The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
J Clin Anesth. 2017 Dec;43:50-58. doi: 10.1016/j.jclinane.2017.09.009. Epub 2017 Oct 3.
Postoperative vision loss following a major spine operation is a rare but life-changing event. Most of reports have been linked to ischemic optic neuropathy, and patients undergoing surgery for scoliosis correction or posterior lumbar fusion seem to be at the highest risk. Despite that some key risk factors have been identified, much of the pathophysiology still remain unknown. In fact, whereas only a minority of patients at high risk will present this complication, others with similar risk factors undergoing different procedures may not develop it at all. On the other hand, even when all preventive measures have been taken, ischemic optic neuropathy may still occur. Therefore, it is appropriate for clinicians involved in these cases to inform their patients about the existence of a small but unpredictable risk of vision loss. Since ischemic optic neuropathy is deemed to be the leading cause of vision loss in the context of major spine surgery in prone position, this review will be focused on its main aspects related to the frequency, diagnosis, predisposing factors, and prevention. Regrettably, no treatment has been proved to be effective for this condition.
术后视力丧失是一种罕见但改变生活的事件，主要与缺血性视神经病变有关，接受脊柱侧凸矫正或后路腰椎融合术的患者似乎风险最高。尽管已经确定了一些关键的危险因素，但大部分病理生理学仍不清楚。事实上，只有少数高危患者会出现这种并发症，而其他具有类似危险因素的患者即使进行了不同的手术也可能不会出现这种并发症。另一方面，即使采取了所有预防措施，缺血性视神经病变仍可能发生。因此，参与这些病例的临床医生应该告知患者存在视力丧失的小但不可预测的风险。由于缺血性视神经病变被认为是俯卧位大脊柱手术中导致视力丧失的主要原因，因此本次综述将重点关注其与频率、诊断、易患因素和预防相关的主要方面。遗憾的是，目前还没有治疗这种疾病的有效方法。
