Perioperative visual loss: what do we know, what can we do?

Abstract

Perioperative visual loss (POVL), a rare, but devastating complication, can follow non-ocular surgery. Highest rates of visual loss are with cardiac and spine surgery. The main causes of visual loss after non-ocular surgery are retinal vascular occlusion and ischaemic optic neuropathy. This review updates readers on the incidence, suspected risk factors, diagnosis, and treatment of POVL due to these conditions.

Figures

Fig 1

Origin, course, and branches of the ophthalmic artery, including the posterior ciliary arteries, seen from above. Ant. sup. hyp. art., anterior superior hypophyseal artery; CAR, central retinal artery; Col. Br., collateral branches; CZ, circle of Zinn and Haller; ICA, internal carotid artery; LPCA, lateral posterior ciliary artery; MPCA, medial posterior ciliary artery; OA, ophthalmic artery; Rec. br., recurring branches. Figure reproduced with permission from Hayreh SS. ‘The central artery of the retina. Its role in the blood supply of the optic nerve.’ Br J Ophthalmol 1963; 47: 651–63 (later reproduced in Pillanut and colleagues).

Fig 2

Mechanisms of retinal ischaemia. Modified with permission from Roth.