Blindness, a Rare Complication of Liposuction: Report of a Case of Unilateral Blindness; Notes on the Effect of Compassionate Care

Care more particularly for the individual patient than for the special features of the disease. —William Osler (Canadian physician, 1849–1919) Sir: Approximately 2 years ago, at my accredited surgery facility, a 58-year-old woman underwent abdominoplasty and liposuction of the waistline and hips under general anesthesia in the supine position. During the 3-hour operation, 3400 ml of tumescent solution was injected, a total of 1700 ml of fat was suctioned, and 900 g of dermofat from the abdominal wall was removed. During the operation, vital signs remained within normal limits. In the recovery room, the patient complained of blurred vision that was dismissed by the recovery room nurse as the effect of general anesthesia and the use of eye lubricant during surgery. On the fifth day postoperatively, I received a call from the emergency room of the local hospital by an ophthalmologist who had seen the patient for blindness of the left eye caused by central retinal artery occlusion. Doppler study of the carotid artery, brain magnetic resonance imaging, and magnetic resonance angiography were all within normal limits, with minimal plaque in the carotid artery. No patent foramen ovale was found. All consultants agreed that the most probable cause of central retinal artery occlusion was an embolus from carotid artery plaque, even though it was minimal. There have been two other reported cases of blindness (one unilateral and one bilateral) following liposuction.1,2 In both cases, blindness was attributable to anterior ischemic optic neuropathy after liposuction. As to the possible early detection of blindness as a result of surgery, I would like to suggest that recovery room nursing staff must take complaints of visual changes earnestly and perform a basic visual acuity and confrontational visual field testing. Even though by the time diagnosis is made, the 90-minute “golden period” may have expired, recovery of vision 24 hours after the injury has been reported. The second and probably more important subjectin the article is the effect of a compassionate surgeon on the patient's well-being and physician's liability. In my case, I believe there are several reasons why no malpractice claims were made. Most important was that the patient sensed my genuine concern. Immediately upon her diagnosis of blindness, she was admitted to the hospital for a complete medical workup. I accepted all of her expenses not covered by the insurance carrier. I made all of the arrangements to have her seen by the best authorities in the field. It is true that performing these actions might have backfired and given the impression that I performed them out of guilt. However, recognizing when and how to perform these “hand holdings” is by itself an art that is so critical in patient care. DISCLOSURE The author has no financial interest to disclose in relation to the content of this article. Iraj Zandi, M.D. 2557 Mowry Avenue, Suite 20 Fremont, Calif. 94538 [email protected]

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