Intraocular Pressure in Pediatric Patients After Congenital Heart Surgery
Purpose
To determine the impact of varying cardio-pulmonary interactions on intraocular pressure (IOP) in children after congenital heart surgery.
Methods
Patients in the age group 0 days to 18 years after congenital heart surgery were included. IOP was measured using Icare tonometer. IOP was measured between 3 to 14 days after cardiac surgery. The following patients were excluded: genetic disorder, intracranial bleed or increased intracranial pressure, seizure disorder, receiving invasive mechanical ventilation, glaucoma or elevated IOP prior to surgery, retinopathy of prematurity, gestational age ≤ 34 weeks, receiving ketamine as an anesthetic in operating room or in CVICU, receiving extracorporeal membrane oxygenation or ventricular assist device, and receiving orthotopic heart transplantation.
Results
Fifty patients (32 males, 64%) with a mean age of 28.4 ± 45.8 months were prospectively enrolled. Majority patients required cardiopulmonary bypass (41 patients, 82%) for their cardiac surgery. 30 patients (60%) were associated with univentricular physiology. The mean IOP for the study cohort was 12.4 ± 3.9 mm Hg in the right eye, and 11.4 ± 4.3 mm Hg in the left eye. The patients with univentricular physiology had mean IOP of 15.2 ± 3.3 mm Hg, while the patients with biventricular physiology had mean IOP of 11.2 ± 2.8 mm Hg. The patients with highest IOP were associated with central shunt (21 mm Hg), Fontan circulation (19 mm Hg), Glenn circulation (18.5 mm Hg), Atrioventricular canal repair (18 mm Hg), and Tetralogy of Fallot repair (18 mm Hg).
Conclusion
IOP changes may happen with varying physiology in children after heart surgery. Further study is warranted to study the IOP trends and pathophysiology mechanisms in children after heart surgery.