Hirooka Kazuyuki, Ukegawa Kaori, Nitta Eri, Ueda Nobufumi, Hayashida Yushi, Hirama Hiromi, Taoka Rikiya, Sakura Yuma, Yamasaki Mari, Tsunemori Hiroyuki, Sugimoto Mikio, Kiuchi Yoshiaki
Department of Ophthalmology and Visual Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
Department of Ophthalmology, Kagawa University Faculty of Medicine, Miki, Kagawa 761-0793, Japan.
J Ophthalmol. 2019 Dec 6;2019:6576140. doi: 10.1155/2019/6576140. eCollection 2019.
To investigate the effect of the steep Trendelenburg position surgical procedure on the retinal structure and function during robotic-assisted laparoscopic radical prostatectomy (RALP) in glaucoma patients.
At 1 month and 1 day before and at 1 and 2 months after the RALP operation, 10 glaucoma patients underwent standard automated perimetry and optical coherence tomography. After placing patients in a supine position, intraocular pressure (IOP) was measured at 5 min after intubation under general anesthesia (T1), at 5 discrete time points (5, 30, 60, 120, and 180 min; T2-6) and at 5 min after returning to a horizontal supine position (T7). The Guided Progression Analysis software program was used to assess serial retinal nerve fiber layer (RNFL) thicknesses and visual field progression.
Eight additional patients were newly diagnosed in addition to the two previous glaucoma patients. Average IOP (mmHg) at each time point was as follows: T1 = 11.2 ± 3.8, T2 = 19.0 ± 4.4, T3 = 23.3 ± 6.3, T4 = 25.1 ± 4.3, T5 = 25.5 ± 5.1, T6 = 28.3 ± 4.8, and T7 = 22.6 ± 5.4. IOP significantly increased during RALP. RNFL thickness progressed in two eyes of two patients after the surgery, even though there was no progression of the visual field.
Two eyes of two patients exhibited significant RNFL thickness progression. Since an increased IOP during the surgery was the probable cause of the changes, ophthalmologic examinations should be performed before and after RALP, especially in glaucoma patients.
探讨在青光眼患者机器人辅助腹腔镜根治性前列腺切除术（RALP）中，陡峭头低脚高位手术操作对视网膜结构和功能的影响。
10例青光眼患者在RALP手术前1个月零1天、术后1个月和2个月接受标准自动视野计检查和光学相干断层扫描。患者仰卧位后，在全身麻醉下插管后5分钟（T1）、5个离散时间点（5、30、60、120和180分钟；T2 - 6）以及恢复水平仰卧位后5分钟（T7）测量眼压（IOP）。使用引导进展分析软件程序评估视网膜神经纤维层（RNFL）厚度的系列变化和视野进展情况。
除之前的2例青光眼患者外，又新诊断出8例患者。各时间点的平均眼压（mmHg）如下：T1 = 11.2±3.8，T2 = 19.0±4.4，T3 = 23.3±6.3，T4 = 25.1±4.3，T5 = 25.5±5.1，T6 = 28.3±4.8，T7 = 22.6±5.4。RALP手术期间眼压显著升高。术后两名患者的两只眼睛RNFL厚度出现进展，尽管视野没有进展。
两名患者的两只眼睛表现出显著的RNFL厚度进展。由于手术期间眼压升高可能是这些变化的原因，因此应在RALP手术前后进行眼科检查，尤其是青光眼患者。
