Kaeser P-F, Borruat F-X
Department of Neuro-Ophthalmology, Hôpital Ophtalmique Jules Gonin, Lausanne, Switzerland.
Klin Monbl Augenheilkd. 2008 May;225(5):517-9. doi: 10.1055/s-2008-1027348.
Perioperative visual loss (PVL) refers to the loss of vision following surgery performed at distance from the visual pathways. An ischemic optic neuropathy (ION) is the most frequent clinical presentation of PVL, and can be bilateral.
A retrospective chart review of 11 consecutive patients with PVL examined between 2002 and 2007 was undertaken.
An ION was found in all 11 cases: 8 were anterior (AION) and 3 were posterior (PION). Visual loss was bilateral in 9 patients. Mean visual acuity (VA) was 0.2 on the Snellen chart (0.74 LogMAR). Most frequently an arcuate/altitudinal visual field defect was present. PVL followed orthopedic (6), spinal (1), cardiac (2) and vascular (2) procedures. The average delay between surgery and visual loss was 32 hours (range: 0-96 hours). Average lowest perioperative hemoglobin level was 75 g/L. Average follow-up time was 14.7 months. VA improved by at least 2 Snellen lines in 5/20 eyes (25 %).
PVL is a rare but dreadful complication of surgery, and is usually associated with severe anemia. Like other causes of ION, there is no specific therapy. Prompt correction of the anemia might decrease the rate of this complication.
围手术期视力丧失（PVL）是指在远离视觉通路处进行手术后出现的视力丧失。缺血性视神经病变（ION）是PVL最常见的临床表现，且可为双侧性。
对2002年至2007年间检查的11例连续PVL患者进行回顾性病历审查。
11例患者均发现ION：8例为前部缺血性视神经病变（AION），3例为后部缺血性视神经病变（PION）。9例患者视力丧失为双侧性。Snellen视力表平均视力（VA）为0.2（LogMAR为0.74）。最常见的是弓形/象限性视野缺损。PVL发生于骨科手术（6例）、脊柱手术（1例）、心脏手术（2例）和血管手术（2例）后。手术至视力丧失的平均间隔时间为32小时（范围：0 - 96小时）。围手术期血红蛋白最低平均水平为75 g/L。平均随访时间为14.7个月。20只眼中有5只眼（25%）视力至少提高了2行Snellen视力表。
PVL是一种罕见但可怕的手术并发症，通常与严重贫血有关。与ION的其他病因一样，没有特异性治疗方法。及时纠正贫血可能会降低这种并发症的发生率。
