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Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 167-173

Posterior ischemic optic neuropathy: Perioperative risk factors

1 Department of Ophthalmology, Southern California Permanente Medical Group, Los Angeles, California, USA
2 San Antonio Health Science Center and San Antonio Uniformed Services Health Education Consortium, University of Texas, Austin, Texas, USA
3 Department of Ophthalmology, Doheny Eye Institute, UCLA, Pasadena, California, USA

Correspondence Address:
Dr. Michelle Y Wang
1515 N Vermont Ave., Los Angeles, California 90027
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tjo.tjo_41_20

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Perioperative posterior ischemic optic neuropathy (PION) is a rare but devastating condition. Visual impairment is commonly bilateral, profound, and irreversible. The most frequently associated triggering events are spine surgeries, other orthopedic surgeries, cardiac bypass surgeries, and radical neck dissection. The etiology is multifactorial. The most commonly reported risk factors are severe and prolonged hypotension, anemia, hemodilution, orbital and periorbital edema, direct orbital compression by prone position, and abnormal autoregulation. This review discusses the current literature on perioperative PION and includes a study conducted by our group to investigate the perioperative risk factors of PION in order to better understand the pathogenesis and help identify high-risk patients. Our results provide further corroborating evidence that PION is associated with spinal, cardiovascular, and abdominal surgeries, longer duration of procedure, and facial edema. Anemia and chronic hypertension are frequent risk factors. Treatment for perioperative PION is uncertain and depends largely on the immediate reversal of hemodynamic alterations. Hence, it is important to identify patients at risk and accordingly take prophylactic measures to prevent its occurrence. Optimizing hemoglobin levels, hemodynamic status, and tissue oxygenation is crucial.

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