Mizumoto Kyoichi, Gosho Masahiko, Iwaki Masayoshi, Zako Masahiro
Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan.
Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Clin Ophthalmol. 2017 Sep 13;11:1643-1650. doi: 10.2147/OPTH.S139874. eCollection 2017.
Intraocular pressure (IOP) increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP). We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery.
A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Perioperative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1), immediately post-steep Trendelenburg position (T2), and prior to returning to a flat supine position while in a steep Trendelenburg position (T3). The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC), and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery.
The average IOPs (mmHg) at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution), IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion cell complex and retinal nerve fiber layer thicknesses measured at each location and the central fovea thicknesses measured before and after surgery did not differ significantly.
No significant disorders in ocular structural and functional parameters were found until long after RALP.
在机器人辅助腹腔镜根治性前列腺切除术（RALP）期间，处于陡峭头低脚高位的患者眼内压（IOP）会升高。我们推测，RALP期间的陡峭头低脚高位是一种涉及IOP短暂升高的特殊全身状况，可能会诱发眼部病变，而这种病变在手术后很长时间通过详细评估才能被检测到。本研究旨在探讨患者手术前及术后长期的眼部结构和功能参数。
进行了一项对比观察性研究。纳入了2012年8月至2013年7月在爱知医科大学计划接受RALP的22名男性患者的44只眼睛。比较了RALP前后的临床参数。在平卧位麻醉诱导后立即（T1）、在陡峭头低脚高位后立即（T2）以及在陡峭头低脚高位恢复到平卧位之前（T3）测量围手术期眼压。用光谱域光学相干断层扫描测量视乳头周围视网膜神经纤维层、神经节细胞复合体（GCC）和中央凹的厚度。在手术前以及手术后3个月和6个月进行汉弗莱视野检查。
各阶段的平均眼压（mmHg）分别为T1 = 10.4、T2 = 21.7和T3 = 29.6，差异有统计学意义。汉弗莱视野分析仪测量的平均视力（最小分辨角对数）、眼压、平均偏差和模式标准偏差在手术前后无统计学显著差异。每个位置测量的神经节细胞复合体和视网膜神经纤维层厚度以及手术前后测量的中央凹厚度无显著差异。
直到RALP术后很长时间，未发现眼部结构和功能参数有明显紊乱。
