Perioperative Visual Loss Following Transanal Endoscopic Microsurgery in Prone Position: Medico Legal Consideration

Abstract

Claudio Bianchin, Carolina Prevaldi, Mario Saia and Mazzon Davide

A 67-yr-old man developed Perioperative Vision Loss (POVL) after Transanal Endoscopic Microsurgery (TEM) under general anesthesia in prone position with head-down and turned to one side. After surgery, he complained of ocular pain and no light perception in the left eye. The examination revealed lid edema, ptosis, exotropia, proptosis, chemosis and fixed pupil not reactive to direct light. At funduscopy examination a pathognomonic cherry-red spot in the macula and retinal and disk ischemic pallor were appreciable. The right eye was normal. A diagnosis of left central retinal artery occlusion (CRAO) due to intraoperative extrinsic pressure on the eye was suspected. He never regained vision. POVL is frequently involved in malpractice claims. We discuss the legal implication for anesthesia practitioners.

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