Amaurosis Post-Bilateral Neck Dissection: A Systematic Review

To discuss the prevalence of amaurosis post-bilateral radical neck dissections; and to provide a management algorithm that highlights the approaches undertaken in available literature to minimize incidence and maximally improve outcomes. This objective will be achieved by systematically reviewing and highlighting current literature. We systematically reviewed Pubmed, EMBASE, and Web of Science for articles pertaining to the management of amaurosis post-bilateral neck dissection. A comprehensive search of available literature was conducted by two independent authors to yield 23 articles to be included in the review. Due to the heterogeneity of study designs and outcome measures, findings were summarized and analyzed descriptively. 23 cases were reported between 1960 and 2021; n = 21 were reported through case reports. Neck dissection type alongside pharyngectomy (n = 7) and laryngectomy (n = 13) status were documented. Mean symptomatic onset was 7.3 ± 5.561 days; median onset n = 3. Seven reported symptoms post-operative day (POD) 0. n = 17 patients underwent bilateral radical neck dissections. n = 16 patients reported intraoperative hypotension. Investigations the patients underwent were documented. The most common causes of the disease included posterior ischaemic optic neuropathy (PION) (n = 8) and anterior ischaemic optic neuropathy (AION) (n = 5). The mean transfused amount of blood was 750 ml. The most common management of amaurosis post-bilateral neck dissection were through high dose corticosteroids. Mannitol and acetazolamide were also documented managements of the condition. Overall, there is a paucity of evidence pertaining to the management of amaurosis post-bilateral neck dissection; highlighting the importance of reviewing the available literature and proposing a management algorithm.