Changes in Day 1 Post-Operative Intraocular Pressure Following Sutureless 23-Gauge and Conventional 20-Gauge Pars Plana Vitrectomy

Abstract

Background/Aims: The benefits associated with transconjunctival sutureless vitrectomy techniques are continuing to be defined. The purpose of this study was to compare the incidence of extreme changes in day 1 intraocular pressure (IOP) following 23-gauge sutureless vitrectomy compared with conventional 20-gauge vitrectomy.Methods: Fifty consecutive 23-gauge and 50 consecutive 20-gauge cases were included; eyes with a history of previous vitreoretinal surgery were excluded. 23-gauge surgery was completed with passive fluid air exchange where no long acting tamponade was indicated. The surgery remained sutureless unless a leak was visible at the end of the procedure. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher’s exact and chi-square tests.Results: Twenty-two percent (11/50) of 23-gauge vitrectomies required suturing of one or more ports. On the first post-operative day hypotony (IOP<5mmHg) occurred in 1/50 eyes in the 20- and 23-gauge groups. Raised pressure (IOP>21mmHg) occurred in 30% (15/50) of eyes in the 20-gauge group and 8% (4/50) of eyes in the 23-gauge group; IOP>30mmHg only occurred in the 20-gauge group (3/50).Conclusion: Fluid air exchange following 23-gauge vitrectomy is associated with very low risk of day 1 hypotony. This predominantly sutureless technique appears to reduce the incidence and magnitude of early post-operative IOP elevation compared with conventional 20-gauge vitrectomy.

The role of day one postoperative review of intraocular pressure in modern vitrectomy surgery

“…This finding is consistent with previous studies 10 11. Other risk factors for raised postoperative IOP have included high preoperative IOP,10 gas tamponade,6 10 and combined phacoemulsification/ vitrectomy surgery, which we did not find in our series 11 12…”

“…Advances in operative technique with the introduction of small port transonjunctival sutureless vitrectomy has led to shorter operative time and quicker patient recovery relative to traditional 20G vitrectomy 3. Comparison of 20G versus 23G vitrectomy have suggested that the newer 23G techniques do not have the same magnitude of postoperative ocular hypertension, although postoperative pressure spikes still occur 3 6. Singh et al noted that although the mean IOP did not rise significantly, 54% eyes recorded an IOP of ≥22 mm Hg and 14% ≥30 mm Hg within the first postoperative month.…”

Is day-1 postoperative review necessary after pars plana vitrectomy?

“…IOP spikes following vitrectomy may become less common as the use of small-gauge vitrectomy instruments becomes more widespread. 21,22 We have only studied patients who attended our hospital for follow-up on day 1. Around half of patients undergoing vitrectomy do not attend our unit for day-1 follow-up, because some missed their day-1 visit and a larger population of non-attendees were advised to attend their local eye unit instead for convenience.…”

Is intraocular pressure the only important postoperative variable? The role of first day postoperative review after vitrectomy

“…However, there is no consensus on the number of injections that designate a patient as a non-responder. Bhisitkul et al, 3 using data from the CRUISE study, classified patients as early responders (vs late or non-responders) based on OCT thickness o250 μm 3 months after initiation of treatment. As our study reflects real-life practices, physicians used their own discretion to designate a patient as a poor on nonresponder after no less than three injections as stated in the paper and in the example in Figure 4.…”

“…Depending on that, management can vary from intensive topical steroids to re-surgery, which is a change in routine treatment. 3 Thus, the empirical use of AGMs and their subsequent cessation without investigating the true cause for hypotony is questionable. Second, the rate of intervention is unassociated with the indication of surgery in this study.…”