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Jorge Alberto Jimenez, Taylor Coleman, Salma Dawoud, Hannah Miller, Johnny Lippincott, Johnny McKenzie, Albert Lin, Brian Tieu; Post-Operative Day 1 and Week 1 Complications and Their Potential Risk Factors Following Pars Plana Vitrectomy. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5775. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To assess overall post-operative complication rates from microincision vitrectomies done at a level 1, academic center and to identify risk factors for these complications
A retrospective chart review of 3210 vitrectomies was performed for surgeries between June 1, 2012 and April 28, 2018. Charts without Post-Op Day 1 (POD1) or Post-Op Week 1 (POW1) information were excluded. The following complication rates: intraocular pressure ≥ 30 mm Hg, hypotony/intraocular pressure ≤ 5, and intervention rates on POD1 or POW1 were measured. Potential risk factors were identified including tamponade agent, Phaco use during surgery, glaucoma history, and history of recent trauma. Odds Ratios with a CI of 95% were calculated.
The overall complication rates were 11.9% at POD1 and 12.2% at POW1. The most common complication was IOP ≥ 30 (8.0% at POD1 and 7.6% at POW1). The least common complication was interventions performed (0.72%) at POD1 and hypotony (2.0%) at POW1. At POD1, an IOP ≥ 30 was more likely in glaucoma patients (OR = 2.18, CI: 1.58 - 2.99), silicone oil (OR = 1.72, CI: 1.21 - 2.44), and C3F8 (OR = 1.42, CI: 1.01 - 2.01), but less likely with air tamponade (OR = 0.35, CI: 0.19 - 0.64). At POD1, hypotony was more likely in patients with recent trauma (OR = 5.02, CI: 3.14 - 8.01) and BSS fill (OR = 3.03, CI: 1.88 - 4.89), but less likely with C3F8 tamponade (OR = 0.46, CI: 0.22 - 0.97). At POW1, an IOP ≥ 30 was more likely in glaucoma patients (OR = 2.56, CI: 1.86 - 3.52), recent trauma (OR = 1.49, CI: 1.01 - 2.19), and C3F8 tamponade (OR = 1.48, CI: 1.05 - 2.10), but less likely with air tamponade (OR = 0.44, CI: 0.25 - 0.77). However, at POW1, hypotony was also associated with glaucoma (OR = 1.94, CI: 1.06 - 3.57) and recent trauma (OR = 4.67, CI: 2.61 - 8.35) as well as PFO tamponade (OR = 13.93, CI: 3.76 - 51.65). SF6 tamponade and Phaco use had no increased risk for IOP ≥ 30 or hypotony at either visit.
Microincision vitrectomy has low complication rates. Glaucoma medications should be continued in glaucoma patients after surgery but may need adjustment at POW 1 given increased risk for having either high or low pressures. Patients with Silicone Oil and C3F8 tamponade should have their intraocular pressure monitored closely. Air tamponade is least associated with post-operative complications. Consider SF6 tamponade over C3F8 when possible.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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