Abstract
Purpose :
Acute drops and elevations in intraocular pressure are common post-surgical complications following rhegmatogenous retinal detachment (RRD) repairs. Predictors of acute intraocular hypertension (≥ 35mmHg) as well as hypotension (≤6mmHg) after RRD repair with pars plana vitrectomy (PPV) were evaluated. We tested the hypothesis that history of glaucoma, use of C3F8 and higher concentrations of expandable gases were responsible for extremes in IOP during postoperative day 1 (POD1) and postoperative week 1 (POW1). We designed a retrospective cohort study to assess these potential risk factors.
Methods :
A chart review of 754 patients undergoing RRD repair at the University of Virginia between July 1, 2012 and July 1, 2020 was conducted. All cases of PPV with completed postoperative day POD1 and POW1 visits were included. 178 eyes of 178 patients met the inclusion criteria for this study. Demographics, past medical history, ocular history, surgical and postoperative notes were reviewed. Additionally, data was gathered to compare different tamponades (C3F8 vs SF6 vs silicon oil) utilized during surgery.
Results :
16 (9%) cases had IOP elevation on POD1 and 14 cases (7.9%) on POW1. Out of those 14 patients, 12 (85.7%) did not present with elevated IOP during their POD1 visit. We did not find a significant relationship between acute elevation in postoperative IOP and type of tamponade. There was an association with history of glaucoma and increased IOP only during POW1, but it was not statistically significant (P=0.076). 8 patients (4.5%) experienced hypotony during POD1 and 13 cases (7.3%) on POW1. Silicon oil and SF6 tamponade were positively associated with postoperative hypotony on both POD1 (P=0.037) and POW1 (P<0.001). However, we did not find correlations between fill concentrations and acute drops in IOP.
Conclusions :
Our results revealed silicon oil and SF6 to have statistically significant correlations with acute drops in postoperative pressure (≤6mmHg). To our knowledge, there are no studies clearly stating these associations. Larger studies are needed to better understand the roles that silicon oil and SF6 tamponade play in postoperative hypotony. Finally, although we did not find significant risk factors for hypertony, we discovered that 12 cases (6.7%) had delayed spikes in IOP. This data highlights the utility of 1-week post-op appointments.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.