Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.03.005
Brazilian Journal of Anesthesiology
Scientific Article

Changes in retinal nerve fiber layer thickness after spinal surgery in the prone position: a prospective study

Alterações da espessura da camada de fibras nervosas da retina após cirurgia da coluna vertebral em pronação: estudo prospectivo

Baran Gencer; Murat Cosar; Hasan Ali Tufan; Selcuk Kara; Sedat Arikan; Tarik Akman; Hasan Ali Kiraz; Arzu Taskiran Comez; Volkan Hanci

http://dx.doi.org/10.1016/j.bjane.2014.03.005 Braz J Anesthesiol, vol.65, n1, p.41-46, 2015
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Abstract

BACKGROUND AND OBJECTIVES: Changes in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position. METHODS: This prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline); 10 min after intubation (Supine 1); 10 (Prone 1), 60 (Prone 2), 120 (Prone 3) min after prone position; and just after postoperative supine position (Supine 2). RESULTS: Our study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (p = 0.009 and p = 0.003, respectively). We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in Prone 1, Prone 2 and Prone 3, when compared with the baseline. CONCLUSIONS: Our study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery.

Keywords

Retinal nerve fiber layer thickness, Prone position, Spinal surgery, Intraocular pressure

Resumo

JUSTIFICATIVA E OBJETIVOS: As alterações de perfusão ocular desempenham um papel importante na patogênese da neuropatia óptica isquêmica. A pressão de perfusão ocular é igual à pressão arterial média menos a pressão intraocular. O objetivo deste estudo foi avaliar as alterações da pressão intraocular e da espessura da camada de fibras nervosas da retina em pacientes submetidos à cirurgia da coluna vertebral em pronação. MÉTODOS: Este estudo prospectivo incluiu 30 pacientes submetidos à cirurgia da coluna vertebral. A espessura da camada de fibras nervosas da retina foi medida um dia antes e um depois da cirurgia, com o uso da tomografia de coerência óptica. A pressão intraocular foi medida seis vezes com o Tonopen e o tempo de duração em posições diferentes: em supinação (basal), 10 minutos após a intubação (Supinação 1); após a pronação aos 10 minutos (Pronação 1), 60 minutos (Pronação 2) e 120 minutos (Pronação 3) e logo após a supinação no período pós-operatório (Supinação 2). RESULTADOS: Nosso estudo envolveu 10 pacientes do sexo masculino e 20 do feminino, com média de 57 anos. No pós-operatório, quando as medidas da espessura da camada de fibras nervosas da retina foram comparadas com os valores do pré-operatório, um afinamento estatisticamente significativo da retina foi observado nos quadrantes nasais e inferiores (p = 0,009 e p = 0,003, respectivamente). Observamos uma diminuição da pressão intraocular estatisticamente significante em Supinação 1 e um aumento em ambos momentos Pronação 2 e Pronação 3, em comparação com os valores basais. A pressão arterial média e a pressão de perfusão ocular foram significativamente mais baixas em Pronação 1, Pronação 2 e Pronação 3, em comparação com os valores basais. CONCLUSÕES: Nosso estudo mostrou aumento da pressão intraocular durante a cirurgia da coluna vertebral em pronação. Um afinamento estatisticamente significante da espessura da camada de fibras nervosas da retina foi observado nos quadrantes nasais e inferiores um dia após a cirurgia da coluna vertebral.

Palavras-chave

Espessura da camada de fibras nervosas da retina, Pronação, Cirurgia da coluna vertebral, Pressão Intraocular

References

Patil CG, Lad EM, Lad SP. Visual loss after spine surgery: a population-based study. Spine.. ;33:1491-1496.

Stevens WR, Glazer PA, Kelley SD. Ophthalmic complications after spinal surgery. Spine.. ;22:1324-1319.

Chang SH, Miller NR. The incidence of vision loss due to perioperative ischemic optic neuropathy associated with spine surgery: the Johns Hopkins Hospital Experience. Spine.. ;30:1299-1302.

