Corneal Abrasion After Robotic-Assisted Sacrocolpopexy: A Case Series

Objectives: 1) Describe the presentation, management, and sequelae of corneal abrasions after robotic-assisted sacrocolpopexy (RA-SCP). 2) Discuss possible mechanisms for injury, including modifiable clinical or surgical factors.

Methods: This is a retrospective case series of four patients that experienced corneal abrasion after RA-SCP within a single academic medical center between May 1, 2022 and January 31, 2024.

Results: Four patients experienced an immediate post-operative corneal abrasion after RA-SCP. Patient ages ranged from 52 to 69; all were post-menopausal. Three of the four patients had follow-up with ophthalmology with no identifiable ophthalmologic risk factors. One patient had bilateral abrasions, while the other three had unilateral (two left eye, one right eye). Both propofol and sevoflurane were used in all four cases. Three of the four cases lasted approximately 5.5 hours, and one lasted 7.5 hours. The degree of Trendelenburg was set at 30 degrees in three of the cases and 38 degrees in the fourth case. None of the patients were current tobacco users; one had a remote 0.5 pack year history and the other three never used tobacco. IV fluids administered ranged from 1100cc to 2400cc. BMI ranged from 27 to 34. Two of the patients had pre-diabetes, the third had high cholesterol, hypothyroidism, arthritis and strabismus, and the fourth had no noted medical problems.

Conclusions: Corneal abrasion is a painful but transient post-operative complication which occurs when the epithelial layer of the cornea is disrupted from the underlying basement membrane. Corneal abrasions are reported to be the most common eye-related injury in non-ocular surgery. Importantly, robotic surgery has been reported to be a risk factor for corneal abrasion with incidence reported between 2-3% for RA-SCP.

Known risk factors for corneal abrasions include glaucoma, advanced age, common subclinical corneal dystrophies, longer surgery time, diabetes, and steep Trendelenburg positioning. Some proposed mechanisms of action include increased intraocular pressure due to Trendelenburg, drying secondary to failure to completely tape the eyelids closed , decreased tear production from general anesthesia, and direct abrasions. Corneal abrasions are typically transient with complete resolution within a few days. Symptomatic treatment includes lubricating ointment, prophylactic topical antibiotics, cycloplegic eyedrops, patching, and oral analgesics.

Novel risk factors for corneal abrasion could not be identified from this case series due to the low number of patients assessed. However, given RA-SCP is a common UPRS procedure, a detailed understanding of this distressing condition is important and surgeons should be aware of modifiable peri-operative measures that may reduce the incidence of this complication. Familiarity with this transient condition can help distinguish it from vision threatening conditions such as retinal ischemia or optic nerve injury. A larger case series in the future may provide additional insights.