Michalak Suzanne M, Mukherjee Nisha, Gospe Sidney M
Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
Retin Cases Brief Rep. 2022 May 1;16(3):285-288. doi: 10.1097/ICB.0000000000000982. Epub 2020 Feb 6.
To report the first two observations of bilateral paracentral acute middle maculopathy in the early postoperative period after cardiopulmonary bypass procedures.
Comprehensive ophthalmic examinations were performed, including best-corrected visual acuity, Humphrey visual field testing, dilated fundus examination, and optical coherence tomography.
Two patients complained of unilateral vision loss after cardiac surgery involving cardiopulmonary bypass. Unilateral optic disc edema consistent with ischemic optic neuropathy was observed in the symptomatic eye of each patient, whereas scattered cotton-wool spots were identified bilaterally. In addition, optical coherence tomography imaging revealed bilateral paracentral acute middle maculopathy, correlating with visual field defects detected on automated perimetry in the asymptomatic eyes.
Although symptomatic postoperative vision loss is a rare complication of cardiac surgery, intraoperative retinal microvascular nonperfusion as a consequence of extracorporeal circulation of blood may be a more common and under-recognized occurrence.
报告心肺转流手术后早期双侧旁中心急性黄斑病变的首例两例观察病例。
进行了全面的眼科检查，包括最佳矫正视力、Humphrey视野测试、散瞳眼底检查和光学相干断层扫描。
两名患者在涉及心肺转流的心脏手术后出现单侧视力丧失。每名患者的患眼均观察到与缺血性视神经病变一致的单侧视盘水肿，而双侧均发现散在的棉絮斑。此外，光学相干断层扫描成像显示双侧旁中心急性黄斑病变，与无症状眼自动视野检查中检测到的视野缺损相关。
虽然术后有症状的视力丧失是心脏手术罕见的并发症，但体外循环导致的术中视网膜微血管无灌注可能是一种更常见且未被充分认识的情况。