Alexandrakis G, Lam BL. Bilateral posterior ischemic optic neuropathy after spinal surgery. Am J Ophthalmol.. ;127:355-354.

Ho VT, Newman NJ, Song S. Ischemic optic neuropathy following spine surgery. J Neurosurg Anesthesiol.. ;17:44-38.

Lee LA, Roth S, Posner KL. The American Society of Anesthesiologists Postoperative Visual Loss Registry: analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology.. ;105:652-659.

Risk factors associated with ischemic optic neuropathy after spinal fusion surgery. Anesthesiology.. ;116:24-15.

Hayreh SS. Ischemic optic neuropathy. Prog Retin Eye Res.. ;28:62-34.

Ozcan MS, Praetel C, Bhatti MT. The effect of body inclination during prone positioning on intraocular pressure in awake volunteers: a comparison of two operating tables. Anesth Analg.. ;99:1158-1152.

Cheng MA, Todorov A, Tempelhoff R. The effect of prone positioning on intraocular pressure in anesthetized patients. Anesthesiology.. ;95:1351-1355.

Hunt K, Bajekal R, Calder I. Changes in intraocular pressure in anesthetized prone patients. J Neurosurg Anesthesiol.. ;16:290-287.

Roth S. Perioperative visual loss: what do we know, what can we do?. Br J Anaesth.. ;103:31-40.

Sugata A, Hayashi H, Kawaguchi M. Changes in intraocular pressure during prone spine surgery under propofol and sevoflurane anesthesia. J Neurosurg Anesthesiol.. ;24:152-156.

Piette S, Liebmann JM, Ishikawa H. Acute conformational changes in the optic nerve head with rapid intraocular pressure elevation: implications for LASIK surgery. Ophthal Surg Lasers Imaging.. ;34:334-341.

Fortune B, Yang H, Strouthidis NG. The effect of acute intraocular pressure elevation on peripapillary retinal thickness, retinal nerve fiber layer thickness, and retardance. Invest Ophthalmol Vis Sci.. ;50:4726-4719.

Fortune B, Choe TE, Reynaud J. Deformation of the rodent optic nerve head and peripapillary structures during acute intraocular pressure elevation. Invest Ophthalmol Vis Sci.. ;52:6661-6651.

Contreras I, Rebolleda G, Noval S. Optic disc evaluation by optical coherence tomography in nonarteritic anterior ischemic optic neuropathy. Invest Ophthalmol Vis Sci.. ;48:4092-4087.

Hoff JM, Varhaug P, Midelfart A. Acute visual loss after spinal surgery. Acta Ophthalmol.. ;88:490-492.

Hong JT, Sung KR, Cho JW. Retinal nerve fiber layer measurement variability with spectral domain optical coherence tomography. Korean J Ophthalmol.. ;26:32-38.

Lam AK, Douthwaite WA. Does the change of anterior chamber depth or/and episcleral venous pressure cause intraocular pressure change in postural variation?. Optom Vis Sci.. ;74:667-664.

Walick KS, Kragh JE, Ward JA. Changes in intraocular pressure due to surgical positioning: studying potential risk for postoperative vision loss. Spine.. ;32:2595-2591.

Aref AA, Budenz DL. Spectral domain optical coherence tomography in the diagnosis and management of glaucoma. Ophthal Surg Lasers Imaging.. ;41:27-15.

Savini G, Carbonelli M, Barboni P. Spectral-domain optical coherence tomography for the diagnosis and follow-up of glaucoma. Curr Opin Ophthalmol.. ;22:115-123.

Pierro L, Gagliardi M, Iuliano L. Retinal nerve fiber layer thickness reproducibility using seven different OCT instruments. Invest Ophthalmol Vis Sci.. ;53:5920-5912.

Buyukates M, Kargi S, Kandemir O. The use of the retinal nerve fiber layer thickness measurement in determining the effects of cardiopulmonary bypass procedures on the optic nerve. Perfusion.. ;22:406-401.

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