Abstract
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.
Highlights
Prostate cancer is one of the most common cancers in men
It has been reported that increases in the intraocular pressure (IOP) during the operation can potentially lead to complications such as glaucoma and ischemic optic neuropathy [9, 10]
Despite reports of increases in the IOP during the surgery in normal subjects, our current study demonstrated that there were no changes in the values for the visual field and retinal nerve fiber layer (RNFL) thickness observed at 1 month and 1 day prior to the radical prostatectomy (RALP) procedure and at 1 and 3 months after the RALP procedure
Summary
Prostate cancer is one of the most common cancers in men. there are several treatment options, radical prostatectomy is a standard treatment for clinically localized prostate cancer. As compared to the radical prostatectomy, there are several benefits associated with RALP, including reduced blood loss, fewer perioperative complications, improved functional outcomes, and a faster return to work [1,2,3]. Taketani et al recently reported OCTdetected visual field defects at 1 week after surgery, even though they found no abnormal findings in the fundus, RNFL thickness, or optic disc morphology, with the visual field returning to normal within 3 months after the surgeries in all cases [7].
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