Visual Problems

Most patients notice an improvement in their vision within hours of surgery, often as soon as consciousness returns in the recovery room. Many studies have shown that this occurs in more than 80% of patients (6,7). Equally fortunately, visual deterioration is rare, occurring in less than 3% in a survey by Ciric (8). If vision deteriorates postoperatively, early rescanning is mandatory. However, the scan, particularly the standard emergency computed tomography (CT) series may be difficult to interpret. Intracavity hematomas of some sort are sometimes seen even in "normal" recovering patients, and residual tumor is also a distinct possibility that can look surprisingly similar to clot. For the majority of us without an interventional magnetic resonance (MR) scanner, urgent re-exploration is the best option when there is any question of a significant clot.

A formal visual check after surgery should be carried out within the first few postoperative weeks. Ophthalmology departments find it difficult to get patients to concentrate adequately for the complexities of the Humphrey test or a Goldman field in the first 24-48 h, and prefer a longer delay to give a meaningful assessment. Vision can go on improving for many months, if not years, after surgery.

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