3. University of Chicago 0.0000016%
Mayo Clinic (Cx no cardiaca) 0.0008%
Mayo Clinic (CABG) 0.06%
John Hopkins (Cx Columna) 0.028%
ASA POVL Registry 0.2 - 4.5%
NIS (CABG) 0.08%
NIS (Columna) 0.03%
Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610
Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from
1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009 Nov;109(5):1534-45. Epub
2009 Aug 27.

4. Pérdida de visión perioperatoria
Se refiere a la alteración permanente o
pérdida total de la visión durante un
procedimiento de columna en el cual
se administra anestesia general
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

5. Cámara Anterior Abrasión corneal
Retina Oclusión Art. Central Retina
Vías Retroquiásmicas Infartos origen embólico
Lesión Nervio Óptico Neuropatía Óptica Isquémica
Anterior Posterior
Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610

6. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of
Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative
visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

7. Etiología: Compresión externa del globo ocular *
Cabeza en mala posición
PIO > PAM
Generalmente unilateral
Acompañado de otros signos de trauma periocular
Ptosis
Eritema
Abrasión Corneal
Oftalmoplegía

8. CRITERIOS DIAGNÓSTICOS
Retina pálida isquémica
Punto rojo cereza en la mácula
Defecto pupilar aferente
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of
Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative
visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

12. ANTERIOR
Fondo de ojo temprano : disco
edematoso con o sin hemorragias
peripapilares en forma de llama
Defecto aferente en reflejo pupilar
POSTERIOR
Fondo de ojo temprano : normal
Defecto aferente en reflejo pupilar
o ausencia del mismo
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative
Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

13. Palidez del nervio óptico
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative
Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

14. ANTERIOR
Irrigación: arterias
ciliares posteriores
POSTERIOR
Irrigación: Plexo vascular
de la pia y art central de la
retina
Dentro de cavidad ósea
Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye
(Lond). 2004 Nov;18(11):1188-206.

15. Multifactorial
Etiología Vascular: venosa vs arterial??
Pobre contenido de oxígeno
Compresión local del plexo de la pia
Aumento de presión venosa
Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610
Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye
(Lond). 2004 Nov;18(11):1188-206.

16. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

17. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

18. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

19. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

20. Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

21. Edad
Presión sobre globo ocular
Hipotensión
Anemia
Duración procedimiento
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists
Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006
Oct;105(4):652-9; quiz 867-8.

22. American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

23. Paciente de Alto Riesgo
Cirugía de Columna
Prono
Procedimiento prolongado
Pérdida de sangre importante
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

24. No valoración preoperatoria por oftalmología o
neuro-oftalmología
Pacientes de alto riesgo explicar posibilidad de
pérdida de visión
Monitorizar presión arterial de forma continua en
pacientes de alto riesgo
Uso de técnicas hipotensivas no se asocia a
aumento en el riesgo de POVL
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

25. Mantener volumen intravascular con coloides y
cristaloides
Considerar monitoreo de PVC en alto riesgo
Monitorizar niveles de Hb-Hto en pacientes de alto
riesgo con pérdida substancial de sangre
No existe un límite definido ni un umbral para
transfusión adecuado
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

26. Compresión no es causa de ION, pero debe
prevenirse al ser causa de CRAO
Mantener la cabeza a nivel o por encima del
corazón
Cabeza en posición neutra
Evaluar posibilidad de hacer procedimiento por
etapas
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

27. Evaluar visión al
recuperar
conciencia
Normal SI
NO
Valoración por
oftalmología
ION NO Examen
Normal
SI
Neuroimágenes Manejar según
causa
NO Otra SI
Causa
American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for
perioperative visual loss associated with spine surgery: a report by the American Society of
Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28