Increase in intraocular pressure is less with propofol and remifentanil than isoflurane with remifentanil during cataract surgery: A randomized controlled trial


1 Department of Anesthesiology and Critical Care, School of Medicine and Anesthesiology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Anaesthesiology and Anaesthesiology and Intensive Care Unit, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran


Background: This double-blinded, randomized clinical trial was designed to evaluate intraocular pressure (IOP) change in cataract surgery using the combination of propofol and remifentanil or the combination of isoflurane and remifentanil.
Materials and Methods: One hundred sixty patients were randomly allocated to a maintenance anesthetic consisting of remifentanil + isoflurane (group I), normal saline + isoflurane (group II), propofol + remifentanil (group III) or normal saline + propofol (group IV). IOP was measured at seven predefined time points, baseline (T0), 3 min after the start of continuous remifentanil infusion (T2), after induction of anesthesia (T3), immediately after laryngoscopy and intubation (T4), 5 min after laryngoscopy (T5), immediately after the block of continuous remifentanil infusion (T6) and 3 min after T6 (T7). Outcomes included IOP, systole blood pressure (SBP) and diastole blood pressure (DBP), mean arterial pressure (MAP) and heart rate (HR).
 The mean of IOP in Group III was lower than other groups and in group IV was higher than other groups. At time point T4 and T5 differences in the mean of IOP between groups III and IV was significantly different (P > 0.05). The trend in changes in the mean of IOP was statistically significant among groups (P value = 0.01). The trends in changes in the mean of SBP, DBP and MAP were not significantly different among groups (P value = 0.41). HR in group III was significantly lower than other groups. The trend in changes in the mean of HR was significantly different among groups (P value = 0.002).
 Propofol with remifentanil was more effective than placebo or adding remifentanil to isoflurane in management of IOP in cataract surgery.


Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Minerva Anestesiol 2012;78:596-604.  Back to cited text no. 1
Molloy BL. Implications for postoperative visual loss: Steep trendelenburg position and effects on intraocular pressure. AANA J 2011;79:115-21.  Back to cited text no. 2
Goepfert CE, Ifune C, Tempelhoff R. Ischemic optic neuropathy: Are we any further? Curr Opin Anaesthesiol 2010;23:582-7.  Back to cited text no. 3
Weber ED, Colyer MH, Lesser RL, Subramanian PS. Posterior ischemic optic neuropathy after minimally invasive prostatectomy. J Neuroophthalmol 2007;27:285-7.  Back to cited text no. 4
Bathija R, Gupta N, Zangwill L, Weinreb RN. Changing definition of glaucoma. J Glaucoma 1998;7:165-9.  Back to cited text no. 5
Kymes SM, Kass MA, Anderson DR, Miller JP, Gordon MO; Ocular Hypertension Treatment Study Group (OHTS). Management of ocular hypertension: A cost-effectiveness approach from the Ocular Hypertension Treatment Study. Am J Ophthalmol 2006;141:997-1008.  Back to cited text no. 6
He Z, Vingrys AJ, Armitage JA, Bui BV. The role of blood pressure in glaucoma. Clin Exp Optom 2011;94:133-49.  Back to cited text no. 7
Moore D, Harris A, Wudunn D, Kheradiya N, Siesky B. Dysfunctional regulation of ocular blood flow: A risk factor for glaucoma? Clin Ophthalmol 2008;2:849-61.  Back to cited text no. 8
Butterworth JF, Mackey DC, Wasnick JD. Anesthesia for ophthalmic surgery. Morgan and Mikhail's Clinical Anesthesiology. 5 th ed. New York: McGraw-Hill Professional; 2013. p. 759-71.  Back to cited text no. 9
Grosso A, Scozzari G, Bert F, Mabilia MA, Siliquini R, Morino M. Intraocular pressure variation during colorectal laparoscopic surgery: Standard pneumoperitoneum leads to reversible elevation in intraocular pressure. Surg Endosc 2013;27:3370-6.  Back to cited text no. 10
Murphy DF. Anesthesia and intraocular pressure. Anesth Analg 1985;64:520-30.  Back to cited text no. 11
Alexander R, Hill R. Lipham WJ, Weatherwax KJ, el-Moalem HE. Remifentanil prevents an increase in intraocular pressure after succinylcholine and tracheal intubation. Br J Anaesth 1998;81:606-7.  Back to cited text no. 12
Schäfer R, Klett J, Auffarth G, Polarz H, Völcker HE, Martin E, et al. Intraocular pressure more reduced during anesthesia with propofol than with sevoflurane: Both combined with remifentanil. Acta Anaesthesiol Scand 2002;46:703-6.  Back to cited text no. 13
Sator S, Wildling E, Schabernig C, Akramian J, Zulus E, Winkler M. Desflurane maintains intraocular pressure at an equivalent level to isoflurane and propofol during unstressed non-ophthalmic surgery. Br J Anaesth 1998;80:243-4.  Back to cited text no. 14
Sator-Katzenschlager S, Deusch E, Dolezal S, Michalek-Sauberer A, Grubmüller R, Heinze G, et al. Sevoflurane and propofol decrease intraocular pressure equally during non-ophthalmic surgery and recovery. Br J Anaesth 2002;89:764-6.  Back to cited text no. 15
Sugata A, Hayashi H, Kawaguchi M, Hasuwa K, Nomura Y, Furuya H. Changes in intraocular pressure during prone spine surgery under propofol and sevoflurane anesthesia. J Neurosurg Anesthesiol 2012;24:152-6.  Back to cited text no. 16
Newman NJ. Perioperative visual loss after nonocular surgeries. Am J Ophthalmol 2008;145:604-10.  Back to cited text no. 17
Pinkney TD, King AJ, Walter C, Wilson TR, Maxwell-Armstrong C, Acheson AG. Raised intraocular pressure (IOP) and perioperative visual loss in laparoscopic colorectal surgery: A catastrophe waiting to happen? A systematic review of evidence from other surgical specialities. Tech Coloproctol 2012;16:331-5.  Back to cited text no. 18
Awad H, Santilli S, Ohr M, Roth A, Yan W, Fernandez S, et al. The effects of steep trendelenburg positioning on intraocular pressure during robotic radical prostatectomy. Anesth Analg 2009;109:473-8.  Back to cited text no. 19
Mowafi HA, Al-Ghamdi A, Rushood A. Intraocular pressure changes during laparoscopy in patients anesthetized with propofol total intravenous anesthesia versus isoflurane inhaled anesthesia. Anesth Analg 2003;97:471-4, table of contents.  Back to cited text no. 20
Lee LA, Roth S, Posner KL, Cheney FW, Caplan RA, Newman NJ, et al. The American Society of Anesthesiologi`sts Postoperative Visual Loss Registry: Analysis of 93 spine surgery cases with postoperative visual loss. Anesthesiology 2006;105:652-9; quiz 867-8.  Back to cited text no. 21