Retinal Nerve Fiber Layer Thickness Progression after Robotic-Assisted Laparoscopic Radical Prostatectomy in Glaucoma Patients

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.

Effects of robot-assisted laparoscopic radical prostatectomy on normal and glaucomatous eyes

“…In the trend analysis of OCT ndings for each patient with glaucoma, there were no statistically signi cant trends based on simple regression. In the only previous report on the effect of RARP on glaucomatous eyes, RNFL thinning progressed in 2 of 10 patients with glaucoma evaluated until 2 months after surgery but there was no progression of visual eld defects 9 . It is unclear whether this was also due to the effects of increased IOP during RARP, but attention may be required in some patients.…”

“…There has only been one report about changes in IOP during RARP and in OCT and visual eld measurements after RARP in glaucomatous eyes followed for up to 2 months after surgery. 9 This is the rst report on follow-up until 12 months after RARP in glaucomatous eyes. In addition, to the best of our knowledge, there have been no reports comparing increases in IOP during RARP between normal and glaucomatous eyes.…”

“…However, there has only been one study evaluating patients with glaucoma undergoing RARP. Hirooka et al reported that no visual eld changes were observed even though RNFL thinning progressed in 2 of 10 patients with glaucoma until 2 months after RARP 9 . Thus, there is no established consensus on the surgical contraindications for RARP in patients with glaucoma.…”

Perioperative Care of the Patient with Eye Pathologies Undergoing Nonocular Surgery

“…Most studies are small and limited, measuring intraocular pressure mostly in nonglaucomatous subjects. 173–180…”

“…Most studies are small and limited, measuring intraocular pressure mostly in nonglaucomatous subjects. [173][174][175][176][177][178][179][180] Head-down Positioning in Subjects with Glaucoma: Nonsurgical. Moderate head-down tilting can be used as a provocative test to identify patients who progress to development of glaucoma.…”