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Abstract #5764 Published in IGR 2-1
Anterior ischemic optic neuropathy: a complication after systemic inflammatory response syndrome
Cullinane DC; Jenkins JM; Reddy S; VanNatta T; Eddy VA; Bass JG; Chen A; Schwartz M; Lavin P; Morris JA JrJournal of Trauma 2000; 48: 381-386, 386-387
BACKGROUND: Patients are surviving previously fatal injuries. Unique morbidities are occurring in these survivors. Anterior ischemic optic neuropathy represents a previously unrecognized cause of blindness in the trauma victim. The authors hypothesize that this phenomenon is caused by unique characteristics of optic edema/pressure or decreased blood flow associated with massive resuscitation. METHODS: Between November of 1991 and August of 1998, there were 18,199 admissions to the authors' trauma center. Of this group, 350 patients required massive volume resuscitation (>20 liters infused over first 24 hours). Patients having closed head injuries, facial fractures or direct orbital trauma were excluded from study. The following variables were studied: demographics, injury severity (Injury Severity Score, highest lactate, worst base deficit, and lowest pH) crystalloid and transfusion requirements, ventilator requirements (PEEP) RESULTS: Of the 350 patients with massive resuscitation, nine were diagnosed with anterior ischemic optic neuropathy (2.6%). Of these, seven patients required celiotomy (78%). Six of the seven celiotomy patients had damage control celiotomies and abdominal compartment syndrome (86%). One patient had a repair of a subclavian artery; one had a complex acetabular repair. Blindness was unilateral in five patients and bilateral in four. All nine patients had evidence of global hypoperfusion, systemic inflammatory response, massive resuscitation, and high ventilatory support; one patient required cardiopulmonary resuscitation. CONCLUSIONS: Prone positioning is known to be associated with an increased intraocular pressure. The authors postulate that the combination of massive resuscitation and prone positioning will increase the incidence of anterior ischemic optic neuropathy. As such, they recommend that prone positioning for adult respiratory distress syndrome be reserved for only those patients at risk of death.
Dr. D.C. Cullinane, Vanderbilt University Medical Center, Nashville, Tennessee, USA
Classification:
10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy