Intraocular pressure change during laparoscopic sacral colpopexy in patients with normal tension glaucoma

• Published in: International Urogynecology Journal 2019-11, Vol.30 (11), p.1933-1938
• Main Authors: Moriyama, Yoji, Miwa, Kosei, Yamada, Tadanori, Sawaki, Ayako, Nishino, Yoshinori, Kitagawa, Yasuhide
• Format: Article
• Language: English
• Subjects: Aged; Eye diseases; Female; Glaucoma; Gynecologic Surgical Procedures - methods; Gynecology; Humans; Intraocular Pressure - physiology; Laparoscopy; Low Tension Glaucoma - complications; Low Tension Glaucoma - physiopathology; Medicine; Medicine & Public Health; Middle Aged; Monitoring, Intraoperative; Original Article; Patients; Pelvic Organ Prolapse - complications; Pelvic Organ Prolapse - physiopathology; Pelvic Organ Prolapse - surgery; Prospective Studies; Sacrum; Surgery; Urology; Vagina - surgery
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-018-03866-w

Introduction and hypothesis 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. Methods 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. Results 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. Conclusions 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.