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To the Editor:—

Drs. Lee and Lam recently reported a case of unilateral blindness in a patient after prone lumbar spine surgery. 1This unfortunate complication of surgery in the prone position has been reported in the surgical literature, 2–5and less commonly in anesthesia journals. 6,7 

Drs. Roth and Barach write in the accompanying editorial 8that there still are no answers as to the etiology of postoperative visual loss (PVL), although researchers are currently in the process of collecting much-needed prospective data to establish the cause(s) of PVL. In the meantime, we as anesthesiologists must be aware that PVL can occur despite our best efforts at prevention. Should we routinely inform patients of this risk? Our answer is yes, although there are some that would beg to differ. It is, however, an indisputable point that we should routinely ask patients questions about their vision in the recovery room and during the postoperative check. Although there is no definitive treatment for PVL, early detection with subsequent consultation with ophthalmologists, and rapid correction of possible causes of decreased oxygen delivery (e.g. , anemia) may be the greatest hope for a patient who has suffered PVL.

Lee LA, Lam AM: Unilateral blindness after prone lumbar spine surgery. A nesthesiology 2001; 95: 793–5
Meyers MA, Hamilton SR, Bogosian AJ, Smith CH, Wagner TA: Visual loss as a complication of spine surgery: A review of 37 cases. Spine 1997; 22: 1325–9
Stevens WR, Glazer PA, Kelley SD, Lietman TM, Bradford DS: Ophthalmic complications after spine surgery. Spine 1997; 22: 1319–24
Lee AG: Ischemic optic neuropathy following lumbar spine surgery: Case report. J Neurosurg 1995; 83: 348–9
Cheng MA, Sigurdson W, Tempelhoff R, Lauryssen C: Visual loss after spine surgery: A survey. Neurosurgery 2000; 46: 625–31
Brown RH, Schauble JF, Miller NR: Anemia and hypotension as contributors to perioperative loss of vision. A nesthesiology 1994; 80: 222–6
Roth S, Nunez R, Schreider BD: Unexplained visual loss after lumbar spinal fusion. J Neurosurg Anesth 1997; 9: 346–8
Roth S, Barach P: Postoperative visual loss: still no answers — yet. A nesthesiology 2001; 95: 575–7