Published: 2021-02-23

Hyperbaric oxygenation therapy treatment option in perioperative visual loss in spine surgery

Catarina Aleixo, Ricardo Santos Pereira, Filipe Lima Santos, Henrique Sousa, José Carlos Soares, João Pedro Maia Gonçalves


Perioperative vision loss (POVL) is a catastrophic complication of spine surgery and several risk factors are identified. As spine fusion surgery is rising in number, POVL incidence is increasing. Preventive strategies can decrease the risk of this complication. Prognosis depends on the level of occlusion and how quickly oxygen supply can be restored to retina. We present a 65-year-old female patient with multiple cardiovascular risk factors that who underwent lumbar fusion. Upon waking up from anesthesia, the patient reported total loss of vision in her left eye. An occlusion of the central retinal artery due to a probable embolic cause was diagnosed and the patient promptly started treatment with anti-aggregation therapy and hyperbaric oxygen therapy (HBOT) with good results. The combination of HBOT with anti-aggregation therapy may have had a synergistic effect contributing to the good outcome presented in this case and may be a good option for the treatment of this patients. 


Perioperative vision loss, Hyperbaric oxygen therapy, Spine surgery, Central retinal artery occlusion  

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Alwon K, Hewer I. Perioperative Vision Loss: Considerations and Management. AANA J. 2016;84(5):363-370.

Kitaba A, Martin DP, Gopalakrishnan S, Tobias JD. Perioperative visual loss after nonocular surgery. J Anesth. 2013;27(6):919-926. doi:10.1007/s00540-013-1648-y

Mendel E, Stoicea N, Rao R, et al. Revisiting Postoperative Vision Loss following Non-Ocular Surgery: A Short Review of Etiology and Legal Considerations. Front Surg. 2017;4:34. Published 2017 Jun 26. doi:10.3389/fsurg.2017.00034

Baig MN, Lubow M, Immesoete P, Bergese SD, Hamdy EA, Mendel E. Vision loss after spine surgery: review of the literature and recommendations. Neurosurg Focus. 2007;23(5):E15. doi:10.3171/FOC-07/11/15

Li A, Swinney C, Veeravagu A, Bhatti I, Ratliff J. Postoperative Visual Loss Following Lumbar Spine Surgery: A Review of Risk Factors by Diagnosis. World Neurosurg. 2015;84(6):2010-2021. doi:10.1016/j.wneu.2015.08.030

Nickels TJ, Manlapaz MR, Farag E. Perioperative visual loss after spine surgery. World J Orthop. 2014;5(2):100-106. Published 2014 Apr 18. doi:10.5312/wjo.v5.i2.100

De la Garza-Ramos R, Samdani AF, Sponseller PD, et al. Visual loss after corrective surgery for pediatric scoliosis: incidence and risk factors from a nationwide database. Spine J. 2016;16(4):516-522. doi:10.1016/j.spinee.2015.12.031

Kim SH, Cha YS, Lee Y, Kim H, Yoon IN. Successful treatment of central retinal artery occlusion using hyperbaric oxygen therapy. Clin Exp Emerg Med. 2018;5(4):278-281. doi:10.15441/ceem.17.271

Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol. 2005;140(3):376-391. doi:10.1016/j.ajo.2005.03.038

Lee LA, Roth S, Posner KL, et al. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology. 2006;105(4):652-868. doi:10.1097/00000542-200610000-00007

Epstein NE. How to avoid perioperative visual loss following prone spinal surgery. Surg Neurol Int. 2016;7(Suppl 13):S328-S330. Published 2016 May 17. doi:10.4103/2152-7806.182543

Chandra KN, Kundan M. Perda visual no pós‐operatório de laminectomia cervical em pronação [Post operative visual loss after cervical laminectomy in prone position]. Rev Bras Anestesiol. 2017;67(4):435-438. doi:10.1016/j.bjan.2017.03.003

Murphy-Lavoie H, Butler F, Hagan C. Arterial inefficiencies: central renal artery occlusion. In: Lindell KW, editor. Hyperbaric oxygen therapy indication. 13th ed. Durham, NC: Best Publishing Company; 2014. p.11-24.