Man of 58 years-old with trauma (D12 vertebral fracture, fractured left shoulder blade, multiple rib fractures on the left). The scapular fracture treated with immobilization for 30 days (orthopedic). The patient has undergone neurosurgery of reduction / stabilization of the fracture with screws transpedicular D12 D11-D12 L1e kyphoplasty (duration surgery - 1 hour and 25 minutes, anesthesia duration - 2 hours and 15 minutes). The patient was placed in the prone position with the head resting on blankets and turned to the left. Immediately after the operation, during arousal, the patient experienced pain in the left eye, edema and amaurosis. He underwent angiography which showed signs of retinopathy in both eyes and a central retinal artery occlusion in the left eye (CRAO).The patient is diabetic with insulin pump therapy, hyperlipidemic (rosuvastatina), hypertension, occasional smoker or former smoker, hyperhomocysteinemia, assumes Cardioaspirin. The doppler has revealed a thickening of the left carotid artery with a fibro-calcific plaque without significant impairment of flow. In addition, both the CT that the brain MRI showed multiple small areas of gliosis of the white matter, as from vascular cerebral disease. According to your experience, could the prone position to have been the only cause of ocular damage?
I believe systemic conditions have resulted in an embolus which had blocked the central retinal artery. Echocardiography should be done to rule out cardiac thrombus. The prone position seems unrelated.
this patient under discussion here has multiple risk factors which independently cause CRAO.. prone position has nothing to do with it.
Bone fracture, post op immobilisation , DM , hyperlipidaemia, carotid plaque etc has the potentiality to develop thrombus and or embolus which can cause blockage of arteriole on their circulating path way. We ophthalmologist often keep our patient in prone position following VR surgery. There is hardly any report of CRAO following such procedure. I also agree w other responder that positioning of the patient has not caused CRAO.
I agree with my colleagues -ophthalmologists that the prone position itself will be not proposed as a cause for CRAO, besides all systemic comorbidity predisposing to CRAO are present in the case. I would like to add from my own experiencea case - after open cardial surgery and general anestesia te patient developed CRAO
I thank all of you for your answers . Useful comments that comfort me that only the position is not the only cause of ocular damage. The patient has perfomed echocardiogram that was normal. Only one doubt it is that it was not tested for PFO . Some studies showed an association between PFO and CRAO. Thanks again.