Changes in intraocular pressure due to surgical positioning : Studying potential risk for postoperative vision loss
Parallel group design. Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position. Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure,...
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| Veröffentlicht in: | Spine (Philadelphia, Pa. 1976) Pa. 1976), 2007-11, Vol.32 (23), p.2591-2595 |
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| container_title | Spine (Philadelphia, Pa. 1976) |
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| creator | WALICK, Kristina S KRAGH, John E WARD, John A CRAWFORD, John J |
| description | Parallel group design.
Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position.
Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure, which may decrease perfusion pressure to the optic nerve (perfusion pressure = mean arterial pressure - intraocular pressure [IOP]). The prone Trendelenburg's position is often used during spine surgery; however, its effect on optic nerve perfusion is unknown. The purpose of this study is to compare the IOP responses in the prone flat versus prone Trendelenburg's positions to determine if prone Trendelenburg's position also risks PVL.
Twenty subjects randomized into 2 groups. Group 1 lay in the prone flat position (0 degrees). Group 2 lay in the prone Trendelenburg's position (-7 degrees). IOPs were measured with a hand-held applanation tonometer while seated, 1 minute after assuming the group's position (Time 0), and at 10-minute intervals for 60 minutes.
The differences in mean IOPs with respect to positions and time were significant (P = 0.0001, P = 0.000). There was a significant difference between sitting and all other times for both groups. In Group 1, there was a significant difference in IOP between Time 0 and all other times prone flat (P < 0.05). In Group 2, there was a significant difference in IOP between Time 0 all other times prone Trendelenburg (P < 0.05).
IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made. |
| doi_str_mv | 10.1097/BRS.0b013e318158cc23 |
| format | Article |
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Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position.
Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure, which may decrease perfusion pressure to the optic nerve (perfusion pressure = mean arterial pressure - intraocular pressure [IOP]). The prone Trendelenburg's position is often used during spine surgery; however, its effect on optic nerve perfusion is unknown. The purpose of this study is to compare the IOP responses in the prone flat versus prone Trendelenburg's positions to determine if prone Trendelenburg's position also risks PVL.
Twenty subjects randomized into 2 groups. Group 1 lay in the prone flat position (0 degrees). Group 2 lay in the prone Trendelenburg's position (-7 degrees). IOPs were measured with a hand-held applanation tonometer while seated, 1 minute after assuming the group's position (Time 0), and at 10-minute intervals for 60 minutes.
The differences in mean IOPs with respect to positions and time were significant (P = 0.0001, P = 0.000). There was a significant difference between sitting and all other times for both groups. In Group 1, there was a significant difference in IOP between Time 0 and all other times prone flat (P < 0.05). In Group 2, there was a significant difference in IOP between Time 0 all other times prone Trendelenburg (P < 0.05).
IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.</description><identifier>ISSN: 0362-2436</identifier><identifier>EISSN: 1528-1159</identifier><identifier>DOI: 10.1097/BRS.0b013e318158cc23</identifier><identifier>PMID: 17978659</identifier><identifier>CODEN: SPINDD</identifier><language>eng</language><publisher>Philadelphia, PA: Lippincott</publisher><subject>Adult ; Biological and medical sciences ; Cerebrospinal fluid. Meninges. Spinal cord ; Electrodiagnosis. Electric activity recording ; Female ; Head-Down Tilt - adverse effects ; Head-Down Tilt - physiology ; Humans ; Intraocular Pressure - physiology ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Nervous system ; Nervous system (semeiology, syndromes) ; Neurology ; Neurosurgery ; Ocular Hypertension - etiology ; Ocular Hypertension - physiopathology ; Postoperative Complications - etiology ; Postoperative Complications - prevention & control ; Prone Position - physiology ; Random Allocation ; Reference Values ; Risk ; Skull, brain, vascular surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tonometry, Ocular ; Vision Disorders - etiology ; Vision Disorders - prevention & control</subject><ispartof>Spine (Philadelphia, Pa. 1976), 2007-11, Vol.32 (23), p.2591-2595</ispartof><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c284t-a9ec9f0096681197c83ca05b1a370f8bdf1fbdb550f0f8b4f3a4f836aaa1892b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19211577$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17978659$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>WALICK, Kristina S</creatorcontrib><creatorcontrib>KRAGH, John E</creatorcontrib><creatorcontrib>WARD, John A</creatorcontrib><creatorcontrib>CRAWFORD, John J</creatorcontrib><title>Changes in intraocular pressure due to surgical positioning : Studying potential risk for postoperative vision loss</title><title>Spine (Philadelphia, Pa. 1976)</title><addtitle>Spine (Phila Pa 1976)</addtitle><description>Parallel group design.
Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position.
Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure, which may decrease perfusion pressure to the optic nerve (perfusion pressure = mean arterial pressure - intraocular pressure [IOP]). The prone Trendelenburg's position is often used during spine surgery; however, its effect on optic nerve perfusion is unknown. The purpose of this study is to compare the IOP responses in the prone flat versus prone Trendelenburg's positions to determine if prone Trendelenburg's position also risks PVL.
Twenty subjects randomized into 2 groups. Group 1 lay in the prone flat position (0 degrees). Group 2 lay in the prone Trendelenburg's position (-7 degrees). IOPs were measured with a hand-held applanation tonometer while seated, 1 minute after assuming the group's position (Time 0), and at 10-minute intervals for 60 minutes.
The differences in mean IOPs with respect to positions and time were significant (P = 0.0001, P = 0.000). There was a significant difference between sitting and all other times for both groups. In Group 1, there was a significant difference in IOP between Time 0 and all other times prone flat (P < 0.05). In Group 2, there was a significant difference in IOP between Time 0 all other times prone Trendelenburg (P < 0.05).
IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cerebrospinal fluid. Meninges. Spinal cord</subject><subject>Electrodiagnosis. Electric activity recording</subject><subject>Female</subject><subject>Head-Down Tilt - adverse effects</subject><subject>Head-Down Tilt - physiology</subject><subject>Humans</subject><subject>Intraocular Pressure - physiology</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Ocular Hypertension - etiology</subject><subject>Ocular Hypertension - physiopathology</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - prevention & control</subject><subject>Prone Position - physiology</subject><subject>Random Allocation</subject><subject>Reference Values</subject><subject>Risk</subject><subject>Skull, brain, vascular surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tonometry, Ocular</subject><subject>Vision Disorders - etiology</subject><subject>Vision Disorders - prevention & control</subject><issn>0362-2436</issn><issn>1528-1159</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkVtr3DAQRkVJabZJ_0EoeknfnGokX6S-pUtvECg0zbMZy9JGrddyNHIg_75ashAoDMwIzjcMR4xdgLgCYbqPn3_dXolBgHIKNDTaWqlesQ00UlcAjTlhG6FaWclatafsLdEfIUSrwLxhp9CZTreN2TDa3uO8c8TDXConjHadMPElOaI1OT6ujufIy7wLFie-RAo5xDnMO_6J3-Z1fDqMS8xuzqEAKdBf7mM6kDkuLmEOj44_BiopPkWic_ba40Tu3bGfsbuvX35vv1c3P7_92F7fVFbqOldonDVeCNO2GsB0ViuLohkAVSe8HkYPfhiHphH-8Ky9wtpr1SIiaCMHdcY-PO9dUnxYHeV-H8i6acLZxZX6VtddLSUUsH4GbSrnJef7JYU9pqceRH-Q3RfZ_f-yS-z9cf867N34EjraLcDlEUAq7nzC2QZ64YwsH9V16h9v7Ivv</recordid><startdate>20071101</startdate><enddate>20071101</enddate><creator>WALICK, Kristina S</creator><creator>KRAGH, John E</creator><creator>WARD, John A</creator><creator>CRAWFORD, John J</creator><general>Lippincott</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071101</creationdate><title>Changes in intraocular pressure due to surgical positioning : Studying potential risk for postoperative vision loss</title><author>WALICK, Kristina S ; KRAGH, John E ; WARD, John A ; CRAWFORD, John J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c284t-a9ec9f0096681197c83ca05b1a370f8bdf1fbdb550f0f8b4f3a4f836aaa1892b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cerebrospinal fluid. Meninges. Spinal cord</topic><topic>Electrodiagnosis. Electric activity recording</topic><topic>Female</topic><topic>Head-Down Tilt - adverse effects</topic><topic>Head-Down Tilt - physiology</topic><topic>Humans</topic><topic>Intraocular Pressure - physiology</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Neurosurgery</topic><topic>Ocular Hypertension - etiology</topic><topic>Ocular Hypertension - physiopathology</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - prevention & control</topic><topic>Prone Position - physiology</topic><topic>Random Allocation</topic><topic>Reference Values</topic><topic>Risk</topic><topic>Skull, brain, vascular surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tonometry, Ocular</topic><topic>Vision Disorders - etiology</topic><topic>Vision Disorders - prevention & control</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>WALICK, Kristina S</creatorcontrib><creatorcontrib>KRAGH, John E</creatorcontrib><creatorcontrib>WARD, John A</creatorcontrib><creatorcontrib>CRAWFORD, John J</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>WALICK, Kristina S</au><au>KRAGH, John E</au><au>WARD, John A</au><au>CRAWFORD, John J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changes in intraocular pressure due to surgical positioning : Studying potential risk for postoperative vision loss</atitle><jtitle>Spine (Philadelphia, Pa. 1976)</jtitle><addtitle>Spine (Phila Pa 1976)</addtitle><date>2007-11-01</date><risdate>2007</risdate><volume>32</volume><issue>23</issue><spage>2591</spage><epage>2595</epage><pages>2591-2595</pages><issn>0362-2436</issn><eissn>1528-1159</eissn><coden>SPINDD</coden><abstract>Parallel group design.
Compare the intraocular pressure responses in the prone flat versus prone Trendelenburg's position.
Postoperative vision loss (PVL) complicates approximately 0.05% of spine surgeries. Prone positioning is considered a risk factor because it increases intraocular pressure, which may decrease perfusion pressure to the optic nerve (perfusion pressure = mean arterial pressure - intraocular pressure [IOP]). The prone Trendelenburg's position is often used during spine surgery; however, its effect on optic nerve perfusion is unknown. The purpose of this study is to compare the IOP responses in the prone flat versus prone Trendelenburg's positions to determine if prone Trendelenburg's position also risks PVL.
Twenty subjects randomized into 2 groups. Group 1 lay in the prone flat position (0 degrees). Group 2 lay in the prone Trendelenburg's position (-7 degrees). IOPs were measured with a hand-held applanation tonometer while seated, 1 minute after assuming the group's position (Time 0), and at 10-minute intervals for 60 minutes.
The differences in mean IOPs with respect to positions and time were significant (P = 0.0001, P = 0.000). There was a significant difference between sitting and all other times for both groups. In Group 1, there was a significant difference in IOP between Time 0 and all other times prone flat (P < 0.05). In Group 2, there was a significant difference in IOP between Time 0 all other times prone Trendelenburg (P < 0.05).
IOP increases in the prone Trendelenburg's position, and when combined with other factors, may be a risk factor for PVL. The pathophysiology is discussed and suggestions for clinicians are made.</abstract><cop>Philadelphia, PA</cop><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>17978659</pmid><doi>10.1097/BRS.0b013e318158cc23</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Adult Biological and medical sciences Cerebrospinal fluid. Meninges. Spinal cord Electrodiagnosis. Electric activity recording Female Head-Down Tilt - adverse effects Head-Down Tilt - physiology Humans Intraocular Pressure - physiology Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Nervous system Nervous system (semeiology, syndromes) Neurology Neurosurgery Ocular Hypertension - etiology Ocular Hypertension - physiopathology Postoperative Complications - etiology Postoperative Complications - prevention & control Prone Position - physiology Random Allocation Reference Values Risk Skull, brain, vascular surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tonometry, Ocular Vision Disorders - etiology Vision Disorders - prevention & control |
| title | Changes in intraocular pressure due to surgical positioning : Studying potential risk for postoperative vision loss |
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