Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss
- PMID: 17978659
- DOI: 10.1097/BRS.0b013e318158cc23
Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss
Abstract
Study design: Parallel group design.
Objective: Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position.
Summary of background data: Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure, which may decrease perfusion pressure to the optic nerve (perfusion pressure = mean arterial pressure - intraocular pressure [IOP]). The prone Trendelenburg's position is often used during spine surgery; however, its effect on optic nerve perfusion is unknown. The purpose of this study is to compare the IOP responses in the prone flat versus prone Trendelenburg's positions to determine if prone Trendelenburg's position also risks PVL.
Methods: Twenty subjects randomized into 2 groups. Group 1 lay in the prone flat position (0 degrees). Group 2 lay in the prone Trendelenburg's position (-7 degrees). IOPs were measured with a hand-held applanation tonometer while seated, 1 minute after assuming the group's position (Time 0), and at 10-minute intervals for 60 minutes.
Results: The differences in mean IOPs with respect to positions and time were significant (P = 0.0001, P = 0.000). There was a significant difference between sitting and all other times for both groups. In Group 1, there was a significant difference in IOP between Time 0 and all other times prone flat (P < 0.05). In Group 2, there was a significant difference in IOP between Time 0 all other times prone Trendelenburg (P < 0.05).
Conclusion: IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.
Similar articles
-
Effect of the degree of reverse Trendelenburg position on intraocular pressure during prone spine surgery: a randomized controlled trial.Spine J. 2014 Sep 1;14(9):2118-26. doi: 10.1016/j.spinee.2013.12.025. Epub 2014 Jan 20. Spine J. 2014. PMID: 24456677 Clinical Trial.
-
The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy.Anesth Analg. 2009 Aug;109(2):473-8. doi: 10.1213/ane.0b013e3181a9098f. Anesth Analg. 2009. PMID: 19608821
-
Optic nerve sheath diameter does not change with patient position.Am J Emerg Med. 2005 Sep;23(5):686-8. doi: 10.1016/j.ajem.2004.11.004. Am J Emerg Med. 2005. PMID: 16140179 Clinical Trial.
-
Visual loss as a complication of nonophthalmologic surgery: a review of the literature.AANA J. 2004 Aug;72(4):285-92. AANA J. 2004. PMID: 15354918 Review.
-
[Postoperative visual disturbances after non-ophthalmic surgery].Masui. 2009 Aug;58(8):952-61. Masui. 2009. PMID: 19702207 Review. Japanese.
Cited by
-
Perioperative Blindness in Spine Surgery: A Scoping Literature Review.J Clin Med. 2024 Feb 12;13(4):1051. doi: 10.3390/jcm13041051. J Clin Med. 2024. PMID: 38398364 Free PMC article. Review.
-
A study to evaluate ocular changes in patients undergoing spine surgery in the prone position.J Anaesthesiol Clin Pharmacol. 2021 Oct-Dec;37(4):580-585. doi: 10.4103/joacp.JOACP_428_19. Epub 2022 Jan 6. J Anaesthesiol Clin Pharmacol. 2021. PMID: 35340948 Free PMC article.
-
Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery.Int J Spine Surg. 2020 Apr 30;14(2):195-208. doi: 10.14444/7029. eCollection 2020 Apr. Int J Spine Surg. 2020. PMID: 32355626 Free PMC article.
-
Effects of different sleeping positions on intraocular pressure in secondary open-angle glaucoma and glaucoma suspect patients.Clin Ophthalmol. 2018 Aug 1;12:1347-1357. doi: 10.2147/OPTH.S163319. eCollection 2018. Clin Ophthalmol. 2018. PMID: 30122886 Free PMC article.
-
Are you seeing this: the impact of steep Trendelenburg position during robot-assisted laparoscopic radical prostatectomy on intraocular pressure: a brief review of the literature.J Robot Surg. 2019 Feb;13(1):35-40. doi: 10.1007/s11701-018-0857-7. Epub 2018 Jul 25. J Robot Surg. 2019. PMID: 30047103
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical
Research Materials