The Effect of Steep Trendelenburg Positioning on Retinal Structure and Function during Robotic-Assisted Laparoscopic Procedures

Purpose. Robotic-assisted laparoscopic radical prostatectomy (RALP) has become a standard treatment choice for localized prostate cancer. RALP requires a steep Trendelenburg position, which leads to a significant increase in intraocular pressure (IOP). This study evaluated the effect on the retinal structure and function in patients undergoing RALP. Methods. Standard automated perimetry (SAP) and optical coherence tomography (OCT) were performed in 20 males scheduled for RALP at 1 month and 1 day before the operation and at 1 and 3 months after the operation. IOP measurements were made in the supine position at 5 min after intubation under general anesthesia (T1), at 6 discrete time points (5, 30, 60, 120, 180, and 240 min; T2-7), and at 5 min after returning to a horizontal supine position (T8). Serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression were assessed using the guided progression analysis software program. RNFL thickness progression and visual field progression were evaluated by event analysis. Results. Average IOP (mmHg) for each time point was as follows: T1 = 12.3 ± 2.6, T2 = 20.4 ± 4.2, T3 = 23.3 ± 3.8, T4 = 24.0 ± 3.2, T5 = 24.3 ± 3.4, T6 = 27.1 ± 7.2, T7 = 29.8 ± 8.7, and T8 = 20.1 ± 4.4. During RALP, IOP significantly increased. There was no progression of the visual field and RNFL thickness after surgery or any other ocular complications found. Conclusions. Although IOP significantly increased during RALP, there were no significant changes in the retinal structure and function between the pre- and postoperation observations.

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Structure and function evaluation (SAFE): I. criteria for glaucomatous visual field loss using standard automated perimetry (SAP) and short wavelength automated perimetry (SWAP)11Internet Advance publication at ajo.com June 17, 2002.

American Journal of Ophthalmology ◽

10.1016/s0002-9394(02)01577-5 ◽

2002 ◽

Vol 134 (2) ◽

pp. 177-185 ◽

Cited By ~ 65

Author(s):

Chris A Johnson ◽

Pamela A Sample ◽

George A Cioffi ◽

Jeffrey R Liebmann ◽

Robert N Weinreb

Keyword(s):

Visual Field ◽

Short Wavelength ◽

Visual Field Loss ◽

Structure And Function ◽

Function Evaluation ◽

Automated Perimetry ◽

Standard Automated Perimetry ◽

And Function

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Retinal Nerve Fiber Layer Thickness Progression after Robotic-Assisted Laparoscopic Radical Prostatectomy in Glaucoma Patients

Journal of Ophthalmology ◽

10.1155/2019/6576140 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Kazuyuki Hirooka ◽

Kaori Ukegawa ◽

Eri Nitta ◽

Nobufumi Ueda ◽

Yushi Hayashida ◽

...

Keyword(s):

Visual Field ◽

Radical Prostatectomy ◽

Nerve Fiber ◽

Retinal Nerve Fiber Layer ◽

Supine Position ◽

Laparoscopic Radical Prostatectomy ◽

Fiber Layer ◽

Robotic Assisted ◽

Nerve Fiber Layer ◽

Rnfl Thickness

Purpose. To investigate the effect of the steep Trendelenburg position surgical procedure on the retinal structure and function during robotic-assisted laparoscopic radical prostatectomy (RALP) in glaucoma patients. Methods. At 1 month and 1 day before and at 1 and 2 months after the RALP operation, 10 glaucoma patients underwent standard automated perimetry and optical coherence tomography. After placing patients in a supine position, intraocular pressure (IOP) was measured at 5 min after intubation under general anesthesia (T1), at 5 discrete time points (5, 30, 60, 120, and 180 min; T2-6) and at 5 min after returning to a horizontal supine position (T7). The Guided Progression Analysis software program was used to assess serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression. Results. Eight additional patients were newly diagnosed in addition to the two previous glaucoma patients. Average IOP (mmHg) at each time point was as follows: T1 = 11.2 ± 3.8, T2 = 19.0 ± 4.4, T3 = 23.3 ± 6.3, T4 = 25.1 ± 4.3, T5 = 25.5 ± 5.1, T6 = 28.3 ± 4.8, and T7 = 22.6 ± 5.4. IOP significantly increased during RALP. RNFL thickness progressed in two eyes of two patients after the surgery, even though there was no progression of the visual field. Conclusions. Two eyes of two patients exhibited significant RNFL thickness progression. Since an increased IOP during the surgery was the probable cause of the changes, ophthalmologic examinations should be performed before and after RALP, especially in glaucoma patients.

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