Ann Thorac Surg 1996;61:666
© 1996 The Society of Thoracic Surgeons
Invited Commentary
Invited Commentary
Robert M. Feibel, MD
Clinical Ophthalmology, Inc 410 University Club Tower 1034 S Brentwood Blvd st. Louis, MO 63117-1269
See also page 660.
I commend Shapira and associates' thorough investigation to identify the intraoperative factors that may lead to postoperative ischemic optic neuropathy. Because neither preoperative screening nor postoperative therapy exists for this devastating complication, all efforts must be made intraoperatively to reduce its incidence. Presumably, these efforts will also reduce the chance of other neurologic defects arising from open heart operations.
Although there is no treatment for ischemic optic neuropathy, all such patients should have ophthalmologic consultation as soon as possible. Other vascular causes of acute visual loss, such as central retinal artery occlusion, obstruction of the venous drainage of the eye from external pressure, and cortical blindness from occipital ischemia, may be present. In addition, a patient may notice preexisting ocular disease in the postoperative period. These conditions have different prognoses, and therapy may be appropriate in some cases.
It would seem appropriate to perform monocular visual acuity and confrontation field measurement in the postoperative period as soon as the patient's condition allows. This visual screening would ensure immediate identification and referral of affected patients to the ophthalmologist.
Related Article
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Anterior Ischemic Optic Neuropathy After Open Heart Operations
- Oz M. Shapira, Wendy A. Kimmel, Peggy S. Lindsey, and David M. Shahian
Ann. Thorac. Surg. 1996 61: 660-666.
[Abstract]
[Full Text]
