Abstract
Purpose: :
To determine the incidence of and risk factors for intraocular pressure (IOP) elevation in the immediate postoperative period after vitrectomy for various vitreoretinal disorders.
Methods: :
A prospective study was performed in 231 consecutive patients with various vitreoretinal disorders including proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), macular hole (MH), epiretinal membrane (ERM), rhegmatogenous retinal detachment (RD), proliferative vitreoretinopathy (PVR), retinal arterial macroaneurysm, and RD due to MH. IOP was measured before surgery, at the end of surgery, and at 5 hours and 1 day after surgery using Tonopen XL®. IOP at the end of surgery was adjusted to 15.0 ± 2.0 mmHg. Clinical data were collected, including age, sex, performance of combined cataract surgery, vitrectomy cutter size (20G or 25G), operation time, use of expanding gas tamponade, number of laser photocoagulation, occurrence of postoperative fibrin formation, and severity of postoperative vitreous hemorrhage, to determine risk factors for IOP elevation.
Results: :
IOP elevation (> 25mmHg) was found in 55 (23.8%) and 54 patients (23.4%) at 5 hours and 1 day postoperatively, respectively. IOP at 5 hours in MH was significantly lower than those in DME, PDR, PVR, and RD. IOP at 1 day in PDR and RD was significantly higher than those in MH and ERM. Stepwise multiple regression analysis revealed that IOP at 5 hours postoperatively had a significant correlation with number of laser photocoagulation, preoperative IOP, combined cataract surgery and 20G vitrectomy. IOP at 1 day postoperatively was also significantly associated with these four parameters as well as severity of postoperative vitreous hemorrhage and use of expanding gas tamponade.
Conclusions: :
IOP elevation was found in approximately one-quarter of cases within 1 day following vitrectomy. The risk factors for IOP elevation included number of laser photocoagulation, preoperative IOP, combined cataract surgery and 20G vitrectomy, severity of postoperative vitreous hemorrhage, and the use of expanding gas tamponade. Prophylactic treatment may be considered in eyes at a high-risk of IOP elevation.
Keywords: intraocular pressure • vitreoretinal surgery • clinical (human) or epidemiologic studies: outcomes/complications