Factors Predictive of Intraocular Pressure Increases during Robotic-Assisted Radical Prostatectomy

Abstract

Purpose : Intraocular pressure (IOP) increases during robotic-assisted radical prostatectomy (RARP) performed in patients in the steep Trendelenburg (ST) position and relationships between configurations of the anterior segment such as anterior chamber depth (ACD) and lens vault (LV) and IOP increases in patients with angle-closure have been reported, but the relationship between the configurations of the anterior chamber and IOP during RARP have not been reported. We performed a prospective, case series study to investigate the time course and factors of IOP increases during

Methods : The IOPs of the right eyes of 24 men who underwent RARP were analyzed. The surgeries were performed in the ST position with the angle of 20 or 25 degrees at the surgeons’s discretion (16 and 8 patients, respectively). Preoperatively, the ACD and LV were measured by CASIA®. IOPs were measured by Tono-Pen AVIA® at the following times: 10 minutes after insufflation in the supine position (S); 10 minutes after assuming the ST position (T0); and hourly after insufflation until cessation of the ST position (T1-T6, according to the surgical duration). We defined the IOP increase rate (IR) as (T2-S)/S, since the IOPs were measured in all patients at least until T2. To evaluate the factors predictive of an IOP increase, the following analyses were performed: comparison of IR between the 20- and 25-degree positions (Mann-Whitney U-test), time dependence of the IOP increases during ST positioning (Friedman test), and multiple linear regression to predict the IR based on age, degrees of ST positioning, ACD, and LV.

Results : The mean age, ACD, and LV were 67.9 ± 5.4 years, 2.83 ± 0.36 mm, and 0.20 ± 0.36 mm, respectively. The mean IOPs were below 25 mmHg at each time point (Figure). The IRs did not differ significntly between the 20- and 25-degree positions (0.6 ± 0.3 and 0.7 ± 0.2 mmHg, respectively; p = 0.133). The IOP increased for 2 hours during ST positioning and plateaued thereafter. The time courses of the IOPs differed significantly between T0 and T2 (p = 0.001) but not between T2 and T3 (p = 1.000). No factors significantly predicted the IR.

Conclusions : The IOP increases during RARP might not become highly elevated in either group of ST positions (20 or 25 degrees) and might not be related to the anterior segment configurations.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

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