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POSTOPERATIVE
VISION LOSS (POVL)
PRESENTED BY :
DR.ANKITA MADAN
 Partial or complete vision loss of vision occuring after
general anaesthesia for nonocular surgery.
 Uncommon complicat...
PATHOPHYSIOLOGY
 Ischemia to visual pathway particulary the optic
nerve and the retina.
 Major source of blood supply of...
Posterior portion of optic nerve more susceptible to poor perfusion in
presence of hypotension due to comparatively less v...
CAUSES OF POVL
 Ischemic optic neuropathy (ION)
 Central retinal artery occlusion (CRAO)
 Cortical blindness
 Posterio...
VISION LOSS AFTER SPINAL
SURGERY
 Anterior ischemic optic neuropathy
 Posterior ischemic optic neuropathy
 Retinal vasc...
ISCHEMIC OPTIC NEUROPATHY(ION)
Irreversible painless loss of vision
Spontaneously without any warning signs
Usually see...
Two types - anterior or posterior ION
AION –Most commonly after cardiac
surgery
PION –After spine surgery in prone
post...
MECHANISM FOR ION
 Increased venous pressure in the globe and
interstitial edema during prone position
 Increase in intr...
RETINAL ISCHAEMIA
 CENTRAL RETINAL ARTERY OCCLUSION
decreases blood supply to the entire retina
 BRANCH RETINAL ARTERY O...
POVL AFTER CARDIAC
SURGERY
 Risk factors :
 Lower postoperative haematocrit
 Presence of clinically significant vascula...
POVL AFTER HEAD AND NECKSURGERY
 ION after neck dissection
 CRAO after neck and nasal or sinus surgery
 Orbital hemorrh...
PERIOPERATIVE VISUAL LOSSIN OTHERSURGERIES
 After robotic and laparoscopic surgeries especially
after laparoscopic nephre...
OTHER CAUSES OF POVL
CORTICAL BLINDNESS
 Result of decreased perfusion to the occipital
cortex due to hypoperfusion and ...
POSTERIORREVERSIBLE ENCEPHALOPATHY
SYNDROME (PRES)
 SEIZURES
 HEADACHE
 VOMITING
 VISION DEFECTS
 DECREASED LEVEL OF ...
Reported after severe hypertension ,
chemotherapy , immune suppression ,
renal disease , vasculitis and eclampsia ,
lumba...
ASA PRACTICE ADVISORY
 Inform patients undergoing spine surgery of long
duration and expected excessive blood lossabout
s...
To maintain hematocrit of above 28%
Use of vasopressors on case by case basis.
During positioning , direct compression ...
Staging of surgical procedure must be given
consideration in high risk patients.
Vision must be tested of high risk pati...
THANKS 
Postoperative vision loss
Postoperative vision loss
Postoperative vision loss
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guidelines to prevent vision loss after surgery

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Postoperative vision loss

  1. 1. POSTOPERATIVE VISION LOSS (POVL) PRESENTED BY : DR.ANKITA MADAN
  2. 2.  Partial or complete vision loss of vision occuring after general anaesthesia for nonocular surgery.  Uncommon complication  Associated more with cardiac surgery or procedures on the spine done in prone position.
  3. 3. PATHOPHYSIOLOGY  Ischemia to visual pathway particulary the optic nerve and the retina.  Major source of blood supply of retina and optic nerve is the Opthalmic artery branch of internal carotid artery.  Branches : Central retinal artery and long and short posterior arteries – blood supply of retina
  4. 4. Posterior portion of optic nerve more susceptible to poor perfusion in presence of hypotension due to comparatively less vascular supply.
  5. 5. CAUSES OF POVL  Ischemic optic neuropathy (ION)  Central retinal artery occlusion (CRAO)  Cortical blindness  Posterior reversible encephalopathy syndrome (PRES)
  6. 6. VISION LOSS AFTER SPINAL SURGERY  Anterior ischemic optic neuropathy  Posterior ischemic optic neuropathy  Retinal vascular occlusion
  7. 7. ISCHEMIC OPTIC NEUROPATHY(ION) Irreversible painless loss of vision Spontaneously without any warning signs Usually seen after cardiac surgery , spine surgery , head and neck surgery , orthopedic joint procedures and surgery on nose or sinuses.
  8. 8. Two types - anterior or posterior ION AION –Most commonly after cardiac surgery PION –After spine surgery in prone postion or radical neck dissection.
  9. 9. MECHANISM FOR ION  Increased venous pressure in the globe and interstitial edema during prone position  Increase in intraocular pressure  Compression of vessels supplying optic nerve  Hypoxia of optic nerve
  10. 10. RETINAL ISCHAEMIA  CENTRAL RETINAL ARTERY OCCLUSION decreases blood supply to the entire retina  BRANCH RETINAL ARTERY OCCLUSION affects only a portion of the retina.  Following ocular trauma , embolic phenomenon following carotid surgery and vasospastic episodes.  In spine surgery , it is due improper patient positioning and external compression of eye.
  11. 11. POVL AFTER CARDIAC SURGERY  Risk factors :  Lower postoperative haematocrit  Presence of clinically significant vascular diseae  Long duration of CPB  Red cell transfusions  Use of other blood components
  12. 12. POVL AFTER HEAD AND NECKSURGERY  ION after neck dissection  CRAO after neck and nasal or sinus surgery  Orbital hemorrhage from blunt trauma during the procedure
  13. 13. PERIOPERATIVE VISUAL LOSSIN OTHERSURGERIES  After robotic and laparoscopic surgeries especially after laparoscopic nephrectomies and robotic prostatectomies.  During robotic prostatectomy, patient in steep trendelenburg position for a prolonged time and co2 insufflation of the abdomen increases the CVP , the intrathoracic pressure and the intraocular pressure.
  14. 14. OTHER CAUSES OF POVL CORTICAL BLINDNESS  Result of decreased perfusion to the occipital cortex due to hypoperfusion and embolic phenomenon.  Normal light reflex and fundoscopic examination.  Prevention by maintaining normal perfusion pressure and hematocrit of about 30%.
  15. 15. POSTERIORREVERSIBLE ENCEPHALOPATHY SYNDROME (PRES)  SEIZURES  HEADACHE  VOMITING  VISION DEFECTS  DECREASED LEVEL OF CONSCIOUSNESS.
  16. 16. Reported after severe hypertension , chemotherapy , immune suppression , renal disease , vasculitis and eclampsia , lumbar spine fusion , hysterectomy and video assisted thoracoscopic surgery . Treatment is symptomatic.
  17. 17. ASA PRACTICE ADVISORY  Inform patients undergoing spine surgery of long duration and expected excessive blood lossabout small and unpredictable risk of POVL.  Systemic BP to be monitored in high risk patients. Deliberate hypotension should be practiced on case by case basis.  Central venous pressure must be monitored in high risk patients.
  18. 18. To maintain hematocrit of above 28% Use of vasopressors on case by case basis. During positioning , direct compression on eyes must be avoided and head should be maitained in neutral position at the level or higher than the level of heart.
  19. 19. Staging of surgical procedure must be given consideration in high risk patients. Vision must be tested of high risk patients for POVL immediately after they are awake and ophthalmology opinion must be taken urgently if there is any concern. Optimization of Hb level , hemodynamic status and oxygenation may be addressed
  20. 20. THANKS 
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different causes of vision loss after surgery guidelines to prevent vision loss after surgery

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