Bilateral posterior ischemic optic neuropathy after spinal surgery

PURPOSE: To report the association between bilateral posterior ischemic opt ic neuropathy and spinal surgery. METHOD: Case report. RESULTS: After prone position spinal surgery of 8 hours' duration, a 68 yea r old woman was completely blind in both eyes. Moderate periorbital edema a nd temporal conjunctival chemosis were present bilaterally. Ophthalmic exam ination disclosed normal-appearing optic nerve heads, except for bilateral nasal fullness related to bilateral optic nerve drusen, and no retinal edem a. Immediate cerebral arteriography, magnetic resonance imaging, and electr oretinography were normal. Visual-evoked response was not detectable, and 7 weeks later, severe bilateral optic nerve head pallor developed. CONCLUSIONS: Severe selective hypoperfusion of the re trobulbar optic nerve s may occur after spinal surgery. Pressure to the periorbital region may be a contributing factor. (C) 1999 by Elsevier Science Inc. All rights reserv ed.