Purpose: To explore the possible ocular complications of intraoperative hypotension (IOH) using data from the TriNetX research platform, which provides de-identified patient records from numerous healthcare organizations worldwide.

Methods: Patients with and without IOH were identified on the TriNetX research platform using ICD-10 codes. The dataset initially included 144,130 patients with IOH and 4,912,179 patients without IOH. Propensity score matching based on sex, race, and relevant ICD-10 diagnoses (diseases of the circulatory, nervous, and respiratory systems, as well as endocrine, nutritional, and metabolic diseases) was used to create balanced groups of 139,967 patients with and without IOH. The outcomes that were evaluated included ischemic optic neuropathy, optic atrophy, retinal ischemia, retinal artery occlusion, and retinal vein occlusion after having a procedure that included the use of anesthesia. Risk ratios were calculated following propensity score matching.

Results: The risk of ischemic optic neuropathy was 0.01% in patients without IOH and 0.04% in those with IOH (RR: 2.94, 95% CI: 1.70, 5.10, p <0.0001). Optic atrophy also showed a significant association, with risks of 0.04% in patients without IOH and 0.06% in those with IOH (RR: 1.55, 95% CI: 1.11, 2.16, p=0.01). The risk of retinal artery occlusion was 0.02% for patients without IOH compared to 0.05% for those with IOH (RR: 2.60, 95% CI: 1.67, 4.05, p<0.001). Retinal ischemia was not shown to have a significant association (RR: 1.25, 95% CI: 0.59, 2.67, p=0.56), as well as retinal vein occlusion (RR: 1.41, 95% CI: 0.82, 2.44, p=0.21).

Conclusions: Patients who experience IOH have a significantly greater risk for ocular complications, supporting the need for close intraoperative monitoring and post-operative ophthalmic follow-up.