American Society of Anesthesiologists Postoperative Visual Loss (POVL) Registry: Preliminary Analysis of 79 Cases

Abstract

Abstract: : Purpose: Due to increased awareness of POVL the American Society of Anesthesiologists (ASA) established the international POVL Registry in July 1999. The goal is to acquire a large database with detailed information on patient characteristics and preoperative conditions to better identify factors associated with this devastating complication occuring after non–ocular surgery. Methods: After IRB approval, we analyzed 79 cases submitted to the POVL Registry. For entry into the database, POVL onset must be within the first 7 days after anesthesia and surgery involving non–eye surgery. Cases are reported anonymously on a standardized form available on the Registry website (www.asaclosedclaims.org) that utilizes data abstracted from patients' medical records from the perioperative period. A link to the Registry website has also been available at the NANOS website, members section (nanosweb.org). Results: Most of the cases of post–operative visual loss were associated with spine surgery (67%), followed by coronary artery or valvular heart surgery (10%), and miscellaneous procedures (23%). Cases after spine surgery were further analyzed after breakdown into ischemic optic neuropathy (ION) and central retinal artery occlusion (CRAO) (see table). The spine operations were performed with the patient in the prone position. Conclusions: Visual loss due to ION after spine surgery occured in 8 patients where the head had been secured in a Mayfield head holder, with no possibility of pressure on the eyes and face. In contrast, no CRAO patients were in a head holder. Blood loss and operative duration were longer in ION compared to CRAO patients, and bilateral involvement was more common in ION patients. ION also occured in young patients, with relatively short operative durations, with low blood loss, with normal hematocrit, or without hypotension. ASA Postoperative Visual Loss Registry: Spine Cases # 

Keywords: optic disc • clinical (human) or epidemiologic studies: outcomes/complications • ischemia