Evaluering av intraokulært trykk ved robotassistert prostatakirurgi i ekstremt Trendelenburgs leie

Abstract

Background: Intraocular pressure (IOP) increases in steep Trendelenburg position and increases the risk of Post Operative Loss of Vision (POLV). There is a lack of knowledge concerning medical and surgical factors that affects the risk of reaching critical values of IOP. Purpose: The purpose of this study was to measure IOP in patients undergoing RoboticAssisted Radical Prostatectomy (RARP) to study if IOP reaches critical values while patients are in steep Trendelenburg positioning. Further, the aim was to describe these patients in terms of their medical condition and factors related to surgery. Matherial and methods: In this prospective study we measured IOP in 53 patients undergoing RARP. We used an ICare tonopen for the measurements, and IOP was measured at seven predefined time points including baseline, every 30 minutes in the extreme position and after the surgery was finished. Phone calls were made to 51 of 53 patients one week after surgery to get information of any ocular problems. Results: IOP was on average 10.95 ± 5.42 (mean ± SD) mm Hg higher in the steep Trendelenburg position compared to baseline IOP, awake in supine position (p<0.001). Four out of 53 patients reached critical values of IOP (> 40 mm Hg). 41 patients (77,4 %) responded on the phone calls and none of them reported ocular problems after surgery. Conclusions: IOP increases significantly when patients are in steep Trendelenburg position. POLV was not found in any of the patients, however 4 patients reached critical levels of IOP. None of the patients reported ocular problems after surgery. Critical high levels of IOP seem to be a result of the combination of several medical and surgical risk factors. RELEVANCE This master thesis increases knowledge of the risk of reaching critical levels of IOP in the steep Trendelenburg position. This knowledge may be used by the clinicians to prevent patients from reaching critical levels of IOP and by that prevent POLV which is a serious and devastating complication.