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A Journal on Ophthalmology
Minerva Oftalmologica 2012 September;54(3):93-100
Changes of intraocular pression and intraoperative surgical positions: studying potential risk for postoperative vision loss
Montorio D. 1, Breve M. A. 1, Russo V. 2, Vivona L. 2, Vivona G. 2
1 Dipartimento Assistenziale di Oftalmologia, Università degli Studi di Napoli, “Federico II”, Napoli, Italia;
2 Dipartimento Assistenziale di Anestesia, Rianimazione, Terapia Intensiva, Terapia Antalgica e Terapia Iperbarica, Università degli Studi di Napoli, “Federico II”, Napoli, Italia
AIM:The aim of this paper was to evaluate changes in intraocular pressure (IOP) which can occur during spine surgery performed under general anesthesia in prolonged prone and prone Trendelenburg.
METHODS: Twenty patients have been divided in two groups: one in prone position (0°), the other in prone Trendelenburg’s position (-7°). Intraocular pressure (IOP) have been measured with Tonopen, applanation tonometer, before the operation in a seated position and then during anesthesia in the two studying position, every 10 minutes for 60 minutes of observation.
RESULTS: IOP medium values of each group changed when the patients were placed in prone and prone Trendelenburg’s position after a seated starting position. Further, those values started to increase in both positions assumed during the observation time of 60 minutes. Compared to values in prone position, IOP in prone Trendelenburg’s position was higher. In each group of patients, IOP medium values measured at each interval resulted statistically significant (P<0.0001) compared to that measured at time zero. Then, comparing this parameter in both groups for each measuring interval it has been found an high significance (P<0.0001).
CONCLUSION: Prone and prone Trendelenburg surgical positions represent an important risk factor for postoperative vision loss, due to the IOP increasing that could decrease the perfusion pressure of the optic nerve and then determine episodes of postoperative ischemic optic neuropathy.