Visual Loss in One Eye after Spinal Surgery Min-Su Chung, MD, Jun-Hyuk Son, MD Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea Purpose: To report a patient who developed an unusual combination of central retinal artery occlusion with ophthalmoplegia following spinal surgery in the prone position. Methods: A 60-year-old man underwent a cervical spinal surgery in the prone position. Soon after recovery he could not open his right eye and had ocular pain due to the general anesthesia. Upon examination, we determined that he had a central retinal artery occlusion with total ophthalmoplegia. Results: Despite medical treatment, optic atrophy was still present at the following examination. Ptosis and the afferent pupillary defect disappeared and ocular motility was recovered, but visual loss persisted until the last follow-up. Conclusions: A prolonged prone position during spinal surgery can cause external compression of the eye, causing serious and irreversible injury to the orbital structures. Therefore, if the patient shows postoperative signs of orbital swelling after spinal surgery the condition should be immediately evaluated and treated. Korean Journal of Ophthalmology 20(2):139-142, 2006 Key Words: Central retinal artery occlusion, Ophthalmoplegia, Prone position, Spinal surgery Sudden unilateral or bilateral visual loss occurring after general anesthesia has been reported and attributed to various causes including hemorrhagic shock, blood dyscrasia, hypo- tension, hypothermia, coagulopathic disorders, direct trauma, embolism, and prolonged compression of the eyes.1,2 However, visual loss with total ophthalmoplegia as a surgical complication has rarely been described as a conse- quence of prolonged compression of the eye.2-5 There have been no case reports in the literature to date of visual loss following spinal surgery in Korea. We present the first case report of a Korean patient who developed an unusual combination of central retinal artery occlusion (CRAO) with ophthalmoplegia after spinal surgery in the prone position. Case Report A 60-year-old man came to the emergency department of our hospital with an arm tingling sensation in both arms that he had experienced for seven months. Prior to the develop- ment of the sensation, he had injuried his neck by a fallen log but reported no pain at the cervical area at the time of presentation at the emergency room. Radiographic views of Received: December 2, 2005 Accepted: April 6, 2006 Reprint requests to Jun-Hyuk Son, MD. Department of Ophthal- mology, Yeungnam University College of Medicine, #317-1 Daemyung- dong, Nam-gu, Daegu 705-717, Korea. Tel: 82-53-620-3444, Fax: 82-53-626-5936, E-mail: junhyuk_son@hanmail.net ＊This study was presented as a poster at the 94th Annual Meeting of the Korean Ophthalmological Society, October 2005. the cervical spine showed osteophytosis at C4-C5, C5-C6 and at the narrow disc space from C4-C7. A magnetic resonance imaging (MRI) scan was performed and revealed a com- pressed dural sac from C3-C5 with spinal stenosis. The patient had a history of diabetes mellitus but had never received medical treatment for the disease. He was on a diet and his preoperative blood glucose was checked at 285 mg/dL. The patient had no other diseases except diabetes mellitus. His preoperative blood count was normal, but he had a slightly low hemoglobin level at 13.5 mg/dL. A C3-C5 laminectomy was performed three days after the hospitalization. Under general anesthesia, the patient was put on the operating table in the prone position according to the standard procedure for spinal surgery. During surgery, his neck was kept in a mild flexion position using a head-holter. The total time for the intervention was 295 minutes, and a total of 60 additional minutes was required for the induction and cessation of anesthesia. During the operation, the patient’s blood pressure decreased from 120/80 mmHg to 100/60 mmHg for 30 minutes because of some blood loss, and four pints of packed RBCs were transfused. There were no other general problems during surgery. The patient's postoperative hemoglobin concentration was 13.3 mg/dL, which recovered to within normal range the next day. Immediately after recovery from general anesthesia, the patient could not open his right eye because of swelling, and he also had ocular pain in the right eye. He showed visual loss when we examined his right eye on the second post- operative day. He had periorbital swelling, ptosis of the eyelid, chemosis, numbness of the first division of the right 139