Changes in the eyes in patients after cardiac surgery using cardiopulmonary bypass

Abstract

PURPOSE: To evaluate changes in the eye of patients after cardiac surgery using a cardiopulmonary bypass.SETTING: P.L. Shupik National Medical Academy of Postgraduate Education, SI “The Heart Institute by the Ministry of Health of Ukraine”, 'Centre of eye microsurgery'METHODS: We examined 15 patients (30 eyes) 7 men and 8 women. The average age of patients was 57 +/ 1.5 years. All patients were diagnosed coronary artery disease with varying degree of obliteration of the coronary arteries. In 5 patients had mixed pathology combined with aortic or mitral valve insufficiency and 1 patient had an aortic aneurysm . All patients were examined by ophthalmologist before surgery which included general ophthalmologic research methods and additional methods the study of light sensitivity using computer perimetry, the analysis of caliber, optical coherence tomography (OCT) with determination of the retinal nerve fiber layer (RNFL) . Patients were performed cardiac surgery using cardiopulmonary bypass, conducted in 9 patients isolated coronary artery bypass grafting (CABG), in 2 – in combination with replacement of the aortic valve and in 3 mitral valve, in 1 patient in combination with the removal of an aortic aneurysm. All patients were examined on the second day after surgery in intensive care unit. Review included measurement of intraocular pressure (IOP) and fundus examination indirect ophthalmoscope in mydriasis conditions. 5 days after surgery performed visual acuity, computer perimetry and OCT.RESULTS: At the examination before cardiac surgery were found the initial cataract of 12 eyes (40%), 4 (13.3%) immature cataract, 16 eyes (53.3%) hypertensive retinal angiopathy. At 2 days after cardiac surgery patients were found in the fundus significant expansion venules 5 eyes (16.6%), edema of disk optic nerve 1 eye (3%), single perypapilar hemorrhage 4 eyes (13.3%), increased IOP 3 eyes (10%). After 5 days there was normalization of IOP, in 3 eyes (10%) showed a reduction in visual acuity, 4 eyes (13.3%) decrease in central light sensivity, in 4 eyes (13.3%) – decrease RNFL in the nasal and temporal segments of the data OCT .CONCLUSIONS: In the early period after cardiac surgery using cardiopulmonary bypass were discovered ophthalmologic complications in a rise in intraocular pressure, reduced visual acuity, retinal vascular caliber changes and perypapilyar hemorrhage. To assess the level of lesions and the risk of further complications of ophthalmic needed further and deep study on a larger group of patients and in long term followup.