Ophthalmological changes after posterior spine surgeries: A prospective study

Introduction: Postoperative visual loss (POVL) after posterior approach to spine surgeries is a devastating complication necessitating a prospective study. The primary aim was to identify ophthalmological changes contributing to POVL (visual acuity, anterior segment, intraocular pressure (IOP), fundus, field of vision, external ocular examination). Secondary objectives was to evaluate the relationship between ophthalmological changes and various perioperative data including patient comorbidities, positioning and other intraoperative details. Materials and Methods: After getting necessary approvals and consent, thirty patients posted for the posterior spine surgeries were assessed preoperatively. Ophthalmological examination was conducted preoperatively, the day before surgery and postoperatively twice (first within an hour of completion of surgery and second at twenty four hours). Perioperatively, data including type of surgical frame, headrest used, duration of prone positioning, total blood loss, total intravenous fluids administered, lowest mean arterial pressure for more than ten minutes, blood transfusion details and use of hypotensive anaesthesia were noted. Data were analyzed using chi-square test, paired t test, and correlation coefficient. Results: There were no changes in visual acuity, anterior segment, fundus and field of vision postoperatively. But 12 patients had a rise in IOP and six developed lid edema and chemosis. There was a minimal increase in IOP at one hour post operatively (right eye- 2.8 mm Hg (p=0.001, and left eye- 3 mmHg(p<0.001). The analysis of perioperative data revealed no relationship with ophthalmological changes noted. Conclusion: There were no clinically significant ophthalmological changes contributing to POVL in spine surgeries in prone position. Observed ophthalmological changes did not have any correlation with patient comorbidities, positioning and other intraoperative details.