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Visual Loss with Ophthalmoplegia after Prone Position Spinal Surgery
엎드린 자세 요추수술 후 발생한 단안 시력 상실 및 전체 눈근육 마비
JKOS 2019 Jul;60(7):712-7
Published online July 15, 2019;  https://doi.org/10.3341/jkos.2019.60.7.712
Copyright © 2019 The Korean Ophthalmological Society.
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Mi Hwa Park, MD1, Ji Hye Kim, MD1,2, Ji Myong Yoo, MD, PhD1
박미화1⋅김지혜1,2⋅유지명1

Department of Ophthalmology, Gyeongsang National University School of Medicine1, Jinju, Korea
Department of Ophthalmology, Gyeongsang National University Changwon Hospital2, Changwon, Korea
경상대학교 의과대학 안과학교실1, 창원경상대학교병원 안과2
Received August 30, 2018; Revised October 11, 2018; Accepted June 19, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Purpose: We report a case of acute visual loss with ophthalmoplegia after prone position spinal surgery who had blood supply dependence on collateral circulation due to occlusion of the Internal carotid artery.
Case summary: A 74-year-old man was referred to the department of ophthalmology for acute visual loss and ophthalmoplegia after lumbar spine surgery performed in prone position. On the initial visit, his right visual acuity was 0.8 and the left visual acuity was negative light perception. Intraocular pressure was normal. There was a relative afferent pupillary defect and ophthalmoplegia of all directions in the left eye. Because of the ptosis of the upper eyelid in the left eye, it was impossible to tune the eye voluntarily. The cherry red spot and pale retina were observed on the fundus examination. On brain magnetic resonance imaging angiography, we found complete obstruction of the left internal carotid artery. He had intravenous injection of 1 g methylprednisolone for 3 days, and discharged with per oral medicine. After 1 month of treatment, the ophthalmoplegia was slightly improved, but visual acuity was not recovered.
Conclusions: In this case, unlike previous reports, acute visual loss and ophthalmoplegia occurred after spinal surgery the patient who had collateral circulation for ocular blood supply because of complete obstruction of the left internal carotid artery. This report highlights the importance of being aware of the anatomical variant in possible complications of external ocular compression after non-ocular surgery.
Keywords : Internal carotid artery occlusion, Ophthalmoplegia, Retinal artery occlusion, Visual loss

 

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