Management of Expected Intraocular Pressure (IOP) Elevation During Prolonged Steep Trendelenburg Positioning: A Case Report and Literature Review

This article presents a case of intraocular pressure (IOP) assessment and perioperative management in a patient with primary open-angle glaucoma undergoing a prolonged surgical procedure in steep Trendelenburg (ST) positioning. The patient was administered prophylactic extended-release oral acetazolamide prior to an uncomplicated cystectomy to mitigate the anticipated IOP elevation associated with the surgical positioning. The patient's IOP was monitored postoperatively at a clinic visit, where it remained stable at 11 mmHg in the right eye and 9 mmHg in the left eye with preserved visual acuity and no evidence of glaucomatous progression on retinal nerve fiber layer (RNFL) and visual field testing. In addition, a review of the existing literature on perioperative IOP management in glaucoma patients undergoing ST procedures was conducted. While prior reports have explored alternative pharmacologic interventions, this case highlights the successful use of acetazolamide as a prophylactic strategy for maintaining IOP control in a primary open-angle glaucoma patient.