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      Bilateral Simultaneous Anterior Ischemic Optic Neuropathy following Total Knee Arthroplasty with Epidural Block

      case-report

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          Abstract

          Ischemic optic neuropathy (ION) resulting in perioperative vision loss (POVL) is a rare occurrence following nonocular procedures. Bilateral simultaneous anterior ION (AION) is even rarer, and no cases have been reported after central neuraxial block. We report a case of bilateral simultaneous AION, confirmed by multimodal imaging, in a 66-year-old male patient who underwent total knee arthroplasty under epidural anesthesia in which episodes of hypotension—one intraoperatively and one late postoperatively—had occurred. Hypotension is the most common adverse effect to epidural block, and counseling about POVL should extend beyond general anesthesia to include those undergoing procedures with central neuraxial block.

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          Epidural anesthesia, hypotension, and changes in intravascular volume.

          N. Foss, Henrik Kehlet, C. Lund … (2004)
          The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase when hypotension is present, which may have implications for the choice of treatment of hypotension. However, no long-term information or measurements of plasma volumes with or without hypotension after epidural anesthesia are available. In 12 healthy volunteers, the authors assessed plasma (125I-albumin) and erythrocyte (51Cr-EDTA) volumes before and 90 min after administration of 10 ml bupivacaine, 0.5%, via a thoracic epidural catheter (T7-T10). After 90 min (t = 90), subjects were randomized to administration of fluid (7 ml/kg hydroxyethyl starch) or a vasopressor (0.2 mg/kg ephedrine), and 40 min later (t = 130), plasma and erythrocyte volumes were measured. At the same time points, mean corpuscular volume and hematocrit were measured. Systolic and diastolic blood pressure, heart rate, and hemoglobin were measured every 5 min throughout the study. Volume kinetic analysis was performed for the volunteers receiving hydroxyethyl starch. Plasma volume did not change per se after thoracic epidural anesthesia despite a decrease in blood pressure. Plasma volume increased with fluid administration but remained unchanged with vasopressors despite that both treatments had similar hemodynamic effects. Hemoglobin concentrations were not significantly altered by the epidural blockade or ephedrine administration but decreased significantly after hydroxyethyl starch administration. Volume kinetic analysis showed that the infused fluid expanded a rather small volume, approximately 1.5 l. The elimination constant was 56 ml/min. Thoracic epidural anesthesia per se does not lead to changes in blood volumes despite a reduction in blood pressure. When fluid is infused, there is a dilution, and the fluid initially seems to be located centrally. Because administration of hydroxyethyl starch and ephedrine has similar hemodynamic effects, the latter may be preferred in patients with cardiopulmonary diseases in which perioperative fluid overload is undesirable.
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            The frequency of perioperative vision loss.

            Wayne D Warner, Ian Mackenzie, Sean Garrity … (2001)
            The frequency of perioperative vision loss, especially for spinal surgery, has been increasing recently. We undertook a retrospective study to determine the frequency of this outcome in a large surgical population receiving general or central neuraxis regional anesthesia for noncardiac procedures from 1986 to 1998. Specific criteria were used to separate cases in which the surgical procedure likely directly contributed to the vision loss. Vision loss was present if any part of the visual field was affected. Initial database screening found 405 cases of new-onset vision loss or visual changes in 410,189 patients who underwent 501,342 anesthetics and who survived at least 30 days after their final procedures. Two hundred sixteen of these patients regained full vision or acuity within 30 days. Of the 189 patients who developed vision deficits for longer than 30 days, 185 underwent ophthalmologic or neurologic procedures in which ocular or cerebral tissues were surgically damaged or resected. The remaining 4 patients (1 per 125,234 overall; 0.0008%) developed prolonged vision loss without direct surgical trauma to optic or cerebral tissues. In this large study population of noncardiac surgical patients, including those who underwent spinal surgical procedures, the frequency of perioperative vision loss persisting for longer than 30 days was very small. Vision loss and blindness after surgery and anesthesia is a very rare event. In this study, only one per 125,234 patients undergoing noncardiac surgery developed vision loss persisting for longer than 30 days.
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              Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss.

              (2012)
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                Author and article information

                Contributors
                Yousef A. Fouad:
                ORCID: https://orcid.org/0000-0002-2954-2917
                Journal
                Journal ID (nlm-ta): Case Rep Ophthalmol Med
                Journal ID (iso-abbrev): Case Rep Ophthalmol Med
                Journal ID (publisher-id): CRIOPM
                Title: Case Reports in Ophthalmological Medicine
                Publisher: Hindawi
                ISSN (Print): 2090-6722
                ISSN (Electronic): 2090-6730
                Publication date Collection: 2021
                Publication date (Electronic): 7 June 2021
                Volume: 2021
                Electronic Location Identifier: 9952500
                Affiliations
                1Al Mashreq Eye Center, Cairo, Egypt
                2Department of Ophthalmology, Ain Shams University Hospitals, Cairo, Egypt
                Author notes

                Academic Editor: Takaaki Hayashi

                Author information
                https://orcid.org/0000-0002-8009-7214
                https://orcid.org/0000-0002-2954-2917
                Article
                DOI: 10.1155/2021/9952500
                PMC ID: 8205573
                PubMed ID: 34211795
                SO-VID: 20af7311-06f9-4859-b815-b8f7be75bde1
                Copyright © Copyright © 2021 Ahmed M. Habib et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 5 March 2021
                Date accepted : 29 May 2021
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Ophthalmology & Optometry
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry

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