Dented corneas related to cardiovascular surgery under general anesthesia

Abstract

An 80-year-old female (height, 148 cm; weight, 40 kg) with systematic hypertension was presented with acute aortic dissection. Phacoemulsification and aspiration and intraocular lens (IOL) implantation were done in both eyes (OU) 10 years prior. Blood vessel prosthesis implantation was performed under general anesthesia. The surgery took 8 hours, and the operative course was good. During the operation, the eyes were closed with eye patches to prevent drying, and were not touched throughout the procedure. The patient was placed on a pump-oxygenator, and the total infusion amount was 3035 ml, including 900 ml of 20% mannitol and 20 mg/ 2 ml of furosemide. In addition, she was given 240 ml of fresh frozen plasma and 880 ml of autotransfusion using a Cell Saver system. Urine volume was 885 ml, and intraoperative hemorrhage amount totaled 1589 ml. Just after the operation, the anesthesiologist noticed that the corneas OU were dented, and the Department of Ophthalmology was consulted. A portable slit-lamp examination revealed that both corneas were dented and that the anterior chambers (ACs) had disappeared (Fig. 1). The IOLs were fixed well, and IOL implantation wound adaptation was good. The next morning, the patient remained under sedation. Intraocular pressure (IOP), measured with a Schiötz tonometer, was 10/5.5 (≈7.1 mmHg) in the right (OD) and 18/5.5 (out of order hypotony) in the left (OS). Another portable slit-lamp examination revealed that the corneas had recovered their convex shape, though a large number of Descemet’s membrane folds were observed OU. The ACs were shallow OU. Computed tomography showed no abnormalities in the orbit or eyeballs. Two days after surgery, the patient noted that she could see well. IOP measured by a Schiötz tonometer was 10/5.5 (≈7.1 mmHg) OU, and a portable slit-lamp examination revealed that the ACs were deep, though funduscopy showed some cotton wool spots (CWS). One week later, the patient was examined in the outpatient clinic. IOP measured with a Goldman applanation tonometer was 10 mmHg OD and 11 mmHg OS. Best-corrected visual acuity (BCVA) was 0.8 OD and 1.0 OS, while critical flicker frequency (CFF) was 37.5 and 35.6 Hz respectively. A Goldman perimeter examination showed normal visual fields. The ACs were deep and the IOLs were fixed well, though funduscopy showed some CWS OU (Fig. 2). One month later, IOP was 9 mmHg OD and 8 mmHg OS, while BCVA was 0.9 and 1.0 respectively. The ACs All authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review our data upon request. T. Hasegawa (*) :Y. Matsui Department of Ophthalmology, Kyoto-Katsura Hospital, 17 Yamadahirao-cho, Nishikyo-ku, Kyoto 615–8256, Japan e-mail: tomoko11@kuhp.kyoto-u.ac.jp

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