Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Can J Anaesth. 2019 Jul;66(7):772-780. doi: 10.1007/s12630-019-01323-w. Epub 2019 Feb 21.
Ocular injury and vision loss are rare complications of surgery. Spine surgery has been identified as particularly high risk for postoperative vision loss; nevertheless, ocular injuries have not been comprehensively assessed in this patient population.
This historical cohort study assessed incidence, cause, and risk factors of perioperative ocular injury after spine surgery at a tertiary care medical centre from January 1, 2006 through January 31, 2018. Patients were included who had ocular injury identified during an ophthalmology consultation in the first seven postoperative days. Differences in demographic, laboratory, intraoperative, and postoperative characteristics between those experiencing or not experiencing ocular injury were assessed with Fisher exact and Wilcoxon signed-rank tests for categorical and continuous variables, respectively.
Of 20,128 qualifying spine surgeries, 39 cases of perioperative ocular injuries were identified (39/20,128; 0.19% [95% confidence interval (CI), 0.14 to 0.26]). The most common ocular injury was blurry vision of unknown cause (13/39; 33%; 95% CI, 18.6 to 46.4), followed by ischemic optic neuropathy (9/39; 23%; 95% CI, 12.6 to 38.3) and corneal abrasion (7/39; 18%; 95% CI, 9.0 to 32.7). All cases of blurry vision of unknown cause were diagnosed via ophthalmology consultation and resolved within several days. Patients with perioperative ocular injury were more likely to have baseline anemia, have undergone fusion and instrumentation procedures, and had longer operative times with greater crystalloid, colloid, and transfusion requirements and more blood loss.
Although not representing a causal relationship, these data suggest that surgical factors may have a greater role than demographic characteristics or other clinical factors in the development of perioperative ocular injury. Surgeons, anesthesiologists, and patients should be aware of the increased risk of ocular injury that accompanies longer, more extensive spine operations.
眼部损伤和视力丧失是手术罕见的并发症。脊柱手术已被确定为术后视力丧失的高风险手术；然而，在这一患者群体中，尚未全面评估眼部损伤。
本回顾性队列研究评估了 2006 年 1 月 1 日至 2018 年 1 月 31 日期间，在一家三级护理医疗中心进行脊柱手术后，七日内眼科会诊中发现的围手术期眼部损伤的发生率、原因和危险因素。研究纳入了术中或术后发生眼部损伤并接受眼科会诊的患者。采用 Fisher 确切检验和 Wilcoxon 符号秩检验，分别对经历或未经历眼部损伤的患者的人口统计学、实验室、术中及术后特征进行差异评估。
在 20128 例符合条件的脊柱手术中，发现 39 例围手术期眼部损伤（39/20128；0.19% [95%置信区间，0.14 至 0.26]）。最常见的眼部损伤是原因不明的视力模糊（13/39；33%；95%置信区间，18.6 至 46.4），其次是缺血性视神经病变（9/39；23%；95%置信区间，12.6 至 38.3）和角膜擦伤（7/39；18%；95%置信区间，9.0 至 32.7）。所有原因不明的视力模糊病例均通过眼科会诊诊断，并在数天内得到解决。发生围手术期眼部损伤的患者更有可能基线贫血、行融合和器械固定手术，手术时间更长，晶体液、胶体液和输血需求更多，出血量更大。
尽管这些数据不代表因果关系，但数据提示手术因素可能比人口统计学特征或其他临床因素在围手术期眼部损伤的发生中起更大的作用。外科医生、麻醉师和患者应意识到，随着脊柱手术时间延长、手术范围扩大，眼部损伤的风险增加。
