Perioperative dorzolamide-timolol intervention for rising intraocular pressure during steep Trendelenburg positioned...

Elevated intraocular pressure (IOP) and venous congestion may produce a low ocular perfusion state that can lead to postoperative visual loss (POVL). The literature cites the importance of early IOP reduction to prevent optic nerve damage and visual loss. This study examined dorzolamide hydrochloride and timolol maleate (Cosopt) eyedrops on reducing elevated IOP during laparoscopic surgery with the patient in steep Trendelenburg position. A quasi-experimental study design was used. Subjects involving robotic urologic and gynecologic procedures at 3 separate medical centers were included. The medication was administered topically to both eyes at time points when IOP approached 40 mm Hg. The IOP was measured at 30-minute intervals compared with a supine, anesthetized baseline and final postprocedure supine measurements. A total of 194 patients were recruited, and 63 patients received dorzolamide-timolol treatment when IOP levels reached 38 to 40 mm Hg. Repeated-measures analysis of variance showed that IOP values dropped significantly after drug intervention at 60, 90, and 120 minutes (P < .001). Effect sizes of pharmacologic intervention on IOP reduction were strong (partial eta2 of 0.60 to 0.66). Treatment with dorzolamide-timolol eyedrops significantly reduces elevated IOP of patients who undergo lengthy laparoscopic surgery in the steep Trendelenburg position.