Abstract
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.
Highlights
One of the most common cancers in men is prostate cancer
Since the initial use in 2000 by Menon et al [1], robot-assisted laparoscopic radical prostatectomy (RALP) has been increasingly used, with the procedure being the predominant technique for the surgical management of prostate cancer in 85% of all prostatectomies [2]
In order to perform this procedure, the use of a steep Trendelenburg position is required with the patients in a supine position with their feet placed above their head at a 25 to 30 degree angle of inclination
Summary
Since the initial use in 2000 by Menon et al [1], robot-assisted laparoscopic radical prostatectomy (RALP) has been increasingly used, with the procedure being the predominant technique for the surgical management of prostate cancer in 85% of all prostatectomies [2]. Journal of Ophthalmology previous studies have reported finding a correlation between intraoperative IOP changes and the clinical postoperative ophthalmological outcomes [6,7,8]. We recently reported that despite all patients having an intraoperative increase in the IOP, their pre- and postoperative observations showed that none of these patients had any significant changes in the retinal structure and function [8]
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