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Visual loss in one eye after spinal surgery.

Chung MS, Son JH - Korean J Ophthalmol (2006)

Bottom Line: Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia.Despite medical treatment, optic atrophy was still present at the following examination.Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

ABSTRACT

Purpose: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position.

Methods: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia.

Results: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up.

Conclusions: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.

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Ocular fundus photography on the second postoperative day. The right eye shows a pale optic disc with an edematous retina and a cherry-red spot on the fovea.
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Figure 1: Ocular fundus photography on the second postoperative day. The right eye shows a pale optic disc with an edematous retina and a cherry-red spot on the fovea.

Mentions: Immediately after recovery from general anesthesia, the patient could not open his right eye because of swelling, and he also had ocular pain in the right eye. He showed visual loss when we examined his right eye on the second postoperative day. He had periorbital swelling, ptosis of the eyelid, chemosis, numbness of the first division of the right trigeminal nerve, afferent pupillary defect, and total ophthalmoplegia. Intraocular pressure was within the normal range. Anterior segments were normal in both eyes. He had a pale optic disc with an edematous retina and fundus examination revealed a cherry-red spot on the fovea (Fig. 1). His fluorescein angiographic examination revealed a delayed arterial filling time (Fig. 2). His brain MRI and magnetic resonance angiography (MRA) findings were normal with no evidence of embolic phenomena. However we noted mild swelling of the right periorbital soft tissue and edema of the extraocular muscles in the right eye, sparing their tendons (Fig. 3). Ptosis, the afferent pupillary defect, and ocular movement improved over three postoperative days, but despite medical treatment with carbonic anhydrase inhibitors and corticosteroids, the patient had optic atrophy on the following examination (Fig. 4). Eventually his vision deteriorated until he had no light perception after the last follow up at three months.


Visual loss in one eye after spinal surgery.

Chung MS, Son JH - Korean J Ophthalmol (2006)

Ocular fundus photography on the second postoperative day. The right eye shows a pale optic disc with an edematous retina and a cherry-red spot on the fovea.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908830&req=5

Figure 1: Ocular fundus photography on the second postoperative day. The right eye shows a pale optic disc with an edematous retina and a cherry-red spot on the fovea.
Mentions: Immediately after recovery from general anesthesia, the patient could not open his right eye because of swelling, and he also had ocular pain in the right eye. He showed visual loss when we examined his right eye on the second postoperative day. He had periorbital swelling, ptosis of the eyelid, chemosis, numbness of the first division of the right trigeminal nerve, afferent pupillary defect, and total ophthalmoplegia. Intraocular pressure was within the normal range. Anterior segments were normal in both eyes. He had a pale optic disc with an edematous retina and fundus examination revealed a cherry-red spot on the fovea (Fig. 1). His fluorescein angiographic examination revealed a delayed arterial filling time (Fig. 2). His brain MRI and magnetic resonance angiography (MRA) findings were normal with no evidence of embolic phenomena. However we noted mild swelling of the right periorbital soft tissue and edema of the extraocular muscles in the right eye, sparing their tendons (Fig. 3). Ptosis, the afferent pupillary defect, and ocular movement improved over three postoperative days, but despite medical treatment with carbonic anhydrase inhibitors and corticosteroids, the patient had optic atrophy on the following examination (Fig. 4). Eventually his vision deteriorated until he had no light perception after the last follow up at three months.

Bottom Line: Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia.Despite medical treatment, optic atrophy was still present at the following examination.Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

ABSTRACT

Purpose: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position.

Methods: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia.

Results: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up.

Conclusions: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated.

Show MeSH
Related in: MedlinePlus