• Danielle A Katz and Lawrence I Karlin.
• Department of Orthopaedic Surgery, Children's Hospital, Boston, Massachusetts, USA. katzdortho@aol.com
• Spine. 2005 Feb 1; 30 (3): E83-5.

Study DesignCase report and literature review.ObjectivesReview cases and literature regarding visual loss following posterior spine fusion for scoliosis and emphasize right-to-left atrial shunt as a risk factor for paradoxical embolus resulting in a postoperative visual field defect.Summary Of Background DataThe existing literature discusses various possible etiologies of postoperative visual loss including direct pressure, hypotension, blood loss, and anemia. One study shows higher rates of cerebral microemboli in patients with right-to-left atrial shunts.MethodsChart and literature review.ResultsA paradoxical embolus to a branch of the central retinal artery resulted in a unilateral quadrant defect (homonymous quadrantanopsia) in a girl with a previously undiagnosed right-to-left atrial shunt.ConclusionsRight-to-left atrial shunts may predispose to cerebral emboli during scoliosis surgery. These emboli may be a cause of postoperative visual field defects.

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