Anterior ischemic optic neuropathy after open heart operations.
BACKGROUND
The overall incidence of anterior ischemic optic neuropathy after open heart operations at the Lahey Clinic is less than 0.5%. However, during the 2-year period, March 1, 1990, to March 1, 1992, an increased incidence (8 of 602 patients or 1.3%) of this complication was observed.


METHODS
A rigorous analysis was conducted of all 602 patients who underwent operation during this period.


RESULTS
No preoperative risk factors were identified. The development of anterior ischemic optic neuropathy was associated with prolonged cardiopulmonary bypass time, low hematocrit levels, excessive perioperative body weight gain, and the use of epinephrine and amrinone. Other hypothetical risk factors include systemic hypothermia, anemia, increased intraocular pressure, and microembolization. Treatment options include the use of corticosteroid medications, reduction of intraocular pressure, and optic nerve fenestration, although recent evidence and our experience indicate that the fenestration procedure is of no benefit.


CONCLUSIONS
Because all methods of treatment have had limited success, efforts to prevent this complication are of paramount importance.
Shapira
O M
OM
Department of Thoracic and Cardiovascular Surgery, Lahey Hitchcock Medical Center, Burlington, Massachusetts 01805, USA.
Kimmel
W A
WA
Lindsey
P S
PS
Shahian
D M
DM
D000368:Aged; D000676:Amrinone / Q000009:adverse effects; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004837:Epinephrine / Q000009:adverse effects; D005260:Female; D006400:Hematocrit; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D015430:Weight Gain
D000676:Amrinone; D004837:Epinephrine