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Ann Thorac Surg 1996;61:660-666
© 1996 The Society of Thoracic Surgeons

Original Article: Cardiovascular

Anterior Ischemic Optic Neuropathy After Open Heart Operations

Oz M. Shapira, MD, Wendy A. Kimmel, Ccp, Peggy S. Lindsey, MD, David M. Shahian, MD

Departments of Thoracic and Cardiovascular Surgery and Ophthalmology, Lahey Hitchcock Medical Center, Burlington, Massachusetts

Accepted for publication September 26, 1995.

Background. The overall incidence of anterior ischemic optic neuropathy after open heart operations at the Lahey Clinic is less than 0.5%. However, during the 2-year period, March 1, 1990, to March 1, 1992, an increased incidence (8 of 602 patients or 1.3%) of this complication was observed.

Methods. A rigorous analysis was conducted of all 602 patients who underwent operation during this period.

Results. No preoperative risk factors were identified. The development of anterior ischemic optic neuropathy was associated with prolonged cardiopulmonary bypass time, low hematocrit levels, excessive perioperative body weight gain, and the use of epinephrine and amrinone. Other hypothetical risk factors include systemic hypothermia, anemia, increased intraocular pressure, and microembolization. Treatment options include the use of corticosteroid medications, reduction of intraocular pressure, and optic nerve fenestration, although recent evidence and our experience indicate that the fenestration procedure is of no benefit.

Conclusions. Because all methods of treatment have had limited success, efforts to prevent this complication are of paramount importance.


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Invited Commentary
Robert M. Feibel
Ann. Thorac. Surg. 1996 61: 666. [Extract] [Full Text]



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