March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Posterior Ischemic Optic Neuropathy: Perioperative Risk Factors
Author Affiliations & Notes
  • Michelle Y. Wang
    Ophthalmology, USC/Doheny Eye Institute, Los Angeles, California
  • J R. Brewer
    Ophthalmology, USC/Doheny Eye Institute, Los Angeles, California
  • Alfredo A. Sadun
    Ophthalmology, USC/Doheny Eye Institute, Los Angeles, California
  • Footnotes
    Commercial Relationships  Michelle Y. Wang, None; J. R. Brewer, None; Alfredo A. Sadun, None
  • Footnotes
    Support  Research to Prevent Blindness
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 4888. doi:
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      Michelle Y. Wang, J R. Brewer, Alfredo A. Sadun; Posterior Ischemic Optic Neuropathy: Perioperative Risk Factors. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4888.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To investigate perioperative risk factors of posterior ischemic optic neuropathy (PION).

Methods: : This is a retrospective study of 55 subjects and 103 eyes with visual loss due to PION who were evaluated at Doheny Eye Institute between 2000 and 2008. The data extracted from chart review included age, unilateral vs bilateral involvement, visual acuity (VA), type and length of surgery, amount of blood loss, lowest blood pressure, lowest hematocrit, known cardiovascular risk factors, and presence of facial edema.

Results: : The age range of the subjects was 10-94 years. Forty-eight (87.3%) subjects had bilateral involvement. Forty-two eyes (40.8%) had no light perception (NLP), six (5.8%) had light perception (LP), eleven (10.7%) had hand motion (HM), nine (8.7%) had count finger (CF), four (3.9%) had 20/400, six (5.8%) had 20/200, and twenty-five (24.3%) had 20/100 or better vision. Subjects were further sub-grouped based on the type of surgery performed prior to visual loss: spinal (44 eyes, 23 subjects), cardiovascular-abdominal (CV-ABD) (32 eyes, 16 subjects), and others (28 eyes, 16 patients). In comparison to the "others" group, spinal (p=0.04) and CV-ABD (p=0.007) groups had poorer VA. VA was associated with the type of surgery (p=0.01) and color vision was associated with age (p=0.04).There were twenty cases with recorded surgery length, ranging from 3 to 12 hours with an average of 7.9 hours. The shortest surgery was 3 hours which led to a VA of 20/50 or better whereas surgeries longer than four hours gave at least one eye NLP (57.9%), LP (2.6%), HM (7.9%), CF (7.9%), except for one spinal surgery. Postoperative facial edema was recorded in eight (34.8%) spinal, four (25%) CV-ABD, and zero others groups (p=0.01).

Conclusions: : PION is characterized by watershed infarction of the posterior segment of the optic nerve often following non-ocular operations. This study provides evidence further corroborating that PION is associated with spinal, cardiovascular, and abdominal surgeries, longer duration in the prone position, and facial edema. PION results from hypoxia of the optic nerve which is a product of the oxygen-carrying capacity in the blood and the amount of blood flow to the optic nerve. Therefore, the risk of PION is inversely related to hematocrit x (blood pressure-tissue perfusion pressure). This formula may be useful in risk stratification for high-risk surgeries in patients with known risk factors for PION.

Keywords: clinical (human) or epidemiologic studies: risk factor assessment • ischemia • visual impairment: neuro-ophthalmological disease 

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