Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.
Spine J. 2010 Sep;10(9):e7-9. doi: 10.1016/j.spinee.2010.07.006.
Multiple studies have reported that facedown positioning can result in elevation of intraocular pressure (IOP) in individuals susceptible to angle-closure glaucoma. Before advances in diagnostic modalities, prone tests were popularly performed in ophthalmology practices as provocative tests for detecting potentially occludable angles. In patients with a positive test result, direct observation shows that the anterior chamber shallows and the angle closes over time, compromising aqueous humor outflow facility. Furthermore, the degree of angle narrowing is proportional to the rise in IOP. A common scenario involving a prone position is spine surgery, which can last several hours with the patient unconscious.
To report a case of a patient who developed bilateral acute angle-closure glaucoma after facedown spine surgery.
Case report and literature review.
A 68-year-old Caucasian woman presented with persistent low back and left lower extremity pain. History was remarkable for L5 radicular pain, spinal stenosis, and an L3-L4 laminectomy performed 6 months previously. Plain films showed instability at the L4-L5 level and degenerative disc disease and scoliosis at L2-L4. The patient underwent spinal fusion surgery.
Postoperatively, the patient complained of pain in the left eye accompanied with nausea and vomiting. Ophthalmology consultation confirmed the diagnosis of bilateral acute angle-closure glaucoma, requiring medical therapy initially followed by laser iridotomies in both eyes.
Bilateral acute angle-closure glaucoma may occur as a complication of facedown spine surgery. It is essential for anesthesiologists and surgeons to be aware of this complication for accurate diagnosis and timely intervention. A preoperative evaluation by an ophthalmologist should be considered for those individuals who are at increased risk of developing angle-closure glaucoma, such as certain ethnicities, including Asians, Canadians, and Eskimos; female gender; hyperopic eyes with a shorter axial length; family history; history of previous attacks in the subject; and so forth. Prophylactic laser iridotomy in eyes with potentially occludable angles is a simple and safe office procedure that can prevent potentially devastating visual outcomes.
多项研究报告称，仰卧位可能导致易患闭角型青光眼的个体眼内压（IOP）升高。在诊断技术进步之前，俯卧位检查在眼科实践中作为一种有争议的检查方法，用于检测潜在可阻塞的角度。在测试结果阳性的患者中，直接观察显示前房变浅，角度随时间推移而关闭，从而影响房水流出。此外，角度变窄的程度与 IOP 升高成正比。涉及俯卧位的常见情况是脊柱手术，患者可能在麻醉状态下持续数小时。
报告一例患者在俯卧位脊柱手术后发生双侧急性闭角型青光眼。
病例报告和文献复习。
一名 68 岁白人女性因持续性腰痛和左下肢疼痛就诊。病史包括 L5 神经根痛、脊柱狭窄症和 6 个月前进行的 L3-L4 椎板切除术。平片显示 L4-L5 水平不稳定，L2-L4 退行性椎间盘疾病和脊柱侧凸。患者接受了脊柱融合手术。
术后，患者诉左眼疼痛，伴有恶心和呕吐。眼科会诊确诊为双侧急性闭角型青光眼，最初需要药物治疗，随后双眼行激光虹膜切开术。
俯卧位脊柱手术后可能会发生双侧急性闭角型青光眼。麻醉师和外科医生需要了解这种并发症，以便进行准确诊断和及时干预。对于那些有发生闭角型青光眼风险增加的个体，如某些种族（包括亚洲人、加拿大人和爱斯基摩人）、女性、远视眼伴有较短的眼轴长度、家族史、既往发作史等，应考虑在术前由眼科医生进行评估。对于可能存在阻塞性角度的眼睛，预防性激光虹膜切开术是一种简单而安全的门诊手术，可以预防潜在的破坏性视力结果。
