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Vandana R. Minnal, Michael S. Lasser, Reza Ghavamian, Assumpta Madu; Safety Of Robot-Assisted Laparoscopic Prostatectomy Despite Known Acute Increase In Intraocular Pressure. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4484.
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Robot-assisted laparoscopic prostatectomy (RALP) is one of many surgeries that utilize steep Trendelenberg. This head down body positioning can lead to various adverse outcomes including an increase in intraocular pressure (IOP), which can result in optic nerve damage and postoperative ocular complications. While previous studies have established this acute increase in IOP during RALP, there is a paucity of literature on the associated long-term consequences. We compared the incidence of glaucoma in patients undergoing RALP and open prostatectomy to the overall incidence in male patients.
Retrospective analysis was performed of all patients who underwent RALP and open prostatectomy since 2002 at a major urban medical center. All patients with a prior history of glaucoma or ocular hypertension were excluded. Outpatient records were reviewed for a new diagnosis of glaucoma and ocular hypertension after prostatectomy using ICD-9 codes 365.01, 365.11, 365.04, and 365.9. These results were compared to the rate of diagnosis in all male outpatients examined during the same time period. Records were also reviewed for a new diagnosis of posterior ischemic optic neuropathy or postoperative visual loss using ICD-9 codes 997.9, 377.41, 369.9, 368.11, and 368.44.
Since 2002, 162,756 males>age 40 with no known history of prostate surgery (Group 1) were examined at all outpatient clinics, and 7669 (4.7%) of these patients had a new diagnosis of glaucoma or ocular hypertension. A total of 488 patients undergoing RALP (Group 2) and 203 patients undergoing open prostatectomy (Group 3) were included with an average age of 58.7 and 61.5 years, respectively. A total of 26(5.3%) patients in Group 2 and and 22(10.8%) in Group 3 had new onset glaucoma or ocular hypertension. Analysis with chi-square testing demonstrated no statistically significant difference between Group 1 and Group 2(p=0.522). There was a statistically significant difference between Group 1 and Group 3(p< 0.0001). One patient(0.18%) in Group 2 and 1 patient(0.47%) in Group 3 had a post-operative complication.
We found no elevated incidence of glaucoma or ocular hypertension, and a lower rate of post-operative complications in the RALP group. The higher incidence of glaucoma in Group 3 needs to be further analyzed to assess the possible contribution of age and lower sample size. In patients with no known history of glaucoma or ocular hypertension, RALP is a safe procedure despite the known acute increase in IOP. Future studies should use structural tests including nerve fiber layer analysis to examine potential optic nerve changes after RALP and possible progression of optic nerve damage in glaucoma patients after surgery.
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