These complications can be very troubling for the patient and while most are self limiting, careful assessment and follow-up is necessary to ensure no long-term complications or disabilities.
The researchers at Loma Linda University Medical Center retrospectively reviewed 241 consecutive patients, including 141 hand-assisted laparoscopic donor nephrectomy (HALDN) and 100 open donor nephrectomy (ODN) patients, over a 9-year period. They noted that 6.4% of the HALDN patients sustained an OC and 1.4% had a CA, compared to none of these complications in the ODN patients. The OC occurred predominately in the dependent eye related to the lateral positioning of the patient. They also noted that the HALDN patients had significantly higher net fluid intake intraoperatively than the ODN patients (P<0.01).
The authors present a useful explanation of the pathophysiology of these OC complications while noting that the exact etiology is difficult to determine. However, it would appear that the edematous conjunctiva prohibits the eyelids from adequately protecting the cornea and a flexed, head-down positioning with aggressive hydration may contribute to this corneal edema. In addition, decreased venous returned because of the effects of pneumoperitoneum may further support the development of conjunctiva edema. Certainly, intraoperative protection of the eye from mechanical trauma and exposure of the cornea is important. We have noted similar ocular complications in our robot-assisted laparoscopic prostatectomy patients and have established a regimen of using protective eye goggles for these patients intraoperatively. Of course, these injuries can also occur due to a patient inadvertent rubbing of the eyes following surgery and this should be watched closely in the immediate post-op recovery area. The majority of corneal abrasions are normally self-limited and resolve within a few days with simple antibiotic ointment treatment. Eye patching does not appear to provide any significant advantage to the antibiotic ointment alone.
It is important for urologic surgeons to recognize the risk factors and identify patients who may sustain these injuries in order to provide them with prompt treatment of the abrasion and appropriate ophthalmologic follow-up.
Koning JL, Nicolay LI, Jellison F, Heldt JP, Dunbar JA, Baldwin DD
Urology. 2011 Jan;77(1):92-6
10.1016/j.urology.2010.03.084
PubMed Abstract
PMID: 20573378
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