A Preventive intervention for rising intraocular pressure: development of the Molloy/Bridgeport anesthesia associates observation scale.

Abstract

There is increasing interest in monitoring intraocular pressure (IOP) during surgery in steep Trendelenburg position because of reported incidents of postoperative visual loss (POVL). A review of 17 patients with POVLs showed findings of eyelid edema, chemosis, and ecchymosis. The aim of this study was to link IOP tonometry measurement to an observation scale enabling caregivers to determine when to institute preventive measures to optimize ocular perfusion. The study design was a prospective repeated-measures correlation regression model. Visual assessment of presence of eyelid edema or chemosis and baseline IOP values determined the probability of when an IOP greater than 40 mm Hg (critical threshold) was reached. Both IOP and Molloy/Bridgeport Anesthesia Associates Observation Scale measures were recorded at start of surgery, 30-minute intervals, and end of surgery. Associations between IOP and facial observations were analyzed via multiple logistic regression. Significant predictors of IOP greater than 40 mm Hg were determined to be presence of chemosis and baseline IOP and significantly correlated to increasing IOP. The receiver operating characteristic curve-area under the curve score was 0.86 (standard error +/- 0.03). Caregivers can use this observation scale to assess the need and timing for IOP-normalizing interventions and possibly to prevent POVL.