Perioperative Visual Loss Following Transanal Endoscopic Microsurgery in Prone Position: Medico Legal Consideration

A 67-yr-old man developed Perioperative Vision Loss (POVL) after Transanal Endoscopic Microsurgery (TEM) under generalanesthesia in prone position with head-down and turned to one side. After surgery, he complained of ocular pain and no lightperception in the left eye. The examination revealed lid edema, ptosis, exotropia, proptosis, chemosis and fixed pupil not reactiveto direct light. At funduscopy examination a pathognomonic cherry-red spot in the macula and retinal and disk ischemic pallorwere appreciable. The right eye was normal. A diagnosis of left central retinal artery occlusion (CRAO) due to intraoperativeextrinsic pressure on the eye was suspected. He never regained vision. POVL is frequently involved in malpractice claims. Wediscuss the legal implication for anesthesia practitioners.