Abstract:Uncomplicated PPV seems to increase the IOP, particularly in those who are pseudophakic and have a family history of open-angle glaucoma. This increase in IOP may lead to glaucomatous damage if not managed appropriately. Patients with a previous PPV need to be followed by an ophthalmologist to monitor the IOP in the vitrectomized eye.
“…Lens extraction has been described as a major risk factor for the development of glaucoma after uncomplicated pars plana vitrectomy [87]. Other risk factors include pseudophakia and family history of open angle glaucoma [88]. Fig.…”
BackgroundThe close structural and microcirculatory co-relation between anterior and posterior segments of eye make them very vulnerable to complications when one of them is affected surgically. With the advent of anti-fibrotic agents in the management of glaucoma, the rates of vitreoretinal complications have become more frequent.
Main bodyCommon retinal complications after glaucoma surgeries include choroidal detachment; ocular decompression retinopathy; haemorrhagic choroidal detachment; hypotony maculopathy; malignant glaucoma; vitreous haemorrhage; bleb endophthalmitis; retinal detachment. Similarly, intraocular pressure rise is often noted after scleral buckle; pars plana vitrectomy; intravitreal gas injection; silicone oil injection; intravitreal steroid injection.ConclusionThe article provides some insight into some of the complications after glaucoma and retina surgeries, including the pathogenetic mechanisms behind each complication and available management options.
“…Lens extraction has been described as a major risk factor for the development of glaucoma after uncomplicated pars plana vitrectomy [87]. Other risk factors include pseudophakia and family history of open angle glaucoma [88]. Fig.…”
BackgroundThe close structural and microcirculatory co-relation between anterior and posterior segments of eye make them very vulnerable to complications when one of them is affected surgically. With the advent of anti-fibrotic agents in the management of glaucoma, the rates of vitreoretinal complications have become more frequent.
Main bodyCommon retinal complications after glaucoma surgeries include choroidal detachment; ocular decompression retinopathy; haemorrhagic choroidal detachment; hypotony maculopathy; malignant glaucoma; vitreous haemorrhage; bleb endophthalmitis; retinal detachment. Similarly, intraocular pressure rise is often noted after scleral buckle; pars plana vitrectomy; intravitreal gas injection; silicone oil injection; intravitreal steroid injection.ConclusionThe article provides some insight into some of the complications after glaucoma and retina surgeries, including the pathogenetic mechanisms behind each complication and available management options.
“…These rates are similar to those reported by Luk et al [19], who reported an overall incidence of 7.9% (eight eyes) with a higher rate in pseudophakic (13%) compared with phakic (2%) eyes. More recently, a retrospective study by Wu et al [20▪▪] examined 198 patients who underwent PPV for idiopathic epiretinal membrane. The incidence of elevated IOP was 19.2% in vitrectomized eyes, compared with 4.5% in the unoperated fellow eye.…”
Section: Glaucoma After Pars Plana Vitrectomymentioning
confidence: 99%
“…The incidence of elevated IOP was 19.2% in vitrectomized eyes, compared with 4.5% in the unoperated fellow eye. As a result of these findings, PPV has been suggested as a risk factor for the development of secondary open-angle glaucoma [17–19,20▪▪]. Other studies, however, have not found a link between open-angle glaucoma or IOP elevation and uncomplicated PPV [21,22].…”
Section: Glaucoma After Pars Plana Vitrectomymentioning
Purpose of review
The surgical management of retinal disorders, including scleral buckling procedures, pars plana vitrectomy, and intravitreal injections of gas or silicone oil, can lead to short-term elevations in intraocular pressure (IOP) and ultimately long-term glaucomatous damage if not treated in a timely manner. Glaucoma in these cases is commonly refractory to conventional therapies. This review highlights the treatment strategies for glaucoma in eyes that have previously undergone vitreoretinal surgery.
Recent findings
Although medical therapy is often used initially to control a temporary rise in IOP, laser and surgical therapy may be required to treat sustained IOP elevation and subsequent glaucomatous damage in eyes that have undergone intraocular surgery for retinal disorders. Glaucoma drainage devices are an important treatment modality, particularly when there is high risk of failure with filtering surgery.
Summary
Previous vitreoretinal surgery is a known risk factor for the development of glaucoma. Treatment is usually initiated with medical therapy, however, surgical intervention is frequently required to control IOP and prevent progressive glaucomatous damage in patients with refractory glaucoma.
“…Consequently, vitrectomy and combined cataract extraction can triple the gradient possibly resulting in increased oxidative stress on the TM [ 14 , 15 ]. Based on these physiological considerations, several studies observed a significant elevation in long-term IOP after vitrectomy for different pathologies [ 16 – 21 ]. However, other studies failed to show significant changes in IOP [ 22 – 25 ] and some even showed reduced IOP values [ 26 , 27 ].…”
Purpose
To evaluate the long-term effect of 20 and 23 gauge pars plana vitrectomy (PPV) on intraocular pressure (IOP).
Methods
Study type: Monocentric retrospective cohort study. 249 eyes of 249 patients undergoing PPV due to epiretinal membrane (EM), idiopathic macular hole (IMH) or vitreoretinal traction (VT) were included. The fellow eye served as control. Exclusion criteria were factors known to influence the IOP, such as cataract surgery during follow-up, extended use of steroids, cryotherapy and silicone oil endotamponade. The relative change of IOP (operated vs. fellow eye) at 6–12 months after surgery was defined as primary endpoint. Secondary endpoints were the relative change of IOP at 3–6 and 12–24 months. Possible influencing cofactors were analysed using ANCOVA.
Results
The primary endpoint did not show a significant IOP reduction of the operated eye relative to the fellow eye (P = 0.089, n = 84). However, the IOP of the operated eye alone was significantly reduced at 6–12 and 12–24 months after surgery (-0.75 ± 2.80 and -1.22 ± 3.29 mmHg, P = 0.008 and 0.007, respectively). The IOP of the fellow eye was also significantly reduced at the 12–24 months period (-0.75 ± 2.73 mmHg, P = 0.008). In the subgroup analysis, sclerotomy size was a significant influencing cofactor, leading to lower IOP after 20G compared to 23G vitrectomy (P = 0.04).
Conclusion
Pars plana vitrectomy did not induce a significant long-term IOP reduction relative to the contralateral eye. However, we observed a IOP lowering potential in 20G vitrectomy.
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