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Selfie ensures eye safety

To the editor,

Prone positioning is commonly used to access the posterior fossa, craniovertebral junction of the neck, spine fixations, endourosurgical procedures, and retroperitoneal surgeries (Kwee et al. 2015). Prone positioning has its impediment, and postoperative vision loss (POVL) is often reported, despite its low overall incidence, chiefly because of the pressure on anterior structures of the eye (Kwee et al. 2015). POVL is frequently involved in malpractice claims and litigations, complicating further research of its causative factors (Mendel et al. 2017). Following spine surgery, postoperative vision loss (POVL) occurs between 0.1% and 0.2% of the time. Ischemic optic neuropathy (ION), central retinal artery occlusion (CRAO), and cortical blindness are the three most frequent causes of vision loss (Mendel et al. 2017). Both anterior and posterior ION (PION) is possible after surgery, PION being more prevalent because the small pial vessels supplying it cannot be controlled by autoregulatory mechanisms. Raised IOP is one of the risk factors for the development of ION, among other things (Gerber et al. January 2021). A raised IOP combined with hypotension during surgery and intraoperative anaemia can cause optic nerve ischemia. Extrinsic ocular pressure from the headrest may lead to central retinal artery occlusion (Gerber et al. January 2021). Reasonably so, the anaesthesiology team is wary of ocular protection during prone positioning. Most often, it is a protocol to check that the eyes are free from pressure from the headsets. Visual inspection in the form of bending under and checking, use of a mirror (Lin et al. 2020) and a video laryngoscope (Mukherjee and Alam 2014) are most often done. Some horseshoe headsets are pre-fitted with mirrors to ease this process of bending down to check the eyes (Mukherjee and Alam 2014). A smartphone in today’s time has undeniably become an inseparable part of everyone's daily routine. And we advocate the use of the front-view capture/ selfie mode to visualise and ensure the safety of eyes in prone positioning. It is a readily available resource, easy to use and can also be used for record-keeping for medico-legal purposes in case of an unforeseen unfortunate event or litigation.

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Post-operative vision loss


Central retinal artery occlusion


Intraoccular pressure


Ischemic optic neuropathy


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AB: literature review, manuscript preparation, data collection. RD: conceptualisation of idea. MK: critical review, proof reading. PA: literature review, manuscript editing, proof reading. All authors read and approved the final manuscript.

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Correspondence to Abhishek Bharadwaj.

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Bharadwaj, A., Dubey, R., Khetarpal, M. et al. Selfie ensures eye safety. Ain-Shams J Anesthesiol 15, 28 (2023).

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