{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T01:31:49Z","timestamp":1793323909738,"version":"4.5.0"},"reference-count":13,"publisher":"Open Medical Publishing","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Perioperative visual loss (POVL) is an uncommon but life-altering complication that has been reported most often after prolonged spine procedures performed in the prone position. Among the recognized causes, posterior ischemic optic neuropathy (PION) accounts for the majority of cases in this setting and is believed to result from impaired perfusion of the retrobulbar optic nerve. Clinical and registry data consistently associate PION with intraoperative anemia, sustained or relative hypotension, substantial blood loss, large-volume fluid administration with hemodilution, and preexisting vascular disease that limits autoregulatory reserve. Advanced age and systemic atherosclerotic burden further increase susceptibility by reducing the optic nerve\u2019s tolerance to ischemic stress.<\/jats:p>\n                  <jats:p>This case-based educational review describes an elderly patient with significant systemic diseases, including vasculopathy, who developed acute, painless visual loss after lumbar spinal surgery. Using this clinical scenario, we examine the interplay between patient-specific risk factors and intraoperative physiology, review the underlying vascular anatomy and pathophysiology of PION, and outline an approach to early recognition and differential diagnosis of postoperative visual deficits. Management principles are discussed with an emphasis on hemodynamic optimization, prompt specialist consultation, and realistic counseling regarding prognosis. The goal of this structured discussion is to provide anesthesiology trainees and perioperative clinicians with a practical framework to recognize high-risk situations, implement preventive strategies, and respond appropriately should this rare but catastrophic complication occur.<\/jats:p>","DOI":"10.52965\/001c.163036","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T18:40:06Z","timestamp":1781289606000},"source":"Crossref","is-referenced-by-count":0,"title":["Perioperative Visual Loss After Spine Surgery: A Case-Based Review of Posterior Ischemic Optic Neuropathy"],"prefix":"10.52965","volume":"18","author":[{"given":"Anvinh","family":"Nguyen","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02pttbw34","id-type":"ROR","asserted-by":"publisher"}],"name":"Baylor College of Medicine","department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal","family":"Hasoon","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03gds6c39","id-type":"ROR","asserted-by":"publisher"}],"name":"The University of Texas Health Science Center at Houston","department":["Department of Anesthesiology, Critical Care, and Pain Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommy","family":"Li","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02pttbw34","id-type":"ROR","asserted-by":"publisher"}],"name":"Baylor College of Medicine","department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher L","family":"Robinson","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University School of Medicine","department":["Department of Anesthesiology and Critical Care, Division of Pain Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vu","family":"Nguyen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/02pttbw34","id-type":"ROR","asserted-by":"publisher"}],"name":"Baylor College of Medicine","department":["Department of Anesthesiology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"30777","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"issue":"Suppl 13","key":"ref1","doi-asserted-by":"publisher","first-page":"S347","DOI":"10.4103\/2152-7806.182550","article-title":"Perioperative visual loss following prone spinal surgery: A review","volume":"7","author":"N. E. Epstein","year":"2016","journal-title":"Surg Neurol Int"},{"issue":"3","key":"ref2","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/ALN.0000000000001211","article-title":"Perioperative Visual Loss in Spine Fusion Surgery: Ischemic Optic Neuropathy in the United States from 1998 to 2012 in the Nationwide Inpatient Sample","volume":"125","author":"D. S. Rubin","year":"2016","journal-title":"Anesthesiology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"557","DOI":"10.3389\/fneur.2018.00557","article-title":"Update on Perioperative Ischemic Optic Neuropathy Associated With Non-ophthalmic Surgery","volume":"9","author":"S. 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Dunker","year":"2002","journal-title":"J Am Coll Surg"},{"issue":"1","key":"ref6","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.survophthal.2004.10.005","article-title":"Perioperative posterior ischemic optic neuropathy: review of the literature","volume":"50","author":"L. M. Buono","year":"2005","journal-title":"Surv Ophthalmol"},{"issue":"5","key":"ref7","doi-asserted-by":"publisher","first-page":"620","DOI":"10.1097\/ALN.0000000000004338","article-title":"Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery","volume":"137","author":"S. Roth","year":"2022","journal-title":"Anesthesiology"},{"issue":"13","key":"ref8","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1016\/S1474-4422(16)30237-X","article-title":"Diagnosis and clinical features of common optic neuropathies","volume":"15","author":"V. Biousse","year":"2016","journal-title":"Lancet Neurol"},{"issue":"Suppl 1","key":"ref9","doi-asserted-by":"publisher","first-page":"i31","DOI":"10.1093\/bja\/aep295","article-title":"Perioperative visual loss: what do we know, what can we do?","volume":"103 Suppl 1","author":"S. Roth","year":"2009","journal-title":"Br J Anaesth"},{"issue":"4","key":"ref10","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1097\/00000542-200610000-00007","article-title":"The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss","volume":"105","author":"L. A. Lee","year":"2006","journal-title":"Anesthesiology"},{"issue":"5","key":"ref11","doi-asserted-by":"publisher","first-page":"1534","DOI":"10.1213\/ane.0b013e3181b0500b","article-title":"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","volume":"109","author":"Y. Shen","year":"2009","journal-title":"Anesth Analg"},{"issue":"1","key":"ref12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.preteyeres.2008.11.002","article-title":"Ischemic optic neuropathy","volume":"28","author":"S. S. Hayreh","year":"2009","journal-title":"Prog Retin Eye Res"},{"issue":"4","key":"ref13","doi-asserted-by":"publisher","first-page":"604","DOI":"10.1016\/j.ajo.2007.09.016","article-title":"Perioperative visual loss after nonocular surgeries","volume":"145","author":"N. J. Newman","year":"2008","journal-title":"Am J Ophthalmol"}],"container-title":["Orthopedic Reviews"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/163036-perioperative-visual-loss-after-spine-surgery-a-case-based-review-of-posterior-ischemic-optic-neuropathy","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:46:07Z","timestamp":1793321167000},"score":1,"resource":{"primary":{"URL":"https:\/\/orthopedicreviews.openmedicalpublishing.org\/article\/163036-perioperative-visual-loss-after-spine-surgery-a-case-based-review-of-posterior-ischemic-optic-neuropathy"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":13,"URL":"https:\/\/doi.org\/10.52965\/001c.163036","relation":{},"ISSN":["2035-8164"],"issn-type":[{"value":"2035-8164","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}