July 2018
Volume 59, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2018
Postoperative complications following 23, 25, and 27-gauge pars plana vitrectomy and the utility of routine follow-up
Author Affiliations & Notes
  • Ryan Alan Shields
    Ophthalmology, Stanford, Palo Alto, California, United States
  • Matthew A Powers
    Ophthalmology, Stanford, Palo Alto, California, United States
  • Cassie Ann Ludwig
    Ophthalmology, Stanford, Palo Alto, California, United States
  • Darius M. Moshfeghi
    Ophthalmology, Stanford, Palo Alto, California, United States
  • Footnotes
    Commercial Relationships   Ryan Shields, None; Matthew Powers, None; Cassie Ludwig, None; Darius Moshfeghi, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2018, Vol.59, 4430. doi:https://doi.org/
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      Ryan Alan Shields, Matthew A Powers, Cassie Ann Ludwig, Darius M. Moshfeghi; Postoperative complications following 23, 25, and 27-gauge pars plana vitrectomy and the utility of routine follow-up. Invest. Ophthalmol. Vis. Sci. 2018;59(9):4430. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : Routine postoperative evaluation following vitreoretinal surgery is the standard of care to detect and intervene on potentially vision threatening complications. Nevertheless, the necessity of multiple postoperative visits is being reassessed. We conducted a retrospective clinical study to assess the complication and intervention rate following pars plana vitrectomy (PPV).

Methods : A retrospective chart review was conducted on all patients undergoing PPV for any indication from January 1, 2016 to December 31, 2016. A total of 310 PPVs in 259 patients were reviewed. Preoperative demographic data, examination findings, diagnoses, surgery performed, postoperative complications and interventions were recorded for a maximum of three months. Descriptive analyses were conducted on baseline characteristics, pre- and postoperative diagnoses, surgery performed, complications and interventions.

Results : The most common postoperative day 1 (POD1) complication was elevated intraocular pressure (IOP) greater than 30 mmHg (3.9%, 12/310) followed by vitreous hemorrhage (2.3%, 7/310). The most common POD2-6 complication was elevated IOP (5.1%, 6/117) followed by hypotony (3.4%, 4/117). The most common POD7-27 complication was again elevated IOP (6.9%, 19/275) followed by vitreous hemorrhage (2.2%, 6/275) and retinal detachment (2.2%, 6/275). The most common POD28 or later complication was cystoid macular edema (CME) (4.8%, 13/269), followed by elevated IOP (3.3% 9/269). No patient had to undergo reoperation on POD1, though two patients required an injection of sterile air for hypotony and one patient required an anterior chamber tap for an IOP of 41mmHg. Patients with the diagnosis of either epiretinal membrane (ERM) or macular hole (MH) had the lowest relative risk of complication (RR 0.672, 95% CI 0.577, 0.784) while those with macula-off retinal detachment (RR 1.500, 95% CI 1.004, 2.241) had the highest relative risk of complication. There was no difference in time-to-complication between larger or smaller vitrectomy gauges (p = .0.372).

Conclusions : The incidence of a complication following 23, 25, and 27-gauge PPV was higher than anticipated though the majority were elevated IOP managed with topical therapy. Patients undergoing isolated macular surgery (ERM peel or macular hole repair) had the lowest relative risk of a postoperative complication.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

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