Moriyama Yoji, Miwa Kosei, Yamada Tadanori, Sawaki Ayako, Nishino Yoshinori, Kitagawa Yasuhide
Department of Urology and Urogynecology Center, Japanese Red Cross Gifu Hospital, 3-36 Iwakura-cho, Gifu City, 502-8511, Japan.
Department of Anesthesia, Japanese Red Cross Gifu Hospital, Gifu, Japan.
Int Urogynecol J. 2019 Nov;30(11):1933-1938. doi: 10.1007/s00192-018-03866-w. Epub 2019 Jan 14.
The steep Trendelenburg position, high pneumoperitoneum pressure, and longer surgical time may lead to significantly increased intraocular pressure (IOP), which could result in unexpected eye disease complications, including perioperative visual loss (POVL). We monitored IOP to induce early laparoscopic sacral colpopexy (LSC) safely.
This prospective study enrolled 39 patients with pelvic organ prolapse (POP), including 10 with eye diseases (6 with normal tension glaucoma and 4 with a narrow anterior chamber and normal range IOP). Enrolled patients underwent LSC under the same surgical settings involving a pneumoperitoneum of 10 mmHg and a Trendelenburg position of 15°. We measured IOP at seven time points during surgery and estimated IOP changes with time in patients with or without eye diseases.
All patients, with or without eye diseases, experienced significantly elevated IOP during LSC. There were no significant differences between these groups. The average maximal IOP reached 20 mmHg at the end of surgery, and recovered to baseline values with the patient in the supine position at the end of anesthesia. No patient had an IOP of >40 mmHg as a critical threshold during surgery, and no substantial clinical eye symptoms were seen after LSC.
Laparoscopic sacral colpopexy using an pneumoperitoneum of 10 mmHg and a Trendelenburg position of 15° during a 3-h surgical period could be performed within a safe range of IOP.
深度头低脚高位、高气腹压力和较长的手术时间可能导致眼内压（IOP）显著升高，进而引发意外的眼部疾病并发症，包括围手术期视力丧失（POVL）。我们监测眼内压以安全地进行早期腹腔镜骶骨阴道固定术（LSC）。
这项前瞻性研究纳入了39例盆腔器官脱垂（POP）患者，其中10例患有眼部疾病（6例为正常眼压性青光眼，4例为前房狭窄且眼压在正常范围内）。纳入的患者在相同的手术条件下接受LSC，气腹压力为10 mmHg，头低脚高位为15°。我们在手术期间的七个时间点测量眼内压，并估计有或无眼部疾病患者的眼内压随时间的变化。
所有患者，无论有无眼部疾病，在LSC期间眼内压均显著升高。这些组之间无显著差异。手术结束时平均最大眼内压达到20 mmHg，并在麻醉结束时患者仰卧位时恢复到基线值。手术期间没有患者的眼内压超过40 mmHg这一临界阈值，LSC术后也未出现明显的临床眼部症状。
在3小时的手术期间，使用10 mmHg的气腹压力和15°的头低脚高位进行腹腔镜骶骨阴道固定术可在眼内压的安全范围内进行。
