title: A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting.
abstract: Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.
authors: Department of Anaesthesia, Royal Group of Hospitals and Dental Hospital Health and Social Services Trust, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland. briantrethowan@hotmail.com
authors: Brian A
authors: BA
authors: Trethowan
authors: Helen
authors: H
authors: Gilliland
authors: Aron F
authors: AF
authors: Popov
authors: Barathi
authors: B
authors: Varadarajan
authors: Sally-Anne
authors: SA
authors: Phillips
authors: Louise
authors: L
authors: McWhirter
authors: Robert
authors: R
authors: Ghent
mesh_terms: D000328:Adult; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000379:methods*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007238:Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery; D011183:Postoperative Complications; D012039:Regional Blood Flow; D015356:Retinal Artery Occlusion / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D012164:Retinal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014792:Visual Acuity