Gastrointestinal Cancer Clinical Trial
Official title:
Correlation Between Intraocular Pressure Measurement by Tomometer and Anterior Chamber Depth Measurement by Ultrasound in Steep Trendelenberg Position During Robotic Assisted Surgery
Intra ocular pressure (IOP) may theoretically increase due to steep Trendelenberg position
and studies showed that IOP reaches peak levels after steep Trendelenberg position on an
average of 13 mmHg higher than preanesthesia induction values. Major determinants of IOP are
aqueous humor flow, choroidal blood volume, central venous pressure and extra ocular muscle
tone.
Hassen GW et al measured anterior chamber depth in 2 patients with glaucoma and compared the
anterior chamber depth (ACD) with the intraocular pressure measured by tonometer. They
concluded that bedside ultrasound could be useful in evaluating patient with suspected
increased IOP, who are unable to open their eyes.
Intra ocular pressure (IOP) may theoretically increase due to steep Trendelenberg position
and studies showed that IOP reaches peak levels after steep Trendelenberg position on an
average of 13 mmHg higher than preanesthesia induction values. Major determinants of IOP are
aqueous humor flow, choroidal blood volume, central venous pressure and extra ocular muscle
tone. During the robotic surgery there are two theories explaining the increase of IOP,
first, gravitational forces increase central venous pressure which in turn affect orbital
venous pressure and increase IOP. Second, intraperitoneal carbon dioxide causes increased
choroidal blood volume which may result in IOP increase. One study reported that low end
tidal carbon dioxide was a significant predictor of the IOP increase. Continuous absorption
of carbon dioxide from peritoneum and increased pressure on diaphragm results in lower
delivered tidal volumes and subsequently increased arterial carbon dioxide levels leading to
increased choroidal blood flow and increased IOP.
Hassen GW et al measured anterior chamber depth in 2 patients with glaucoma and compared the
anterior chamber depth (ACD) with the intraocular pressure measured by tonometer. They
concluded that bedside ultrasound could be useful in evaluating patient with suspected
increased IOP, who are unable to open their eyes. It can also be used for serial examination
and follow-up of treatment success. They also mentioned that, it is necessary to conduct a
prospective study with a larger sample size, to evaluate if there is agreement between
measurements using a tonometer and measurements of the ACD using ultrasound. In addition, it
is essential to determine the cut off normal ACD for evaluation of IOP.
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