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Intraocular pressure variation during colorectal laparoscopic surgery: standard pneumoperitoneum leads to reversible elevation in intraocular pressure

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Abstract

Background

The potential effects of laparoscopic surgery on intra- and postoperative intraocular pressure (IOP) are not completely understood. Although prior studies have reported that pneumoperitoneum may increase IOP, it is not clear whether this increase is related to the effects of pneumoperitoneum or to the patient’s position, such as the Trendelenburg position. This study aimed to evaluate the potential fluctuations of IOP during colorectal laparoscopic surgery in two groups of patients: those with and those without Trendelenburg positioning.

Methods

For this prospective study 45- to 85-year-old patients undergoing laparoscopic colorectal surgery were enrolled after a thorough ophthalmologic assessment. The study protocol included measurement of IOP at eight different time points (before, during, and after surgery) using a contact tonometer in both eyes.

Results

The study enrolled 29 patients: 17 (58.6 %) with Trendelenburg position placement during surgery and 12 (41.4 %) without Trendelenburg positioning. The two groups did not differ in terms of gender, age, body mass index (BMI), American Society of Anesthesiology (ASA) class, or operative time. In all the patients, pneumoperitoneum induction led to a mild rise in IOP, averaging 4.1 mmHg. The patients with Trendelenburg positioning showed a greater increase than the patients without it (5.05 vs 4.23 mmHg at 45 min; p = 0.179), but IOP evaluation 48 h after surgery showed no substantial differences between the two groups. Among the 29 patients, 17 (58.6 %) showed an increase in IOP of 5 mmHg or more during surgery. A greater percentage of the patients who underwent Trendelenburg positioning showed an IOP increase of 5 mmHg or more (76.5 vs 33.3 %; p = 0.020). At the multivariate analysis, no potential predictors of increased IOP during surgery was identified.

Conclusions

Standard pneumoperitoneum (≤14 mmHg) led to mild and reversible IOP increases. A trend was observed toward a greater IOP increase in patients with Trendelenburg positioning. Thus, the patient’s position during surgery may represent a stronger risk factor for IOP increase than pneumoperitoneum-related intraabdominal pressure.

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References

  1. Yanagi M, Kawasaki R, Wang JJ, Wong TY, Crowston J, Kiuchi Y (2011) Vascular risk factors in glaucoma: a review. Clin Exp Ophthalmol 39:252–258

    Article  Google Scholar 

  2. Sung KR, Cho JW, Lee S, Yun SC, Choi J, Na JH, Lee Y, Kook MS (2011) Characteristics of visual field progression in medically treated normal-tension glaucoma patients with unstable ocular perfusion pressure. Invest Ophthalmol Vis Sci 52:737–743

    Article  PubMed  Google Scholar 

  3. Medeiros FA, Weinreb RN, Zangwill LM, Alencar LM, Sample PA, Vasile C, Bowd C (2008) Long-term intraocular pressure fluctuations and risk of conversion from ocular hypertension to glaucoma. Ophthalmology 115:934–940

    Article  PubMed  Google Scholar 

  4. Law SK, Nguyen AM, Coleman AL, Caprioli J (2007) Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol 125:1044–1050

    Article  PubMed  Google Scholar 

  5. Ma Y, Yang Z, Qin H, Wang Y (2011) A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer. Med Oncol 28:925–933

    Article  PubMed  Google Scholar 

  6. Lourenco T, Murray A, Grant A, McKinley A, Krukowski Z, Vale L (2008) Laparoscopic surgery for colorectal cancer: safe and effective? a systematic review. Surg Endosc 22:1146–1160

    Article  PubMed  Google Scholar 

  7. Mowafi HA, Al-Ghamdi A, Rushood A (2003) Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia. Anesth Analg 97:471–474

    Article  PubMed  CAS  Google Scholar 

  8. Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, Roth S, Patel V (2009) The effects of steep Trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg 109:473–478

    Article  PubMed  Google Scholar 

  9. Lentschener C, Leveque JP, Mazoit JX, Benhamou D (1998) The effect of pneumoperitoneum on intraocular pressure in rabbits with alpha-chymotrypsin-induced glaucoma. Anesth Analg 86:1283–1288

