homaei MM, Shahbazi A, Zamani MM, Safari S, Nadi S, Rahimizadeh A, Lashkari MH, Alizadeh zendehrood S. Human erythropoietin effect in postoperative visual loss following spine surgery: a case report. Anesth Pain Med 2014; 4:e7291. [PMID: 24790903 PMCID: PMC3997951 DOI: 10.5812/aapm.7291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/15/2013] [Accepted: 11/03/2013] [Indexed: 01/20/2023] Open
Abstract
Introduction: Postoperative visual loss (POVL) has become the focus of attention for anesthesiologists as a hallmark of perioperative management in spine surgery. A number of Intraoperative and postoperative factors has been documented but the exact etiology is still unclear. Nowadays, perioperative management and also complete curing of POLV is a big question of ophthalmologists and anesthesiologists. The purpose of this case report is to present a unique experience of complete curing the POLV. Case Presentation: Our patient was a 61-year-old man, with 75 kg weight and 180 cm height. The patient had no history of visual impairment except mild cataract in his right eye. The patient had a history of diffuse idiopathic skeletal hyperostosis (DISH). The patient had undergone lumbar surgery in prone position. The operation time was about 6 hours. About 30 minutes after transferring to postanesthesia care unit (PACU), patient was awake and complained of losing his eyesight. There was no vision and light perception in his right eye on primary examination. Urgent ophthalmologist consultation was requested. In ophthalmology examinations, the pupil reflex to light was absent in the right eye. After obtaining patients and his family informed consent, four hours after the operation, 40000 I.U. of recombinant human erythropoietin (rhEPO) was administered for patient in PACU (IV infusion, in 30 min). An ophthalmologist visited him every 6 hours after administration of rhEPO. The patient was transferred to intensive care unit (ICU) one hour later with total visual loss in the right eye. Ophthalmologic examination after the second dose of rhEPO, 30 hours after the operation, reported pupil reflex enhancement and light perception in his right eye. Finally the third dose of rhEPO (40000 I.U., IV infusion) was administered on the third day. Ophthalmologic examination after the third dose of rhEPO, 60 hours after the operation, reported normal pupillary light reflex of the right eye and visual acuity improvement to 20/20. The patient was discharged from hospital after six days, with normal visual acuity and without any new complications except surgical site pain. Conclusions: Our case report showed the therapeutic effect of rhEPO in complete curing of POVL. Regarding the side effects of EPO such as thrombogenic effects or mild hemodynamic changes like transient sinus tachycardia during infusion, it seems that beneficial effects of EPO is more than its disadvantages and expenses, for patients with POVL.
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Affiliation(s)
- Valiollah Hassani
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohsen Homaei
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Shahbazi
- Physiology Research Center (PRC), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Zamani
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Safari
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Saeid Safari, Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Niayesh Av., Tehran, Iran. Tel: +98-2166509059, Fax: +98-2166515758, E-mail:
| | - Shermila Nadi
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
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Jaroudi M, Fadi M, Farah F, El Mollayess GM. Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery. Middle East Afr J Ophthalmol 2014; 20:182-4. [PMID: 23741140 PMCID: PMC3669498 DOI: 10.4103/0974-9233.110620] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To report a case of bilateral acute angle closure glaucoma (AACG) that occurred after cervical spine surgery with the use of glycopyrolate. A 59-year-old male who presented with severe bilateral bifrontal headache and eye pain that started 12 h postextubation from a cervical spine surgery. Neostigmine 0.05 mg/kg (4.5 mg) and glycopyrrolate 0.01 mg/kg (0.9 mg) were used as muscle relaxant reversals at the end of the surgery. Ophthalmic examination revealed he had bilateral AACG with plateau iris syndrome that was treated medically along with laser iridotomies. Thorough examination of anterior chamber should be performed preoperatively on all patients undergoing surgeries in the prone position and receiving mydriatic agents under general anesthesia.
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Affiliation(s)
- Mahmoud Jaroudi
- Department of Ophthalmology, American University of Beirut Medical Center; Beirut, Lebanon
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Hidalgo Grau LA, Opisso Juliá LL, Roqué Meseguer A, Yuste Graupera M, Suñol Sala X. [Postoperative unilateral acute glaucoma after abdominal surgery]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2012; 59:507-510. [PMID: 22749300 DOI: 10.1016/j.redar.2012.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 05/04/2012] [Indexed: 06/01/2023]
Abstract
An early and correct diagnosis substantially improves the post-operative prognosis of acute angle closure glaucoma (AACG). A 90 year-old woman was operated on for a right colon tumour by laparotomy, under combined anaesthesia without any adverse events. Twelve hours after the operation, the patient described recurrent periorbital pain in her right eye, with ocular hyperaemia, blurred vision, and unresponsive mydriasis. A diagnosis of AACG was made, but although conservative treatment was started YAG laser iridotomies were required to reduce the intraocular pressure. In the AACG postoperative period, as well as with an eye with several predisposed local factors including genetic predisposition, female gender, hypermetropia, increased lens thickness and small corneal diameter, can be added a pupillary block induced by adrenergic and anticholinergic drugs used in anaesthetic procedures. An acute and intensive periorbital or ocular pain, with or without visual disturbance, must aware the doctor. A differential diagnosis with other postoperative ocular diseases and cranial pain causes must be done.
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Affiliation(s)
- L A Hidalgo Grau
- Servicio de Cirugía General y Digestiva, Hospital de Mataró, Consorci Sanitari del Maresme, España.
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