A Prospective Study to Evaluate the Effect of Preoperative Topical Brimonidine Tartrate 0.2% (Allergan, Irvine, CA) on Intraocular Pressure (IOP) of Patients Undergoing Robot-assisted Laparoscopic Prostatectomy (RALP)
Patients with prostate cancer undergoing robot assisted radical laparoscopic prostatectomy
(RALP) in steep Trendelenburg position (sTBURG) are noted to have elevated intraocular
pressures (IOP) intraoperatively. One study showed an increase in IOP of 13 millimeters of
mercury (mmHg) from baseline IOP levels intraoperatively. Other studies have shown the IOP
to more than double intraoperatively during RALP in sTBURG. IOP is found to be directly
related to angle of inclination and increases time dependently with sTBURG. The IOP may
remain significantly elevated until the first postoperative day after RALP.
There are no previously published data concerning the safe threshold for IOP elevation and
the effects of this increased IOP on vision and on generalized eye health are still not
entirely known. One study showed postoperative visual field defects in 28% (7/25) of
patients who underwent RALP in sTBURG. It has been theorized that sTBURG and subsequent
increased IOP are risk factors for postoperative vision loss (PVL). It is believed that the
increased IOP decreases optic nerve perfusion pressure causing ischemic optic neuropathy.
Some previously recommended ways to reduce the intraoperative IOP spike during RALP include
shorter operating times, decreased angle of inclination, modified Trendelenburg position,
use of Propofol for maintenance anaesthesia and intraoperative topical hypotensive agents to
reduce IOP. Given the challenges with some of the above options, this study aims to evaluate
the effect of pre-operative treatment with topical Brimonidine Tartrate 0.2% on the IOP of
patients undergoing RALP with sTBURG. The goal is to prevent the anticipated IOP spike
thereby reducing risk of postoperative vision loss.
View this trial on ClinicalTrials.gov
Print this page and take it to your doctor to discuss your eligibilty and treatment options. Only your doctor can refer you to a clinical trial.
These resources are provided in partnership with the
Canadian Cancer Society