The Effect of Head Rotation on Intraocular Pressure in Prone Position: a Randomized Trial

Abstract

Background and objectives: The increased intraocular pressure (IOP)-which decreases perfusion pressure on the optic nerve-increases by prone positioning (1). The aim of our study was to compare the effect of head rotation 45 o laterally in prone position on the increase in IOP of upper placed and lower placed eyes in patients undergoing percutaneous nephrolithotomy (PCNL). Methods: Forty-fi ve patients were randomly divided into 2 Groups. IOP of the patients were recorded bilaterally in supine position before the operation had started. Patients were turned to prone position. The head was placed on a prone headrest without external direct compression to both eyes. Patients in Group I were kept in strictly neutral prone position where as patients in Group II were placed prone with their heads rotated 45º laterally to the right side. At the end of the operation, patients were turned to supine position and their IOP was measured immediately. Results: There was no difference related to demographics, duration of surgery, blood loss and fl uid input data. IOP values after surgery in prone position increased signifi cantly compared to preoperative values in both groups (p < 0.05). After surgery in prone position IOP values of the upper positioned eyes in Group II were signifi cantly lower than Group I and lower positioned eyes in Group II (p < 0.05). Conclusion: prone positioning increases IOP. In patients with prone position with a head rotation of 45o laterally, IOP in the upper positioned eye was signifi cantly lower.

Systematic review and meta-analyses of trendelenburg and prone position on intraocular pressure in adult patients undergoing surgery

“…Although some researchers have studied the quantitative intraoperative increases of IOP in surgical patients in the Trendelenburg Awad et al, 2009;Borahay et al, 2013;Hoshikawa et al, 2014;, and prone position Nuri Deniz et al, 2013;, there is a need for systematic review and meta-analysis of these studies to demonstrate the magnitude and overall effect size of the increase in IOP in adult surgical patients. Meta-analysis research can provide high-quality evidence to support the need for implementing intraoperative interventions designed to mitigate or reduce the increase of IOP and thus decrease the patient's risk for postoperative vision loss or other ocular complications.…”

“…Although some researchers have studied the quantitative increase of IOP in surgical patients in the prone position Nuri Deniz et al, 2013;, there is a need for systematic review and meta-analyses of these studies to demonstrate the overall effect size and provide high-quality evidence supporting the need for implementing interventions to mitigate the increase of IOP and reduce the risk for postoperative vision loss. Meta-analysis research methods provide increased power compared to individual studies, improve estimates of effect size, and help resolve uncertainty when the results of individual studies disagree .…”

“…Participant and surgery characteristics are shown in Nuri Deniz et al, 2013;Pinar et al, 2018). reported patient comorbidities for diabetes (n = 5 of 24; 20.8%), and hypertension (n = 9 of 24; 37.5%).…”

“…The nine reports included in this systematic review and meta-analysis comprised four experimental (n = 97;Nuri Deniz et al, 2013;Pinar et al, 2018), and five non-experimental (n = 132; .…”

“…Researchers have independently investigated the quantitative increases of IOP that occur intraoperatively in adult surgical patients in the Trendelenburg Awad et al, 2009;Borahay et al, 2013;Hoshikawa et al, 2014; and prone Nuri Deniz et al, 2013; positions. However, there is a need for systematic review and meta-analyses of these studies to demonstrate the magnitude of the increase in IOP and the overall effect sizes.…”