The effect of robotic surgery on intraocular pressure and optic nerve sheath diameter: a prospective study

Abstract

AbstractBackground and objectives: To investigate the effect of the steep Trendelenburg position (35◦to 45◦) and carbon dioxide (CO2) insufflation on optic nerve sheath diameter (ONSD), intraocularpressure (IOP), and hemodynamic parameters in patients undergoing robot-assisted laparo-scopic prostatectomy (RALP), and to evaluate possible correlations between these parameters.Methods: A total of 34 patients were included in this study. ONSD was measured using ultra-sonography and IOP was measured using a tonometer at four time points: T1 (5 minutes afterintubation in the supine position); T2 (30 minutes after CO2 insufflation); T3 (120 minutes insteep Trendelenburg position); and T4 (in the supine position, after abdominal exsufflation).Systolic and diastolic arterial pressure, heart rate, and end-tidal CO2 (etCO2) were also evalu-ated.Results: The mean IOP was 12.4 mmHg at T1, 20 mmHg at T2, 21.8 mmHg at T3, and 15.6 mmHgat T4. The mean ONSD was 4.87 mm at T1, 5.21 mm at T2, 5.30 mm at T3, and 5.08 at T4. Therewas a statistically significant increase and decrease in IOP and ONSD between measurements atT1 and T4, respectively. However, no significant correlation was found between IOP and ONSD.A significant positive correlation was found only between ONSD and diastolic arterial pressure.Mean arterial pressure, heart rate, and etCO2 were not correlated with IOP or ONSD.Conclusions: A significant increase in IOP and ONSD were evident during RALP; however, therewas no significant correlation between the two parameters.