Effect of Prone Position on Intraocular Pressure in Patients Undergoing Nonocular Surgery: A Systematic Review

Abstract

Postoperative vision loss is a rare complication following surgery in prone positioning. Waking with loss of visual acuity after an elective nonocular surgery is a catastrophic event, not only for the patient but also for the physicians. The specific pathogenesis of postoperative vision loss remains unknown in most cases. This systematic review aims to investigate the effect of prone positioning on intraocular pressure in patients undergoing surgeries and alert physicians to the potential vision loss in the postoperative period. A meticulous research of PubMed, Scopus, and Google Scholar databases was conducted for relevant articles published between January 2012 and September 2023. All relative prospective, retrospective, comparative, and non-comparative studies that investigated prone position and its effect on intraocular pressure during surgery were considered eligible for inclusion in our systematic review. A total of eight studies comprising 649 patients who underwent nonocular surgery under prone positioning were reviewed. Most patients underwent spine surgery with total intravenous anesthesia. The device most frequently used for intraocular pressure measurement was Tono-Pen® XL (Medtronic plc, Galway, Ireland). None of the patients suffered from visual loss postoperatively. Only three patients had vision disturbances after surgery due to prone positioning. There was also a significant rise in intraocular pressure from the supine to the prone position. There is a need to identify crucial factors for the prevention of postoperative vision loss.

Keywords: anesthesia; intraocular pressure; postoperative vision loss; prone position; surgery.

Figure 1. PRISMA flow chart showing the selection of studies

* PubMed, Scopus, and Google Scholar databases ** Articles published before 2012: 66; Articles not published in English: 2; Articles with human participants: 14; Systematic reviews: 3 PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2. Risk of bias summary

References: Carey et al., 2014 [2], Sugata et al., 2012 [3], Emery et al., 2015 [8], Deniz et al., 2012 [10], Pinar et al., 2017 [11], Lyzohub et al., 2020 [13]