Lee Soo Hee, Chung Inyoung, Choi Dae Seob, Shin Il-Woo, Kim Sunmin, Kang Sebin, Kim Ji-Yoon, Chung Young-Kyun, Sohn Ju-Tae
Department of Anesthesiology and Pain Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital Department of Ophthalmology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital Department of Radiology & Gyeongnam Cerebrovascular Center, Gyeongsang National University Hospital Institute of Health Sciences, Gyeongsang National University, Jinju-si, Gyeongsangnam-do, Republic of Korea.
Medicine (Baltimore). 2017 Aug;96(31):e7379. doi: 10.1097/MD.0000000000007379.
Visual loss after spine surgery in the prone position is a serious complication. Several cases of central retinal artery occlusion with ophthalmoplegia after spine surgery have been reported in patients with ophthalmic arteries fed by the internal carotid artery (ICA) in a normal manner.
A 74-year-old man developed visual loss after undergoing a spinal decompression and fusion operation in the prone position that lasted approximately 5 hours.
We detected an extremely rare case of visual loss due to optic nerve infarction and central retinal artery occlusion through fundoscopic examination, fluorescein angiogram, brain magnetic resonance imaging, and magnetic resonance angiography. The patient's visual loss may have been caused by compromised retrograde collateral circulation of the ophthalmic artery from branches of the external carotid artery in the presence of proximal ICA occlusion after a spinal operation in the prone position.
To recover movement of the left extraocular muscles, the patient received intravenous injections of methylprednisolone for 3 days and then oral prednisolone for 6 days.
Twenty days after the treatment, the motion of the left extraocular muscles was significantly improved. However, recovery from the left visual loss did not occur until 4 months after the operation.
In high-risk patients with retrograde collateral circulation of the ophthalmic artery from the external carotid artery due to proximal ICA occlusion, various measures, including the use of a head fixator to provide a position completely free of direct compression of the head and face, should be considered to decrease the risk of postoperative visual loss.
俯卧位脊柱手术后视力丧失是一种严重的并发症。已有数例正常情况下由颈内动脉（ICA）供血的眼动脉患者在脊柱手术后发生中央视网膜动脉阻塞并伴有眼肌麻痹的病例报道。
一名74岁男性在俯卧位接受了持续约5小时的脊柱减压融合手术后出现视力丧失。
通过眼底检查、荧光素血管造影、脑磁共振成像和磁共振血管造影，我们发现了一例极为罕见的因视神经梗死和中央视网膜动脉阻塞导致的视力丧失病例。该患者的视力丧失可能是由于俯卧位脊柱手术后近端ICA闭塞，眼动脉来自颈外动脉分支的逆行侧支循环受损所致。
为恢复左眼球外肌的运动，患者接受了3天的静脉注射甲基泼尼松龙治疗，随后口服泼尼松龙6天。
治疗20天后，左眼球外肌的运动明显改善。然而，直到术后4个月，左眼视力丧失才得以恢复。
对于因近端ICA闭塞导致眼动脉有逆行侧支循环的高危患者，应考虑采取各种措施，包括使用头部固定器以提供完全避免头部和面部直接受压的体位，以降低术后视力丧失的风险。
