Postoperative Visual Loss Following Prone Spinal Surgery
(Ischemic Orbital Compartment Syndrome)

1. Bambang Setiohadji
2. Ardining Sastrosatomo

Cicendo Eye Hospital – National Eye Center, Bandung, Indonesia

Purpose:
To report a patient with ischemic orbital compartment syndrome as a complication of spinal surgery in the prone position.

Case Report:
A 60 years old man referred from Orthopedic department of Hasan Sadikin Hospital to Neuro-Ophthalmology unit of Cicendo Eye Hospital Bandung. He had underwent a lumbar decompression laminectomy for a disc protruded vertebrae lumbal at level IV-V, and sacrum I, under general anesthesia in the prone position in about 6 hours. As soon as he woke up, the patient complained of reduced vision of his left eye. Examination revealed left proptosis, with visual acuity of light perception and elevated intraocular pressure in the left eye, left proptosis and complete limited eye movement in all direction. The funduscopic appearance with characteristic of 'cherry red spot'.

Conclusion:
It is important to be familiar with this rare complication after prolonged surgery in the prone position. Although the prognosis seems to be poor, it is essential to monitor these patients perioperatively once the diagnosis of orbital compartment syndrome is established. The effective treatment of perioperative amaurosis is lacking and usually ineffective, making prevention the cornerstone of management. To best prevent permanent ophthalmologic complications associated with prone positioning during spine surgery, the surgeons and the anaesthesiologists should be aware of pathophysiology and related risks associated with spine surgery in the prone position, and initiate preventive measures and predictable treatment options