Sudden painless loss of vision following spine surgery: lessons learnt in darkness

SUMMARY
A 26-year-old male driver presented with a history
of pain in the neck for the past 1 week following
trauma due to a road traffic accident. The patient had
no neurological deficit. He had type 1 diabetes and
was on regular oral hypoglycemics. After radiological
investigations, the patient was diagnosed to have
traumatic AO Spine Classification type C translational
injury involving anterolisthesis of C6 over C7. After
a detailed preoperative assessment, the patient was
taken up for surgery. The patient underwent posterior
stabilisation with instrumentation from C5 to T2. On
extubation from anaesthesia, he immediately complained
of complete painless loss of this vision in his left eye.
Ophthalmological investigations attributed the cause to
be due to central retinal artery occlusion. The patient was
discharged with reassurance on the 20th postoperative
day with minimal improvement in his vision and at
6-month follow-up, his vision improved to 1/60 and was
advised for close follow-up.