The impact of laparoscopic surgery in Trendelenburg position on intraocular pressure

Abstract

Background Patients′ intraocular pressure (IOP) significantly increase during laparoscopic surgery in Trendelenburg position, and the resulting intraoperative intraocular hypertension may be related to postoperative visual loss (POVL). Objective To review the impact of laparoscopic surgery in Trendelenburg position on IOP to let the practitioners aware of the association between intraocular hypertension and POVL. Content One of the major causes for POVL is ischemia in optic nerve following reduction of ocular perfusion pressure (OPP) because of the increase of IOP. Animal studies prove that persistently increased IOP leads to damages in the retina. Patients often receive the laparoscopic surgery in Trendelenburg position, and low OPP and high IOP are commonly seen in this situation. In addition to the body position, the increase of IOP can also be a consequence of hypercapnia following CO2 inflation in the abdominal cavity, and may be affected by anesthetics, duration of the surgery, blood pressure, obesity and gender, etc. Several procedures have been performed to alleviate the increase of IOP, such as, intermittent shift the Trendelenburg position into supine position and intraoperative pharmacological intervention. Trend POVL is rarely seen in laparoscopic surgery, but severely compromises patient′s life quality if happens. Cautions should be taken to carefully monitor IOP in the patients with risk factors for POVL during laparoscopic surgery in the Trendelenburg position. Key words: Intraocular pressure; Laparoscopic surgery; Trendelenburg position