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. 2025 Jul 1;25(1):324.
doi: 10.1186/s12871-025-03204-w.

The effects of prone position on optic nerve sheath diameter and intraocular pressure in elective lumbar disc surgery

Resmi Hakan Adas  1 , Sule Batcik  2 , Tolga Koyuncu  2
Affiliations

The effects of prone position on optic nerve sheath diameter and intraocular pressure in elective lumbar disc surgery

Resmi Hakan Adas et al. BMC Anesthesiol. .

Abstract

Background: The objective of this study was to determine the efficacy of intraocular pressure (IOP) measurements in diagnosing elevated increased intracranial pressure (ICP) by examining the correlation between optic nerve sheath diameter (ONSD) and IOP in the prone position.

Methods: This prospective observational study included patients in the American Society of Anesthesiologists (ASA) 1–2 risk group, aged 18–65 years, who were scheduled for elective surgery. ONSD and IOP measurements were performed with ultrasound and Tonopen XL.

Results: Data from 59 patients were analysed. Spearman’s correlation analysis was used to determine the relationship between quantitative data. Significance was considered at p < 0.05. ONSD and IOP measurements were significantly higher in the prone position (p = 0.001). However, no correlation was found between ONSD and IOP measurements.

Conclusion: We found that ONSD and IOP measurements increased in the prone position, but these two measurements were not correlated. ONSD can be used in the diagnosis and follow-up of elevated ICP. Since there are many factors affecting IOP values, we concluded that IOP would not be effective in the diagnosis and follow-up of ICP.

Keywords: Intracranial pressure; Intraocular pressure; Optic nerve; Prone position.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the Recep Tayyip Erdogan University Non-invasive Clinical Research Ethics Committee (01.09.2021-2021/155). This prospective observational study was conducted in the operating theatre of Recep Tayyip Erdogan University Training and Research Hospital between September 2021 and September 2022. The study was conducted within the guidelines of the World Medical Association’s Declaration of Helsinki. The study was conducted in accordance with the guidelines and regulations regarding human experimentation and/or the use of human tissue samples. Informed consent for participation was obtained from all participants in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Ultrasound image and the markers position
Fig. 2
Fig. 2
Left ONSD measurement in prone position
Fig. 3
Fig. 3
Periodic mean values of vital signs [R: heart rate (beats/min), MAP: mean arterial pressure (mmHg), SpO2: peripheral oxygen saturation (mmHg), etCO2: end-breath carbon dioxide pressure (mmHg)]
Fig. 4
Fig. 4
Variation of ONSD measurements according to periods [T0 (supine baseline), T1 (supine 10. min), T2 (prone 45. min), ONSD: optic nerve sheath diameter (mm))
Fig. 5
Fig. 5
Variation of IOP measurement values according to periods [T0 (supine baseline), T1 (supine 10th min), T2 (prone 45th min), IOP: intraocular pressure, (mmHg)]
Fig. 6
Fig. 6
A dot scatter plot demonstrating the correlation between OSCC and IOP values (ONSD: optic nerve sheath diameter; IOP: intraocular pressure)
See this image and copyright information in PMC

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