[Loss of vision after non-ophthalmic surgery: systematic review of the literature on incidence, pathogenesis, treatment and prevention].

BACKGROUND AND GOAL: Postoperative loss of vision is a rare, but devastating complication after non-ocular surgery. It can occur partially or completely and may involve one or both eyes. Since its etiology has not yet been solved, the purpose of this review was to extract potential causes from the case collections reported to propose prophylactic measures.
METHODS: A literature search was performed using the "Pubmed" database of the US National Library of Medicine. MeSH terms and combinations used were: blindness, postoperative complications, ischemic optic neuropathy, not ophthalmological surgical procedures, not neurosurgical procedures. Additionally, the results of the interim analysis of the postoperative visual loss (POVL) registry of the ASA were considered.
RESULTS: The incidence of permanent loss of vision after non-ophthalmologic surgery is reported to be 0.0008%. However, it is elevated up to 0.11% after cardiac and 0.08% after spine surgery. Risk factors seem to be perioperative anemia, arterial hypotension and prone position, but also pre-existing diseases such as arteriosclerosis. Thus hemodynamic stabilization or correction of anemia may be successful in therapy.
CONCLUSION: Patients with pre-existing arteriosclerotic disease scheduled for spine or cardiac surgery, but also for bilateral neck dissection should be informed preoperatively about the rare possibility of POVL. Postoperatively any visual changes should be immediately referred to an ophthalmologist and treated accordingly.