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Research ArticleComplications

Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery

SHARON ANN VAN WICKLIN
International Journal of Spine Surgery April 2020, 14 (2) 195-208; DOI: https://doi.org/10.14444/7029
SHARON ANN VAN WICKLIN
Aurora, Colorado
PHD, RN CNOR, CRNFA(E), CPSN-R, PLNC, FAAN, ISPAN-F
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  • For correspondence: SharonVWRN@aol.com
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    Figure 1

    Flow diagram of study selection; s indicates studies. Adapted from Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med. 2009;6(6):e1000097.53

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    Figure 2

    Magnitude of change in intraocular pressure and upper prediction intervals for T0 (induction of anesthesia) through T2 (0 to 10 minutes of prone position to the end of prone position). IOP indicates intraocular pressure; T, time point. Intraocular pressure increases significantly when the patient is placed in prone position (T1 [after induction of anesthesia to 0 to 10 minutes of prone position]: +7.5 mm Hg; P < .001) and continues to increase significantly until the end of prone position (T2: +10.1 mm Hg; P = 0.002). The upper prediction interval shows that in 95% of all populations, at the end of prone position, IOP could increase to 71.1 mm Hg (13.3 mm Hg + 19.8 mm Hg + 38.0 mm Hg = 71.1 mm Hg). *Pooled mean at T0.

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    Figure 3

    Forest plot of meta-analysis of T1 (after induction of anesthesia to 0 to 10 minutes of prone position). This analysis included 6 studies representing 11 participant groups (n = 179). Effect sizes were calculated using a random effects model. The area of each square is proportional to study weight.

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    Figure 4

    Forest plot of meta-analysis of T2 (0 to 10 minutes of prone position to the end of prone position). This analysis included 3 studies representing 5 participant groups (n = 80). Effect sizes were calculated using a random effects model. The area of each square is proportional to study weight.

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    Figure 5

    Funnel plot of publication bias for T1 (after induction of anesthesia to 0 to 10 minutes of prone position). Larger studies are shown at the top of the funnel. Positive smaller studies should appear at the right of the mean effect size (ie, center line). The significant Egger regression intercept for this funnel plot (bias = 9.11; P = .00015) may be indicative of potential publication bias in the studies included in the meta-analysis for this time point. However, the Orwin fail-safe N is 177, suggesting a need for 177 additional studies with an effect size of 0 before the cumulative effect would become trivial (defined as a Cohen d of 0.1).

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International Journal of Spine Surgery
Vol. 14, Issue 2
1 Apr 2020
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Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery
SHARON ANN VAN WICKLIN
International Journal of Spine Surgery Apr 2020, 14 (2) 195-208; DOI: 10.14444/7029

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Systematic Review and Meta-Analysis of Prone Position on Intraocular Pressure in Adults Undergoing Surgery
SHARON ANN VAN WICKLIN
International Journal of Spine Surgery Apr 2020, 14 (2) 195-208; DOI: 10.14444/7029
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