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The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome
BACKGROUND: A variety of factors have been linked to perioperative visual loss during or directly after nonocular and ocular surgeries. Prolonged immobilization, biochemical factors and hemodynamic instability have been discussed as factors in the pathogenesis of this devastating complication. Perio...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741007/ https://www.ncbi.nlm.nih.gov/pubmed/26846332 http://dx.doi.org/10.1186/s12871-016-0176-3 |
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author | Bojinova, Rossiana I. Konieczka, Katarzyna Meyer, Peter Todorova, Margarita G. |
author_facet | Bojinova, Rossiana I. Konieczka, Katarzyna Meyer, Peter Todorova, Margarita G. |
author_sort | Bojinova, Rossiana I. |
collection | PubMed |
description | BACKGROUND: A variety of factors have been linked to perioperative visual loss during or directly after nonocular and ocular surgeries. Prolonged immobilization, biochemical factors and hemodynamic instability have been discussed as factors in the pathogenesis of this devastating complication. Perioperative visual loss in four consecutive patients, all featuring Flammer syndrome, is reported herein. To our knowledge, we present the first case series, which associates perioperative visual loss with Flammer syndrome. We assume that a low perfusion pressure, disturbed autoregulation of the ocular blood flow and altered drug sensitivity in such subjects, play significant role in the pathogenesis of this dreaded complication. CASES PRESENTATION: We analysed the medical records of four consecutive patients with permanent perioperative visual loss and complemented our findings with additional history taking and clinical examinations. A variety of tests was performed, including colour Doppler ultrasonography of the retroocular vessels, static and dynamic retinal vessel analysis. The visual loss was unilateral in three patients and bilateral in one. An extensive review of published perioperative vision loss cases was conducted. All four patients were male Caucasians, and exhibited prominent signs and symptoms of Flammer syndrome. The visual loss originated from a propensity for unstable ocular blood flow, combined with hyperreactivity toward pharmacological stimuli, leading together to disturbed autoregulation of the blood supply, and subsequently - to ocular hypoxia. An identified intrinsic hypoperfusion diathesis was a crucial pathophysiologic link in all of the patients. Other, yet unknown systemic or local factors may also be involved in this process. CONCLUSIONS: A review of numerous publications of perioperative visual loss and our data, support our hypothesis for a novel pathophysiologic model and incorporate Flammer syndrome as a distinct risk factor for paradoxical visual loss, during nonocular and ocular surgeries, or invasive procedures. To prevent the complications produced by disturbed blood flow autoregulation in such patients, guidelines for screening and tailored preoperative approach are given. |
format | Online Article Text |
id | pubmed-4741007 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-47410072016-02-05 The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome Bojinova, Rossiana I. Konieczka, Katarzyna Meyer, Peter Todorova, Margarita G. BMC Anesthesiol Case Report BACKGROUND: A variety of factors have been linked to perioperative visual loss during or directly after nonocular and ocular surgeries. Prolonged immobilization, biochemical factors and hemodynamic instability have been discussed as factors in the pathogenesis of this devastating complication. Perioperative visual loss in four consecutive patients, all featuring Flammer syndrome, is reported herein. To our knowledge, we present the first case series, which associates perioperative visual loss with Flammer syndrome. We assume that a low perfusion pressure, disturbed autoregulation of the ocular blood flow and altered drug sensitivity in such subjects, play significant role in the pathogenesis of this dreaded complication. CASES PRESENTATION: We analysed the medical records of four consecutive patients with permanent perioperative visual loss and complemented our findings with additional history taking and clinical examinations. A variety of tests was performed, including colour Doppler ultrasonography of the retroocular vessels, static and dynamic retinal vessel analysis. The visual loss was unilateral in three patients and bilateral in one. An extensive review of published perioperative vision loss cases was conducted. All four patients were male Caucasians, and exhibited prominent signs and symptoms of Flammer syndrome. The visual loss originated from a propensity for unstable ocular blood flow, combined with hyperreactivity toward pharmacological stimuli, leading together to disturbed autoregulation of the blood supply, and subsequently - to ocular hypoxia. An identified intrinsic hypoperfusion diathesis was a crucial pathophysiologic link in all of the patients. Other, yet unknown systemic or local factors may also be involved in this process. CONCLUSIONS: A review of numerous publications of perioperative visual loss and our data, support our hypothesis for a novel pathophysiologic model and incorporate Flammer syndrome as a distinct risk factor for paradoxical visual loss, during nonocular and ocular surgeries, or invasive procedures. To prevent the complications produced by disturbed blood flow autoregulation in such patients, guidelines for screening and tailored preoperative approach are given. BioMed Central 2016-02-04 /pmc/articles/PMC4741007/ /pubmed/26846332 http://dx.doi.org/10.1186/s12871-016-0176-3 Text en © Bojinova et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Bojinova, Rossiana I. Konieczka, Katarzyna Meyer, Peter Todorova, Margarita G. The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title | The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title_full | The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title_fullStr | The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title_full_unstemmed | The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title_short | The trilateral link between anaesthesia, perioperative visual loss and Flammer syndrome |
title_sort | trilateral link between anaesthesia, perioperative visual loss and flammer syndrome |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4741007/ https://www.ncbi.nlm.nih.gov/pubmed/26846332 http://dx.doi.org/10.1186/s12871-016-0176-3 |
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