Lee A G
Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
J Neurosurg. 1995 Aug;83(2):348-9. doi: 10.3171/jns.1995.83.2.0348.
This 48-year-old hypertensive man, a cigarette smoker, awoke in the recovery room with visual loss in the right eye after uncomplicated lumbar spine surgery. His intraoperative blood pressure had been maintained at relatively low levels to reduce bleeding; a loss of 1500 cc of blood was reported. Postoperative hemoglobin was 4.2 g/dl less than the preoperative hemoglobin; however, the patient did not receive a blood transfusion. A postoperative ophthalmological examination revealed decreased visual acuity, color vision, and visual field in the right eye. The right optic nerve and retina were initially normal but the patient eventually developed optic nerve atrophy consistent with the clinical diagnosis of ischemic optic neuropathy. Neurosurgeons should be aware that this condition may follow uncomplicated lumbar spine surgery and should obtain prompt ophthalmological consultation when patients develop postoperative visual loss. Aggressive and rapid correction of blood pressure and hematocrit may be helpful in individuals who develop ischemic optic neuropathy after lumbar spine surgery.
这位48岁的男性高血压患者，有吸烟史，在腰椎手术顺利完成后于恢复室醒来时右眼视力丧失。术中血压维持在相对较低水平以减少出血，据报告失血量为1500毫升。术后血红蛋白比术前低4.2克/分升，但患者未接受输血。术后眼科检查显示右眼视力、色觉和视野下降。右眼视神经和视网膜最初正常，但患者最终发展为视神经萎缩，符合缺血性视神经病变的临床诊断。神经外科医生应意识到这种情况可能发生在腰椎手术顺利完成之后，当患者术后出现视力丧失时应及时寻求眼科会诊。对于腰椎手术后发生缺血性视神经病变的患者，积极快速地纠正血压和血细胞比容可能会有帮助。
