Update on Perioperative Ischemic Optic Neuropathy Associated With Non-ophthalmic Surgery

摘要

Perioperative visual loss (POVL) is a rare, serious complication of non-ophthalmic surgeries. Ischemic optic neuropathy (ION), and retinal arterial occlusion (RAO) are the main causes (, ). Less frequent are cortical blindness (), acute glaucoma (), and choroidal and vitreous hemorrhage (). ION is the most common cause for which the neurologist or neuro-ophthalmologist is consulted as it is associated either with a normal ophthalmic exam (posterior ION, PION), or less often, with optic nerve (ON) head swelling (anterior ION, AION). The presumed cause is impaired blood supply to the optic nerve (Figure ). The most common surgical procedures complicated by ION are cardiac surgery and spinal fusion. Retrospective studies, surveys, and case reports are the basis of most knowledge regarding peri-operative ION (poION), with cohort and case-control studies helping to identify candidate risk factors (, ). Animal models have provided insight regarding mechanisms (). This mini-review is an update on the latest advancements regarding poION in non-ophthalmic surgeries in epidemiological, clinical, and animal studies.Blood supply to the optic nerve and ON head structure. The blood supply is primarily from the ophthalmic artery. The posterior ON is supplied by pial branches of the ophthalmic artery posteriorly and the posterior ciliary arteries anteriorly; the supply to the central region is limited to the branches that penetrate deeply. The ON head is supplied by the circle of Zinn, from the short posterior ciliary arteries, and from choroidal vessels. The cup-to-disc ratio is the diameter of the central cup divided by diameter of the entire disc [Biousse and Newman () used with permission].