• Written By: Howard Pomeranz, MD, PhD
    Neuro-Ophthalmology/Orbit

    The authors describe a case of bilateral posterior ischemic optic neuropathy that occurred in a 45-year-old man after surgery for a burn on his back, neck and shoulders.

    He had sustained a 10% total body surface area partial and full thickness burn 48 hours earlier.

    He underwent an excision and autografting procedure while in the prone position in a Wilson frame over 3.5 hours.

    Two days after surgery, he complained of reduced vision in the right eye, which progressed over two days.

    An ophthalmic exam found bilateral vision loss worse in the right eye than the left, an afferent pupillary defect and a normal dilated fundus exam.

    As of around two years after the surgery, the patient had not regained any vision in the right eye and had poor vision in the left eye, with visual acuity of 20/30.

    Intraoperative risk factors for ischemic optic neuropathy included a period of hypotension with systolic blood pressure of 75 mm Hg and blood loss of 44% of estimated blood volume.

    The authors note that risk factors for perioperative visual loss are present during many prone burn operations as these patients have long operative times and significant blood loss. They recommend minimization of these factors whenever possible.