Visual loss after hip and shoulder arthroplasty, two case reports.

PURPOSE The report of two cases of ischemic optic neuropathy after hip and shoulder arthroplasty under general anesthesia. One of them is the first reported posterior ischemic optic neuropathy after shoulder surgery up to our knowledge. METHODS Case reports and review of the literature reporting also data of the anesthesia period. RESULTS The first case is a 74-year-old male patient with postoperative visual loss after awakening from hip arthroplasty. He had bilateral visual loss due to an anterior ischemic optic neuropathy with no vascular risk factors associated, probably due to intraoperative blood loss and short periods of drop of his blood pressure. The second case is a 65-year-old man who developed postoperative visual loss because of posterior ischemic optic neuropathy in one single eye after shoulder arthroplasty. To the best of our knowledge there are only three cases reported of ischemic optic neuropathy after shoulder surgery and none of them due to posterior ischemia. This patient had history of vascular risk factors, such as hypertension and diabetes. The repeated tests during the follow up of the patients revealed no significant improvement of their visual function. CONCLUSIONS Perioperative visual loss after hip and shoulder surgery is a very rare but fatal complication that is difficult to prevent with a poor visual prognosis. Both anesthetist and surgeon should be aware of this problem.