University of Chicago

0.0000016%

Mayo Clinic (Cx no cardiaca)

0.0008%

Mayo Clinic (CABG)

0.06%

John Hopkins (Cx Columna)

0.028%

ASA POVL Registry

0.2 - 4.5%

NIS (CABG)

0.08%

NIS (Columna)

0.03%

Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610 Shen Y, Drum M, Roth S. The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg. 2009 Nov;109(5):1534-45. Epub 2009 Aug 27.

Pérdida de visión perioperatoria Se refiere a la alteración permanente o pérdida total de la visión durante un procedimiento de columna en el cual se administra anestesia general

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

Cámara Anterior

Abrasión corneal

Retina

Oclusión Art. Central Retina

Vías Retroquiásmicas

Infartos origen embólico

Lesión Nervio Óptico

Neuropatía Óptica Isquémica

Anterior

Posterior

Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Etiología: Compresión externa del globo ocular * Cabeza en mala posición PIO > PAM

Generalmente unilateral Acompañado de otros signos de trauma periocular Ptosis Eritema Abrasión Corneal Oftalmoplegía

CRITERIOS DIAGNÓSTICOS

Retina pálida isquémica

Punto rojo cereza en la mácula Defecto pupilar aferente

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

ANTERIOR Fondo de ojo temprano : disco edematoso con o sin hemorragias peripapilares en forma de llama Defecto aferente en reflejo pupilar

POSTERIOR Fondo de ojo temprano : normal Defecto aferente en reflejo pupilar o ausencia del mismo Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Palidez del nervio óptico Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

ANTERIOR Irrigación: arterias ciliares posteriores

POSTERIOR Irrigación: Plexo vascular de la pia y art central de la retina Dentro de cavidad ósea

Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond). 2004 Nov;18(11):1188-206.

Multifactorial Etiología Vascular: venosa vs arterial?? Pobre contenido de oxígeno Compresión local del plexo de la pia Aumento de presión venosa

Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol. 2008 Apr;145(4):604-610 Hayreh SS. Posterior ischaemic optic neuropathy: clinical features, pathogenesis, and management. Eye (Lond). 2004 Nov;18(11):1188-206.

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

Edad Presión sobre globo ocular Hipotensión Anemia Duración procedimiento

Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, Domino KB. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006 Oct;105(4):652-9; quiz 867-8.

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

Paciente de Alto Riesgo Cirugía de Columna

Prono Procedimiento prolongado Pérdida de sangre importante

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

No valoración preoperatoria por oftalmología o neuro-oftalmología Pacientes de alto riesgo explicar posibilidad de pérdida de visión Monitorizar presión arterial de forma continua en

pacientes de alto riesgo Uso de técnicas hipotensivas no se asocia a aumento en el riesgo de POVL American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

Mantener volumen intravascular con coloides y cristaloides Considerar monitoreo de PVC en alto riesgo Monitorizar niveles de Hb-Hto en pacientes de alto riesgo con pérdida substancial de sangre

No existe un límite definido ni un umbral para transfusión adecuado

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

Compresión no es causa de ION, pero debe prevenirse al ser causa de CRAO Mantener la cabeza a nivel o por encima del corazón Cabeza en posición neutra

Evaluar posibilidad de hacer procedimiento por etapas

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28

Evaluar visión al recuperar conciencia

Normal

SI

NO

Valoración por oftalmología NO

ION

Examen Normal SI

Manejar según causa

Neuroimágenes

NO

Otra Causa

SI

American Society of Anesthesiologists Task Force on Perioperative Blindness. Practice advisory for perioperative visual loss associated with spine surgery: a report by the American Society of Anesthesiologists Task Force on Perioperative Blindness. Anesthesiology. 2006 Jun;104(6):1319-28