Mất thị lực sau phẫu thuật cột sống tư thế nằm sấp: Báo cáo một trường hợp

Postoperative visual loss (PVL) represents a rare yet devastating complication in surgical practice, particularly significant in complex procedures like spine surgery performed in the prone position. Its severe consequences, ranging from blurred vision to permanent blindness, underscore the critical importance of understanding its diverse etiologies and implementing effective preventive strategies. While common causes such as ischemic optic neuropathy and central retinal artery occlusion are well-documented, this case report brings attention to acute angle-closure Glaucoma as a less frequently recognized but equally serious cause of PVL. By presenting a detailed clinical scenario, this study aims to enhance awareness among clinicians regarding the potential for this specific ocular complication and to highlight the imperative for meticulous pre-operative assessment and intra-operative vigilance to mitigate risks associated with prone position spine surgery.

Neurosurgeons, orthopedic spine surgeons, anesthesiologists, ophthalmologists, critical care physicians, and medical researchers focused on surgical complications and patient safety.

This academic case report thoroughly examines a rare instance of postoperative visual loss (PVL) attributed to acute angle-closure Glaucoma following prone position spine surgery. The paper meticulously documents the case of a 62-year-old female patient who developed severe ocular symptoms post-spinal fusion (L4-S1), ultimately diagnosed with acute angle-closure Glaucoma in both eyes. The authors discuss the patient's pre-existing conditions, including obesity and Cushing's syndrome, which are identified as potential contributing factors to the elevated intraocular pressure in the prone surgical position. The methodology involves a detailed clinical narrative, tracing the patient's journey from pre-operative assessment through diagnosis and treatment. The discussion section contextualizes this specific case within the broader understanding of PVL, reviewing established risk factors like peripheral vascular disease, hypertension, and anemia, and comparing the incidence of various PVL causes. Crucially, the report emphasizes that while PVL is infrequent, its severe outcomes necessitate a robust focus on prevention. It outlines recommendations from leading medical societies for pre-operative evaluation, intraoperative management of blood pressure and patient positioning, and post-operative ophthalmic monitoring. The value of this report lies in its contribution to understanding a less common mechanism of PVL, providing critical insights for anesthesiologists, neurosurgeons, and ophthalmologists to enhance patient safety. It strongly advocates for comprehensive risk stratification and prophylactic measures as the most effective approach to preventing such debilitating complications in complex spinal procedures.