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P. S. Muether, P. Moisiszik, B. Kirchhof, S. Fauser; Course of Intraocular Pressure After Vitreoretinal Surgery. Invest. Ophthalmol. Vis. Sci. 2009;50(13):6049.
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Assessment of intraocular pressure (IOP) after vitreoretinal surgery is a prerequisite for unimpaired functionality of the eye as well as well-being of the patient. Financial rationalization requires an estimate of possible ambulatory treatment of vitreoreatinal cases. This study aims to elucidate reasons for postoperative IOP-decompensations, as well as prerequisites for potentially ambulatory treatable patients.
Medical history was obtained in a case series of 202 consecutive patients undergoing vitreoretinal surgery, including ophthalmologic diseases and prior treatments, lens status, and general diseases. Intraocular pressure at end of surgery was adjusted to 17mmHg (Schiotz scale 7.5 weight 7.5g) whenever possible. IOP was controlled 4, 8 and 12 hours after surgery as well as on first postoperative morning. IOP-lowering treatment was applied at IOP exceeding 30mmHg.
Surgical spectrum included all aspects of vitreoretinal surgery. 68 patients were treated without endotamponade, 72 with gastamponade, 52 with oiltamponade, and 10 with external buckling. PRN medication was given in 29.7% of all patients. Patients with gas- or oiltamponade tended to have higher IOP values. IOP-lowering treatment was necessary in 27.8% of gas-treated eyes, 42.3% of oil-treated eyes, 26.5% in eyes without tamponade and never in external buckling patients. Preoperative lens status, panretinal laser treatment, combined surgery, application of an encircling band or triamcinolone injection were risc factors for high IOP and PRN medication. Surgery related to diabetic retinopathy showed a significant elevation of needed medication at 50%. ,,Uncomplicated" silicone oil removal and peeling for macular hole or pucker were at low risk of IOD decompensation at about 19%.
Following adjustment to physiologic IOP at the end of surgery, 29.7% of all treated patients required IOP-lowering medication. Necessity of treatment was significantly higher in the oiltamponade group, as well as related to several other factors. However, also eyes without tamponade and with gastamponade required treatment in about 19% of all cases. Flexible estimate is necessary to evaluate ambulant treatability. Prophylactic treatment in ambulatory cases has to be taken into consideration as a possibility.
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