{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T04:57:26Z","timestamp":1773464246592,"version":"3.50.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T00:00:00Z","timestamp":1626134400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T00:00:00Z","timestamp":1626134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Ophthalmol"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Non-arteritic ischaemic optic neuropathy (NAION) is a rare but harmful complication of prone positioning. Prone mechanical ventilation is a therapeutic strategy which has been used extensively during the COVID-19 pandemic to treat acutely hypoxemic patients with COVID-19 related acute respiratory distress syndrome (ARDS). Though a small number of cases of unilateral NAION have been reported in patients testing positive for the SARS-CoV-2 virus, we describe what is to our knowledge, the first reported case of bilateral NAION occurring in a patient proned extensively for the treatment of COVID-19 related ARDS. We consider the potential aetiological factors leading to NAION after prone mechanical ventilation in patients with COVID-19 and suggest strategies to protect against its development.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>: We report a case of severe, irreversible, visual impairment secondary to bilateral anterior ION in a fifty-five-year-old male who underwent eight episodes of prone mechanical ventilation to treat COVID-19 related ARDS. Once weaned from his sedation he reported bilateral painless vision loss, and bedside ophthalmological assessment identified a reduced visual acuity of 3\/30 unaided in the left eye and counting fingers in the right. Dilated indirect ophthalmoscopy revealed inferotemporal optic disc oedema with splinter haemorrhages in the right eye and mild disc oedema, temporal pallor, and nerve fibre layer haemorrhages inferiorly in the left eye. Humphrey visual field 24\u2009\u2212\u20092 testing confirmed a severely constricted visual field with macular sparing on the right and depressed inferonasal vision with preserved peripheral vision on the left eye. OCT disc imaging shortly after diagnosis revealed bilateral disc swelling and flame haemorrhages in the right eye.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>NAION is a devastating, but preventable complication of prone positioning, which may pose significant risk of vision loss in patients with COVID-19 related ARDS.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12886-021-02028-9","type":"journal-article","created":{"date-parts":[[2021,7,13]],"date-time":"2021-07-13T11:04:14Z","timestamp":1626174254000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Proning related bilateral anterior ischaemic optic neuropathy in a patient with COVID-19 related acute respiratory distress syndrome"],"prefix":"10.1186","volume":"21","author":[{"given":"Kirsty Michelle","family":"Clarke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vivi","family":"Riga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy-lee","family":"Shirodkar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joel","family":"Meyer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,13]]},"reference":[{"key":"2028_CR1","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1136\/bjo.58.12.955","volume":"58","author":"SS Hayreh","year":"1974","unstructured":"Hayreh SS. Anterior ischaemic optic neuropathy. I. Terminology and pathogenesis. Br J Ophthalmol. 1974;58:955.","journal-title":"Br J Ophthalmol"},{"key":"2028_CR2","doi-asserted-by":"crossref","unstructured":"Denniston A, Murray P, editors. Oxford handbook of ophthalmology. OUP Oxford; 2014;666\u2013676.","DOI":"10.1093\/med\/9780199679980.001.0001"},{"key":"2028_CR3","doi-asserted-by":"crossref","unstructured":"Sanghi P, Malik M, Hossain IT, Manzouri B. Ocular complications in the prone position in the critical care setting: the COVID-19 pandemic. Journal of intensive care medicine. 2020;1\u201312.","DOI":"10.1177\/0885066620959031"},{"key":"2028_CR4","doi-asserted-by":"publisher","first-page":"2200","DOI":"10.1007\/s00134-020-06192-2","volume":"12","author":"C Ferrando","year":"2020","unstructured":"Ferrando C, Suarez-Sipmann F, Mellado-Artigas R, Hern\u00e1ndez M, Gea A, Arruti E, Aldecoa C, Mart\u00ednez-Pall\u00ed G, Mart\u00ednez-Gonz\u00e1lez MA, Slutsky AS, Villar J. 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Spine. 2019;15:1087\u201396.","DOI":"10.1097\/BRS.0000000000003010"},{"key":"2028_CR7","doi-asserted-by":"crossref","unstructured":"Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet Respiratory Medicine. 2020; 8:765\u201374.","DOI":"10.1016\/S2213-2600(20)30268-X"},{"key":"2028_CR8","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1093\/bja\/aei173","volume":"2","author":"D Kamming","year":"2005","unstructured":"Kamming D, Clarke S. Postoperative visual loss following prone spinal surgery. Br J Anaesth. 2005;2:257\u201360.","journal-title":"Br J Anaesth"},{"key":"2028_CR9","doi-asserted-by":"crossref","unstructured":"Rho J, Dryden SC, McGuffey CD, Fowler BT, Fleming J. A Case of Non-Arteritic Anterior Ischemic Optic Neuropathy with COVID-19. Cureus. 2020;12.","DOI":"10.7759\/cureus.11950"},{"key":"2028_CR10","doi-asserted-by":"crossref","unstructured":"Catharino AM, Neves MA, Nunes NS, Nascimento JS, Nascimento JK. COVID-19 Related Optic Neuritis: Case Report. J Clin Neurol Neurosci 2020;1;10.","DOI":"10.52588\/clinical-neurology-neuroscience.1.10"},{"key":"2028_CR11","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1001\/jamaophthalmol.2020.5695","volume":"139","author":"J Fran\u00e7ois","year":"2021","unstructured":"Fran\u00e7ois J, Collery AS, Hayek G, Sot M, Zaidi M, Lhuillier L, Perone JM. Coronavirus disease 2019\u2013associated ocular neuropathy with panuveitis: a case report. JAMA ophthalmology. 2021;139:247\u20139.","journal-title":"JAMA ophthalmology"},{"key":"2028_CR12","first-page":"1","volume":"14","author":"J Finsterer","year":"2002","unstructured":"Finsterer J, Scorza FA, Scorza CA, Fiorini AC. Vascular damage may mimic retinitis and optic neuritis in COVID-19. Curr Eye Res. 2002;14:1\u20132.","journal-title":"Curr Eye Res"},{"key":"2028_CR13","doi-asserted-by":"crossref","unstructured":"Panchabhai TS, Bandyopadhyay D, Kapoor A, Akindipe O, Lane C, Krishnan S. Acute ischemic optic neuropathy. with extended prone position ventilation in a lung transplant\u00a0recipient. International Journal of Critical Illness Injury Science. 2016;1:45.","DOI":"10.4103\/2229-5151.177367"},{"key":"2028_CR14","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1097\/CCM.0000000000003893","volume":"9","author":"S Saran","year":"2019","unstructured":"Saran S, Gurjar M, Kanaujia V, Ghosh PS, Gupta A, Mishra P, Azim A, Poddar B, Baronia A, Singh R. Effect of prone positioning on intraocular pressure in patients with acute respiratory distress syndrome. 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