Влияние положения тела при лапароскопических операциях на динамику внутриглазного давления

Abstract

PURPOSE : To evaluate the effects of laparoscopic surgery on intraocular pressure in the horizontal and Trendelenburg positions. METHODS : A dynamic measurement of intraocular pressure was performed during laparoscopic abdominal surgery in 26 patients (52 eyes) without signs of ophthalmic diseases, mean age 50.4 years. The patients were divided into 2 groups according to the body position during surgery. Group 1 — horizontal position; 16 participants, mean age 50.9 years. Group 2 — Trendelenburg position (head below the legs); 10 participants, mean age 49.7 years. Measurements of intraocular pressure were made with a portable Icare® PRO tonometer. Measurements were performed the day before the intervention, 15 minutes before and 5 minutes after induction of anesthesia, 5 minutes after the start of insufflation, then every 10 minutes until the end of the surgery, and a week later. Pressure of the insufflation gas in the abdominal cavity was recorded synchronously with the measurement of intraocular pressure. RESULTS : Significant decrease of intraocular pressure was observed after the induction of anesthesia. In the horizontal po-sition mean decrease was 3.8 mm Hg, in the Trendelenburg position it was 3.71 mm Hg. Later, during surgery, it grew in both groups. Correlation coefficient between the duration of the surgery and the IOP level in the horizontal position was 0.224 (p=0.008); in the Trendelenburg position — 0.744 (p<0,001). Significant excess of the initial IOP level in the horizontal position — at 55 minutes (p=0.0222), and in the Trendelenburg tilt at 25 minutes (p=0.0284). Positive correlation was found between pressure in the abdominal cavity and intraocular pressure in the horizontal position, correlation coefficient 0.529 (p<0.0001). Relationship between them was weak In Trendelenburg tilt, correlation coefficient -0.168 (p=0.184). One week later, IOP was at the initial level. CONCLUSION : Trendelenburg tilt and increase in laparoscopic surgery duration lead to ophthalmic hypertension. The levels of intra-abdominal pressure during surgery have a mild effect on IOP. The correlations revealed in the study suggest limiting the duration of laparoscopic surgery and Trendelenburg position in patients with existing ophthalmic hypertension or glaucoma.