Abstract
Purpose :
Despite remaining a key issue in post operative management, little data exists regarding the rates, risk factors, and treatment strategies for elevated intraocular pressure (IOP) after pars plana vitrectomy (PPV) for rhegmatogenous retinal detachments (RRD). We performed a retrospective cohort study to evaluate the rates and risk factors for post-operative IOP-lowering drop use following PPV to repair RRDs and to characterize use of post-operative IOP lowering treatment practices.
Methods :
Patients who underwent PPV without scleral buckle at an academic center between 2012-2016 were identified in the primary RRD database. Patients with prior glaucoma or IOP lowering drops were excluded. Peri-operative characteristics were analyzed using ANOVA for continuous variables, and Fisher’s Exact Test for categorical variables.
Results :
251 patients who underwent PPV for RD repair were identified. 87 (34.7%) patients developed elevated IOP and started IOP lowering therapy following surgery. Patients undergoing first time intraocular surgery were significantly more likely to develop a post-operative IOP elevation (37.7% versus 20.5%, p=0.036). Sex, Race, BMI, smoking history, diabetes, lens status, myopia, history of uveitis, history of ocular trauma, time from detachment symptoms to presentation, macula status, number of retinal breaks, tears or holes, number of quadrants detached, presence of vitreous hemorrhage and presence of giant retinal tear were not associated with treatment for post operative IOP rise. There were no associations between post-operative IOP elevations and retinal detachment procedure type, vitrectomy gauge, tamponade type, or poor positioning. Of the 87 patients who were started on drops, 60 had drops started on post operative day 1 (69.0%), and 82 (94.3%) were started on drops prior to post operative day 11. 67% of patients discontinued drops by week 6 and 93.1% discontinued drops by week 14. Three patients (1.2%) developed glaucoma.
Conclusions :
Our results show about a third of patients developed elevated IOP requiring treatment following PPV for RRD repair. Additionally, first-time intraocular surgery was a significant risk factor for IOP elevation, and most patients were successfully treated medically, with normalization of IOP by post operative week 6-14. Further work should examine specific IOP lowering drop regimens.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.