Perioperative posterior ischemic optic neuropathy: review of the literature

• Published in: Survey of ophthalmology Vol. 50; no. 1; pp. 15 - 26
• Main Authors: Buono, Lawrence M., Foroozan, Rod
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2005; Elsevier Science
• Subjects: Biological and medical sciences; blindness after surgery; cardiopulmonary bypass; coronary artery bypass; Diseases of visual field, optic nerve, optic chiasma and optic tracts; Humans; Medical sciences; Ophthalmology; optic nerve atrophy; Optic Neuropathy, Ischemic - epidemiology; Optic Neuropathy, Ischemic - etiology; perioperative PION; perioperative visual loss; posterior ischemic optic neuropathy; Postoperative Complications; postoperative visual loss registry; radical neck dissection; retrobulbar optic neuropathy; spine surgery; Surgical Procedures, Operative - adverse effects; Vision disorders; Vision Disorders - epidemiology; Vision Disorders - etiology; Visual Acuity; retrobulbar optic neuropathy; posterior ischemic optic neuropathy; perioperative PION; radical neck dissection; cardiopulmonary bypass; spine surgery; coronary artery bypass; perioperative visual loss; postoperative visual loss registry; optic nerve atrophy; blindness after surgery; Optic neuropathy; Spine; Vision disorder; Cardiovascular disease; Review; Radical; Retrobulbar; Ischemia; Surgery; Blood vessel; Posterior; Neck; Ophthalmology; Dissection; Postoperative; Nervous system diseases; Optic nerve atrophy; Literature; Pions; Coronary artery; Spines; Cardiopulmonary bypass; Perioperative; Eye disease; Cranial nerve disease; Treatment; Bypass; Visual impairment; Blindness; Bibliographic review
• ISSN: 0039-6257; 1879-3304
• DOI: 10.1016/j.survophthal.2004.10.005

Posterior ischemic optic neuropathy (PION) is an uncommon cause of perioperative visual loss. Perioperative PION has been most frequently reported after spinal surgery and radical neck dissection. The visual loss typically presents immediately after recovery from anesthesia, although it may be delayed by several days. Visual loss is often bilateral and profound with count fingers vision or worse. The examination findings are consistent with an optic neuropathy; however the funduscopic examination is initially normal. The cause is unknown, although patient-specific susceptibility to perioperative hemodynamic derangements is likely. No treatment has proven to be effective. The prognosis for visual recovery is generally poor.