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Table of Contents    
Year : 2017  |  Volume : 65  |  Issue : 3  |  Page : 657-658

“Smart click” to the rescue of the patient's eye: Preventing compression on the globe during surgery in prone position using the selfie mode

1 Department of Neurosurgery, PGIMER, Chandigarh, India
2 Department of Neuroanesthesia, PGIMER, Chandigarh, India

Date of Web Publication9-May-2017

Correspondence Address:
Pravin Salunke
Department of Neurosurgery, PGIMER, Chandigarh - 160 012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/neuroindia.NI_120_17

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How to cite this article:
Satapathy A, Salunke P, Agrawal S, Bhagat H. “Smart click” to the rescue of the patient's eye: Preventing compression on the globe during surgery in prone position using the selfie mode. Neurol India 2017;65:657-8

How to cite this URL:
Satapathy A, Salunke P, Agrawal S, Bhagat H. “Smart click” to the rescue of the patient's eye: Preventing compression on the globe during surgery in prone position using the selfie mode. Neurol India [serial online] 2017 [cited 2019 Dec 16];65:657-8. Available from:


Blindness after surgery in prone position has been described previously with multiple causes being ascribed for it.[1] Of these, pressure on the globe/eyeballs is an avoidable cause. A simple mirror to determine pressure on the globe is a good option; however, it has certain limitations.

Today, smartphone is a way of life. In medicine, it is often being used for image and data transfer.[2],[3] We describe the use of “selfie mode” or front camera image captured from a smartphone as an alternative and probably a better way to confirm proper protection of the eyes in prone position.

Patients with atlantoaxial dislocation (AAD) are operated in prone position, mostly on a horseshoe head rest. The surgical procedure requires manipulation of the C1-2 joints, and therefore, the head cannot be fixed. The eyes need to be protected from compression that may occur due to an improper position of the head on a horseshoe head rest. We used the front camera of a smartphone to click images of the eyes while the patient lay prone with face down on the horse shoe head rest in 10 patients of AAD operated consecutively [Figure 1]. The images were clicked after final positioning and manipulation of joints. The camera could be easily slid underneath the drapes and could click pictures even in low light. The images were transferred to other members of the team in case they were outside the operation theatre.
Figure 1: Intraoperative photograph clicked using the selfie mode of a smartphone under the surgical drapes. Notice the eyes are safe within the horseshoe. Also the lighting is adequate despite the drapes covering the camera. The picture was transmitted as well as saved for the record

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Cervical spinal surgery in prone position often requires positioning of the head on the horseshoe head rest for manipulation during surgery. Improper positioning may cause direct pressure on the globe leading to raised intraocular pressure and intraocular venous pressure precipiating ischemia of the optic nerve head and blindness.[1] Though there are several possible causes of blindness following surgery in prone position, this one in particular is a preventable one. In prone position, it is difficult to view the patient's eyes. A prefixed mirror in the Allen's table is quite helpful. However, the Allen's table may not be available at all places. The mirror's reflective capacity is reduced over time due to oral secretions and cleansing agents. Furthermore, the mirror is not helpful after the patient is draped. This makes it difficult to assess the change in position and any compression on the eye balls after an intraoperative manipulation, both due to blockage of the reflected light from the mirror as well as low illumination. Finally, a record to show a proper positioning can neither be maintained nor be transmitted to others.

The use of a smartphone camera for positioning has been described previously and its advantages have been highlighted in this article.[4] In addition, the technology is easily available even is resource-deficient countries. Smartphones with front (selfie) cameras are available with almost every operating room (OR) personnel. These cameras have a wide angle of view and can easily capture the entire face with eyes of the patient. They can easily be slid under the drapes and act like a periscope even in low illumination under the drapes, which is especially helpful after the intraoperative manipulation has been carried out. In addition, it is a useful tool for record keeping of the correct positioning of the patient. Another advantage is that the photograph can be shared with other members of the team who may join later.

In short, smartphones are an extension of the eye of the operation theatre personnel or the surgeon. This selfie is undoubtedly the saviour, protecting the patient's vision.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Sodhi HB, Salunke P, Kaur S, Singh R. Missing the 'window' might shut the light forever: Central retinal artery occlusion following spine surgery. Surg Neurol Int 2015;6:86.  Back to cited text no. 1
[PUBMED]  [Full text]  
Maugeri R, Giammalva RG, Iacopino DG. On the shoulders of giants, with a smartphone: Periscope in Neurosurgery. World Neurosurg 2016;92:569-70.  Back to cited text no. 2
Zaki M, Drazin D. Smartphone use in neurosurgery? APP-solutely! Surg Neurol Int 2014;5:113.  Back to cited text no. 3
Levan P, O'Rourke M, Presta M, Byram S. The use of mobile smartphone technology to enhance positioning of a prone patient for thoracic spine surgery. Internet J Anesthesiol Volume 30 Number 3.  Back to cited text no. 4


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