No significant retinal damage induced by major orthopedic surgery - a pilot study.
anesthesia
optical coherence tomography
orthopedic surgery
Journal
Biomedical papers of the Medical Faculty of the University Palacky, Olomouc, Czechoslovakia
ISSN: 1804-7521
Titre abrégé: Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub
Pays: Czech Republic
ID NLM: 101140142
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
08
11
2020
accepted:
07
04
2021
pubmed:
23
4
2021
medline:
20
5
2022
entrez:
22
4
2021
Statut:
ppublish
Résumé
Perioperative visual loss is one of the rare but devastating complications of anesthesia and surgery. The incidence of less severe or even subclinical postoperative visual dysfunction is unknown. Therefore, we decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT). Adult patients indicated for elective knee replacement surgery with the absence of known retinal or optic nerve disease were included. Each patient underwent baseline OCT examination of the eyes one day before surgery and it was repeated 4-7 days after the surgery. The surgery was done under general and epidural anesthesia. A total of 18 patients (6 men and 12 women) at the age of 70.8±7.1 years were enrolled. We found statistically significant changes in the Macular central thickness and in a few areas of the Retinal Nerve Fiber Layer between the baseline and postoperative measurements. Even though we found significant changes in some parameters, we did not confirm that general anesthesia and/or surgical damage causes significant damage of the retina using OCT measurement. ClinicalTrials.gov (NCT04311801).
Sections du résumé
BACKGROUND
BACKGROUND
Perioperative visual loss is one of the rare but devastating complications of anesthesia and surgery. The incidence of less severe or even subclinical postoperative visual dysfunction is unknown. Therefore, we decided to perform a pilot prospective observational clinical study to evaluate whether structural changes of the retina can be detected in patients undergoing elective orthopaedic surgery by optical coherence tomography (OCT).
METHODS
METHODS
Adult patients indicated for elective knee replacement surgery with the absence of known retinal or optic nerve disease were included. Each patient underwent baseline OCT examination of the eyes one day before surgery and it was repeated 4-7 days after the surgery. The surgery was done under general and epidural anesthesia.
RESULTS
RESULTS
A total of 18 patients (6 men and 12 women) at the age of 70.8±7.1 years were enrolled. We found statistically significant changes in the Macular central thickness and in a few areas of the Retinal Nerve Fiber Layer between the baseline and postoperative measurements.
CONCLUSIONS
CONCLUSIONS
Even though we found significant changes in some parameters, we did not confirm that general anesthesia and/or surgical damage causes significant damage of the retina using OCT measurement.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov (NCT04311801).
Banques de données
ClinicalTrials.gov
['NCT04311801']
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
217-221Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Roth S. Perioperative visual loss: what do we know, what can we do? Br J Anaesth 2009;103(1):31-40.
doi: 10.1093/bja/aep295
Fujimoto J, Swanson E. The Development, Commercialization, and Impact of Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2016; 1/57(9):OCT1-OCT13.
pubmed: 27409459
doi: 10.1167/iovs.16-19963
Ang, M, Tan AC, Cheung CM. Optical coherence tomography angiography: a review of current and future clinical applications. Graefes Arch Clin Exp Ophthalmol 2018; 256:237-45.
doi: 10.1007/s00417-017-3896-2
Weber KL, Jevsevar DS, McGrory BJ. AAOS Clinical Practice Guideline: Surgical Management of Osteoarthritis of the Knee: Evidence-based Guideline. J Am Acad Orthop 2016; 24(8):94-6.
doi: 10.5435/JAAOS-D-16-00160
Waheed N, Duker J. OCT in the Management of Diabetic Macular Edema. Curr Ophthalmol Rep 2013;1:128-33.
doi: 10.1007/s40135-013-0019-z
Matuskova V, Lizrova Preiningerova J, Michalec M, Kasl Z, Vlkova E. The Use of Optical Coherence Tomography in Multiple Sclerosis. Cesk Slov Neurol N 2016;79/112(1)33-40.
doi: 10.14735/amcsnn201633
Wu H, de Boer JF, Chen TC. Diagnostic capability of spectraldomain optical coherence tomography for glaucoma. Am J Ophthalmol 2012;153(5):815-26.
doi: 10.1016/j.ajo.2011.09.032
ASA Physical Status Classification System. https://www.asahq.org/standardsand-guidelines/asa-physical-status-classification-system. Last amended: October 23, 2019.
Murphy MA. Bilateral posterior ischaemic optic neuropathy after lumbar spine surgery. Ophthalmology 2003;110:1454-7.
pubmed: 12867409
doi: 10.1016/S0161-6420(03)00480-9
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; 109(5):1534-45.
pubmed: 19713263
doi: 10.1213/ane.0b013e3181b0500b
Hironobu H, Kawaguchi M, Okamoto M, Hasuwa K, Matsuura T, Taniguchi S, Furuya H. Asymptomatic and Symptomatic Postoperative Visual Dysfunction After Cardiovascular Surgery With Cardiopulmonary Bypass: A Small-Sized Prospective Observational Study. J Cardiothorac Vasc Anesth 2013;27(5):884-9.
pubmed: 24054186
doi: 10.1053/j.jvca.2013.01.026
Osborne NN, Casson RJ, Wood JP, Chidlow G, Graham M, Melena J. Retinal ischemia: mechanisms of damage and potential therapeutic strategies. Prog Retin Eye Res 2004;23(1):91-147.
pubmed: 14766318
doi: 10.1016/j.preteyeres.2003.12.001
Rozanowska MB. Light-induced damage to the retina: current understanding of the mechanisms and unresolved questions: a symposium-in-print. Photochem Photobiol 2012;88(6):1303-8.
doi: 10.1111/j.1751-1097.2012.01240.x
Bhende M, Shetty S, Parthasarathy MK, Ramya S. Optical coherence tomography: A guide to interpretation of common macular diseases. Indian J Ophthalmol 2018;66(1):20-35.
doi: 10.4103/ijo.IJO_902_17
Trichonas G, Kaiser PK. Optical coherence tomography imaging of macular oedema. Br J Ophthalmol 2014;98(2):24-9.
pubmed: 24934220
doi: 10.1136/bjophthalmol-2014-305305
Herrero R, Garcia-Martin E, Almarcegui C, Ara JR, Rodriguez-Mena D, Martin J, Otin S, Satue M, Pablo LE, Fernandez FJ. Progressive degeneration of the retinal nerve fiber layer in patients with multiple sclerosis. Invest Ophthalmol Vis Sci 2012;53(13):8344-9.
pubmed: 23154461
doi: 10.1167/iovs.12-10362
Kromer R, Eck B, Rahman S, Framme C. Ocular Blood Volume Index Based on Scattering Properties of Retinal Vessels Using Spectral Domain Optical Coherence Tomography. Curr Eye Res 2019;44(1):60-66.
doi: 10.1080/02713683.2018.1527367
Spahr H, Hillmann D, Hain C. Darstellung von Blutfluss und Pulsation in retinalen Gefäßen mit Full-Field-Swept-Source-OCT [Imaging Blood Flow and Pulsation of Retinal Vessels with Full-Field Swept-Source OCT]. Klin Monbl Augenheilkd 2016;233(12):1324-30.
pubmed: 27984838
doi: 10.1055/s-0042-120279