VISION LOSS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY
Doaa Gamal Mustafa El kasas;
Abstract
Postoperative visual loss (POVL) has become the focus of attention for anesthesiologists as a hallmark of perioperative management following CABG. A number of intraoperative and postoperative factors have been documented but the exact etiology is still unclear. Nowadays, perioperative management and also complete curing of POLV is a big question for ophthalmologists and anesthesiologists.
Potential neuro-ophthalmologic complications following nonocular surgery include anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), central retinal artery occlusion, pituitary apoplexy, and cortical blindness.
Reports have attempted to connect anemia, hypotension, blood loss, and other hemodynamic variables to the pathophysiology of AION and PION. These variables occur in nearly all cases of cardiac surgeries and yet, AION and PION occur rarely.
There may be an individual predisposition of certain patients, or multiple factors that lead to a “perfect storm” of events resulting in AION or PION.
Cortical blindness occurs most frequently after cardiac or vascular surgery, and may be due to embolism or general cerebral under perfusion.
Pituitary apoplexy is seen most often following cardiac surgery in patients with pre-existing pituitary adenomas. Causes likely include fluctuations in blood pressure, hypotension, blood dilution with crystalloid, anticoagulation, excessive steroid secretion, and transient increases in intracranial pressure.
The clinical presentation is usually painless loss of vision or visual field defects with sluggish pupil. On the other hand, orbital compartment syndrome is associated with painful loss of vision, acute periorbital edema, conjuctivalchemosis and edema. It probably occurs consequential to raised intraocular pressure as a result of direct pressure on global and periorbital structures due to abnormal head position during prolonged prone position.
While there are currently no established treatments available for AION, PION, CRAO, or cortical blindness, patients with pituitary apoplexy may benefit from urgent transsphenoidal decompression surgery and corticosteroid administration.
Preventive measures include taping the eyes shut,maintaining hemodynamic stability during surgery, management of anemia, reducing procedural risk and careful patient positioning.
Potential neuro-ophthalmologic complications following nonocular surgery include anterior ischemic optic neuropathy (AION), posterior ischemic optic neuropathy (PION), central retinal artery occlusion, pituitary apoplexy, and cortical blindness.
Reports have attempted to connect anemia, hypotension, blood loss, and other hemodynamic variables to the pathophysiology of AION and PION. These variables occur in nearly all cases of cardiac surgeries and yet, AION and PION occur rarely.
There may be an individual predisposition of certain patients, or multiple factors that lead to a “perfect storm” of events resulting in AION or PION.
Cortical blindness occurs most frequently after cardiac or vascular surgery, and may be due to embolism or general cerebral under perfusion.
Pituitary apoplexy is seen most often following cardiac surgery in patients with pre-existing pituitary adenomas. Causes likely include fluctuations in blood pressure, hypotension, blood dilution with crystalloid, anticoagulation, excessive steroid secretion, and transient increases in intracranial pressure.
The clinical presentation is usually painless loss of vision or visual field defects with sluggish pupil. On the other hand, orbital compartment syndrome is associated with painful loss of vision, acute periorbital edema, conjuctivalchemosis and edema. It probably occurs consequential to raised intraocular pressure as a result of direct pressure on global and periorbital structures due to abnormal head position during prolonged prone position.
While there are currently no established treatments available for AION, PION, CRAO, or cortical blindness, patients with pituitary apoplexy may benefit from urgent transsphenoidal decompression surgery and corticosteroid administration.
Preventive measures include taping the eyes shut,maintaining hemodynamic stability during surgery, management of anemia, reducing procedural risk and careful patient positioning.
Other data
| Title | VISION LOSS AFTER CORONARY ARTERY BYPASS GRAFT SURGERY | Other Titles | فقدان الإبصار بعد جراحات ترقيع الشريان التاجي | Authors | Doaa Gamal Mustafa El kasas | Issue Date | 2016 |
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