    PubMed  CAS  Google Scholar 

  10. Sit AJ (2009) Continuous monitoring of intraocular pressure: rationale and progress toward a clinical device. J Glaucoma 18:272–279

    Article  PubMed  Google Scholar 

  11. Scuderi GL, Cascone NC, Regine F, Perdicchi A, Cerulli A, Recupero SM (2011) Validity and limits of the rebound tonometer (ICare®): clinical study. Eur J Ophthalmol 21:251–257

    Article  PubMed  Google Scholar 

  12. Brusini P, Salvetat ML, Zeppieri M, Tosoni C, Parisi L (2006) Comparison of ICare tonometer with Goldmann applanation tonometer in glaucoma patients. J Glaucoma 15:213–217

    Article  PubMed  Google Scholar 

  13. Tarek Shaarawy T, Sherwood MB, Hitchings RA, Crowston JG (2009) Glaucoma. Saunders Ltd, Philadelphia, PA

    Google Scholar 

  14. Morino M, Parini U, Girando G, Salval M, Brachet Contul R, Garrone C (2003) Laparoscopic total mesorectal excision: a consecutive series of 100 patients. Ann Surg 237:335–342

    PubMed  Google Scholar 

  15. Hosmer DW, Lemeshow S (2000) Applied logistic regression (Wiley Series in probability and statistics), 2nd edn. Wiley, New York, NY

    Book  Google Scholar 

  16. Sultan MB, Mansberger SL, Lee PP (2009) Understanding the importance of IOP variables in glaucoma: a systematic review. Surv Ophthalmol 54:643–662

    Article  PubMed  Google Scholar 

  17. Abraham LM, Epasinghe NC, Selva D, Casson R (2008) Comparison of the ICare rebound tonometer with the Goldmann applanation tonometer by experienced and inexperienced tonometrists. Eye Lond 22:503–506

    Article  PubMed  CAS  Google Scholar 

  18. Pinkney TD, King AJ, Walter C, Wilson TR, Maxwell-Armstrong C, Acheson AG (2012) Raised intraocular pressure (IOP) and perioperative visual loss in laparoscopic colorectal surgery: a catastrophe waiting to happen? A systematic review of evidence from other surgical specialities. Tech Coloproctol 16:331–335

    Article  PubMed  CAS  Google Scholar 

  19. Shen Y, Drum M, Roth S (2009) The prevalence of perioperative visual loss in the United States: a 10-year study from 1996 to 2005 of spinal, orthopedic, cardiac, and general surgery. Anesth Analg 109:1534–1545

    Article  PubMed  Google Scholar 

  20. Liu JH, Sit AJ, Weinreb RN (2005) Variation of 24-hour intraocular pressure in healthy individuals: right eye versus left eye. Ophthalmology 112:1670–1675

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Prof. Jonathan G. Crowston, Head of the Department of Ophthalmology at the University of Melbourne, for his help in reviewing the manuscript.

Disclosures

  Andrea Grosso, Gitana Scozzari, Fabrizio Bert, Maria Antonietta Mabilia, Roberta Siliquini, and Mario Morino have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Centre for Macular Research, San Mauro Torinese and Torino Eye Hospital, Via Roma 73, Torino, Italy

    Andrea Grosso

  2. Department of Surgical Sciences, University of Torino, C.so A.M. Dogliotti, 14, Torino, 10126, Italy

    Gitana Scozzari & Mario Morino

  3. Department of Public Health Sciences and Pediatrics, University of Torino, Torino, Italy

    Fabrizio Bert & Roberta Siliquini

  4. Department of Anesthesiology, University of Torino, Torino, Italy

    Maria Antonietta Mabilia

Authors
  1. Andrea Grosso
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  2. Gitana Scozzari
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  3. Fabrizio Bert
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  4. Maria Antonietta Mabilia
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  5. Roberta Siliquini
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  6. Mario Morino
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Correspondence to Mario Morino.

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Grosso, A., Scozzari, G., Bert, F. et al. Intraocular pressure variation during colorectal laparoscopic surgery: standard pneumoperitoneum leads to reversible elevation in intraocular pressure. Surg Endosc 27, 3370–3376 (2013). https://doi.org/10.1007/s00464-013-2919-2

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  • DOI: https://doi.org/10.1007/s00464-013-2919-2

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