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N.G. Anderson, S. Garg, G.C. Brown, M.S. Fineman; Incidence and Economic Impact of Intraocular Pressure Elevation and other Adverse Events following Vitreoretinal Surgery. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2031.
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Purpose: To determine the incidence of significant postoperative intraocular pressure elevation and other adverse events in patients undergoing vitreoretinal surgery. Additionally, the economic impact of routine hospitalization of these patients undergoing vitreoretinal procedures is considered . Methods: All patients undergoing vitreoretinal procedures (vitrectomy and scleral buckling)were routinely admitted for monitoring and treatment of intraocular pressure, blood pressure, pain, nausea and vomiting, and blood sugar in diabetic patients. All patients were empirically treated with topical aqueous suppressants postoperatively. The intraocular pressure in the operated eye was prospectively recorded between 6–12 hours and 1 day postoperatively of thirty consecutive patients hospitalized following vitreoretinal surgery. Additionally, adverse systemic events were recorded. Economic analysis was performed to determine the average cost per patient hospitalization and the economic cost per pressure elevation incident. Results: Five patients underwent scleral buckling procedures and four patients underwent combined scleral buckling and vitrectomy for rhegmatogenous retinal detachment. Twenty–one patients underwent vitrectomy alone for retinal detachment, macular hole, subretinal hemorrhage, or vitreous hemorrhage. Twenty five patients received intraocular tamponade with air, long–acting gas, or silicone oil. The average 6–12 hour intraocular pressure was 19.5 mm Hg (range 11–31). One patient (3.3%) had a pressure greater than 30mm Hg at 6–12 hours postoperatively. The average one day postoperative intraocular pressure was 23.1 mm Hg (range 9–45). Three patients (10%) had pressures above 30mmg Hg at the one day postoperative measurement. All of the patients with significant pressure elevations (>30 mm Hg) had long–acting gas tamponade. The incidence of adverse systemic events was low. The average cost per admission was approximately $2800. The cost of admission per significant pressure elevation incident was $84000. Conclusions: The incidence of significant intraocular pressure elevation and other adverse events following vitreoretinal surgery is low. The presence of long–acting gas tamponade or scleral buckle may increase the risk of postoperative pressure elevation. Based on the low incidence of adverse events within the first 24 hours following vitreoretinal surgery, routine hospitalization of these patients may not be cost effective. Examination of a larger patient population is indicated to increase the statistical power of the study.
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