Long-Term Changes in Intraocular Pressure after Vitrectomy for Rhegmatogenous Retinal Detachment, Epi-Retinal Membrane, or Macular Hole

Abstract

PurposeTo determine the long-term changes in the intraocular pressure (IOP) following vitrectomy for rhegmatogenous retinal detachment (RRD), epiretinal membrane (ERM), and macular hole (MH), and to investigate the relationship between the retinal disease and the incidence of late-onset IOP elevation.MethodsThis was a retrospective, observational, comparative study. We reviewed the medical records of 54 eyes of 54 RRD patients, 117 eyes of 117 ERM patients, and 75 eyes of 75 MH patients who underwent 20-, 23- or 25-gauge vitrectomy. The IOPs before surgery and 1, 3, 6, and 12 months following vitrectomy, and also at the final visit (average, 23.95 months) were evaluated. We defined a significant increase in the IOP as an increase of ≥4 mmHg from the preoperative IOP, and this increase was taken to be a ‘death’ event for the Kaplan-Meier survival analyses.ResultsThe mean follow-up period was not significantly different among the groups. The mean IOP at 3 (P = 0.001) and 12 (P = 0.011) months following the vitrectomy and at the final visit (P = 0.002) were significantly higher than that before the vitrectomy in the RRD group. The mean IOP in the RRD group was significant higher than that in the ERM group at 1 (P = 0.005), 3 (P = 0.009), and 12 (P = 0.013) months following vitrectomy, and at the final visit (P = 0.032). Kaplan-Meier survival analyses showed that the RRD group had a significantly higher risk of an IOP increase following vitrectomy than the other groups (P<0.001 by log-rank test). Multivariate logistic regression analyses showed that a preoperative diagnosis of RRD was the only risk factor that was significantly associated with a postoperative IOP elevation after excluding eyes with a low preoperative IOP (odds ratio, 3.208; P = 0.003).ConclusionsA late-onset IOP elevation following vitrectomy was observed only in eyes that underwent RRD surgery. The elevation was probably caused by the specific characteristics and surgical procedures of RRD. Clinicians should pay more attention to the IOP elevation for long times after vitrectomy especially in eyes with RRD.

Risk factors for neovascular glaucoma after vitrectomy in eyes with proliferative diabetic retinopathy

“…Knowing whether intraoperative gas tamponade is a risk factor for NVG is important because of its frequent use. It has previously been shown that IOP is elevated after vitreous surgery to repair idiopathic macular holes (in patients without PDR) 25 and with rhegmatogenous retinal detachment 26 because of late-stage inflammation caused by surgery. Previous studies have reported increased vascular endothelial growth factor levels in aqueous humor in patients with NVG.…”

Effects of Vitrectomy and Lensectomy on Older Rhesus Macaques: Oxygen Distribution, Antioxidant Status, and Aqueous Humor Dynamics

“…Additionally, several studies have demonstrated increased risk of ocular hypertension and/or open angle glaucoma development following these consecutive procedures, 14 – 18 and we are investigating Chang's hypothesis that increased oxygen in the anterior segment may contribute to oxidative damage to the trabecular meshwork. 19 Other retrospective studies have not supported these findings within limited follow-up periods, 20 – 22 and a prospective trial 23 is underway to provide further information on this risk factor for the most common cause of irreversible blindness.…”

Risk factors for requirement of filtration surgery after vitrectomy in patients with proliferative diabetic retinopathy

“… 14 , 15 A postoperative increase in IOP has also been reported in patients who have undergone vitrectomy for an idiopathic macular hole 16 or rhegmatogenous retinal detachment, in whom postoperative inflammation may lead to increased IOP in the late postoperative phase. 17 In this study, gas tamponade was identified as a significant risk factor for requirement of filtration surgery. Previous studies have reported increased VEGF levels in aqueous humor in patients with NVG.…”