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Anaesthetic protocol for paediatric glaucoma examinations: the prospective EyeBIS Study protocol
Nina Pirlich1, Franz Grehn2, Katja Mohnke1
1Department of Anaesthesiology, University Medical Centre of the Johannes Gutenberg University Mainz, Mainz, Germany.
Insights
Accurate intraocular pressure (IOP) measurement in infants with glaucoma requires anesthesia. This study develops a standardized anesthetic protocol by examining IOP
Area of Science:
- Ophthalmology
- Anesthesiology
- Pediatric Medicine
Background:
- Accurate intraocular pressure (IOP) measurement in neonates and infants with glaucoma is challenging due to factors like crying and squinting.
- Perioperative variables including anesthetic depth, airway management, and hemodynamic factors significantly influence IOP readings under anesthesia.
Purpose of the Study:
- To develop a standardized anesthetic protocol for accurate IOP measurement in childhood glaucoma.
- To investigate the relationship between IOP magnitude and anesthetic depth using the bispectral index (BIS).
Main Methods:
- A single-center, prospective cohort study involving 100 children with diagnosed or suspected glaucoma undergoing general anesthesia.
- Inclusion of 20 control children undergoing general anesthesia for other reasons.
- Assessment of the correlation between IOP and anesthetic depth (BIS), with attention to airway management and hemodynamic parameters, using a mixed-effects linear model.
Main Results:
- The study aims to establish a standardized anesthetic protocol for IOP measurement in pediatric glaucoma.
- Analysis will describe the influence of airway management and hemodynamics on IOP under anesthesia.
- A 95% reference region for IOP in healthy eyes will be determined.
Conclusions:
- A standardized anesthetic protocol is crucial for reliable IOP measurements in pediatric glaucoma.
- Understanding the impact of anesthetic variables on IOP is essential for accurate diagnosis and management.
- The EyeBIS study will provide valuable data for optimizing anesthetic care in children with glaucoma.
Introduction:
Neonates and young infants with diagnosed or highly suspected glaucoma require an examination under anaesthesia to achieve accurate intraocular pressure (IOP) measurements, since crying or squinting of the eyes may increase IOP and lead to falsely high values. IOP considerably depends on perioperative variables such as haemodynamic factors, anaesthetics, depth of anaesthesia and airway management. The aim of this paper is to report the design and baseline characteristics of EyeBIS, which is a study to develop a standardised anaesthetic protocol for the measurement of IOP under anaesthesia in childhood glaucoma, by investigating the link between the magnitude of IOP and depth of anaesthesia.
Methods And Analysis:
This is a single-centre, prospective cohort study in 100 children with diagnosed or highly suspected glaucoma all undergoing ophthalmological examination under general anaesthesia. 20 children, who undergo general anaesthesia for other reasons, are included as controls. The primary outcome measure is the establishment of a standardised anaesthetic protocol for IOP measurement in childhood glaucoma by assessing the relationship between IOP and depth of anaesthesia (calculated as an electroencephalography variable, the bispectral index), with special emphasis on airway management and haemodynamic parameters. The dependence of IOP under anaesthesia on airway management and haemodynamic parameters will be described, using a mixed linear model. Restricting the model to patients with healthy eyes will allow to determine a 95% reference region, in which 95% of the measurement values of patients with healthy eyes can be expected.
Ethics And Dissemination:
The study has been approved by the local ethics committee of the Medical Association of Rhineland-Palatine (Ethik-Kommisssion der Landesaerztekammer Rheinland-Pfalz), Germany (approval number: 2019-14207). This work will be disseminated by publication of peer-reviewed manuscripts, presentation in abstract form at national and international scientific meetings and data sharing with other investigators.
Trial Registration Number:
ClinicalTrials.gov Registry (NCT03972852).
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