Risk Factors for Intraocular Pressure Elevation in Steep Trendelenburg Position During Surgery.

PRÉCIS: The STP significantly increases IOP during TLH, with a more pronounced effect observed in patients with a high BMI.

PURPOSE: The present study sought to determine the impact of steep Trendelenburg position (STP) on intraocular pressure (IOP) in patients undergoing total laparoscopic hysterectomy (TLH) and to establish the relationship between age, body mass index (BMI), iridocorneal angle, and surgical duration about position-related intraocular pressure changes.

METHODS

Preoperative ophthalmologic evaluation was performed 1 day before surgery (T0). IOP was measured using a handheld contact tonometer at T1 (5 min after anesthesia), T2 (5 min after pneumoperitoneum), T3 (5 min in STP), T4 (after pneumoperitoneum release), T5 (at the end of surgery in supine position), and T6 (10 min after returning to supine). Surgery duration and patient demographics were recorded.

RESULTS

The IOP values were found to be considerably elevated in comparison to the baseline (T0) at all designated time points (T1-T6). There was a progressive decrease in intra-abdominal pressure after the pneumoperitoneum was released (T4-T6). The findings revealed no statistically significant correlation between age and iridocorneal angle on the one hand and IOP values on the other. At T6, a negative correlation was observed between IOP and surgical duration and a positive correlation with BMI.

CONCLUSIONS

The STP significantly elevates IOP during TLH, and this effect is more pronounced in patients with higher BMI. Identifying such risk factors may guide anesthetic and surgical strategies to minimize ocular complications in procedures requiring this position.