Postoperative Vision Loss in Shoulder Surgery: A Case Series and Review of the Literature.

Postoperative vision loss (POVL) can be devastating and permanent. We present three unique cases of POVL after shoulder surgery, and we provide recommendations on patient positioning and eye protection perioperatively based on our experience and a review of the literature. In Case 1, our patient underwent an uncomplicated right arthroscopic rotator cuff repair and acromioclavicular (AC) joint resection in the beach-chair (BC) position. He developed bilateral vision loss (right eye greater than the left eye) in the postoperative period, with visual field deficits noted on Humphrey visual field (HVF) 24-2, and decreased retinal function on electroretinography (ERG) in the right eye (OD). In Case 2, our patient underwent an uncomplicated left total shoulder arthroplasty with open biceps tenodesis and implant removal in the BC position. He developed vision loss in the left eye (OS) in the postoperative period, with visual field deficits noted on HVF 24-2, and ERG findings that pointed to an ischemic injury to the retina and optic nerve in the left eye (OS). In Case 3, our patient underwent an uncomplicated right arthroscopic rotator cuff repair in the BC position. He developed vision loss OS in the postoperative period and was diagnosed with a macular-sparing central retinal artery occlusion (CRAO) OS, with eventual foveal recovery. POVL after shoulder surgery is a serious condition with a risk of permanent vision loss. Although POVL after shoulder surgery is rare and likely multifactorial, it is important to minimize risks and optimize both patient positioning and eye protection to promote patient safety and favorable outcomes.