The Effect of Head Inclination on Intraocular Pressure in the Prone Position

Abstract

Postoperative vision loss (POVL) is a devastating complication of spine surgery in the prone position that may result in permanent blindness. Prone position is one of the major factors contributing to the development of increased intraocular pressure (IOP), which leads to POVL. The purpose of this systematic review was to determine the impact of head inclination on IOP in surgical patients positioned in the prone reverse Trendelenburg position compared to patients in the in the prone horizontal position. The CINHAL, EBSCOhost, Pubmed, Academic search complete, MEDLINE, Google scholar and Research Gate databases were utilized during this systematic review and the PRISMA 27-item checklist and four-phase flow diagram were used as well as the CASP tool for critically analyzing randomized controlled trials. Four studies met the inclusion and exclusion criteria and these studies were reviewed and analyzed in depth. Cross study analysis revealed that the reverse Trendelenburg position ameliorated increases in IOP in three out of four of the studies and IOP increased over time in three out of four of the studies. Certified registered nurse anesthetists (CRNAs) may decrease the patient's risk for POVL by maintaining the reverse Trendelenburg position during prone spine surgery and by using a tonometer device for measuring intraocular pressure. By adopting these new practices, CRNAs may provide the highest quality care for their patients.