Ocular complications in robotic-assisted prostatectomy: a review of pathophysiology and prevention

Ocular complications reported after robotic-assisted laparoscopic radical prostatectomy (RALP) include corneal abrasion and ischemic optic neuropathy. While corneal abrasions often resolve without permanent sequelae, scarring or infection can occasionally lead to vision loss and other adverse outcomes. The rare complication of ischemic optic neuropathy leads to permanent vision loss and is a devastating outcome of non-ocular surgery. Given the unique patient positioning of steep Trendelenburg during these operations, ocular complications may be more likely to occur secondary to physiologic changes that occur within the eye itself. A review of the pathophysiology and incidence of ocular complications specific to robotic-assisted laparoscopic prostatectomy as well as the potential preventative measures in the current literature is presented to further inform and guide perioperative patient care. In addition we address other potential ocular complications and the impact of patient's ocular history on choice of RALP as a surgical treatment modality.