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

Kentaro Yamamoto,Takeshi Iwase,Hiroko Terasaki,Demetrios G Vavvas

doi:10.1371/journal.pone.0167303

Kentaro Yamamoto, Takeshi Iwase + Show 2 more

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https://doi.org/10.1371/journal.pone.0167303

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Journal: PLOS ONE	Publication Date: Nov 29, 2016
Citations: 18	License type: CC BY 4.0

Affiliation: Nagoya University Hospital

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.

Highlights

Kaplan-Meier survival analyses showed that the rhegmatogenous retinal detachment (RRD) group had a significantly higher risk of an intraocular pressure (IOP) increase following vitrectomy than the other groups (P
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
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

Summary

Introduction

Pars plana vitrectomy is performed to treat various kinds of vitreoretinal diseases.[1,2,3,4] An early postoperative transient increase in the IOP is not an uncommon complication because of inflammation, hemorrhage, use of viscoelastic materials, silicone oil tamponade, and long-lasting gas tamponade.[5,6,7,8] whether there is an elevation of the IOP in the long term after vitrectomy is still controversial.Some studies have shown a late-onset IOP elevation. [9] [10] [11] Chang first reported the development and worsening of open angle glaucoma (OAG) during a long-term period following vitrectomy compared to the fellow eyes.[9]. Some studies have shown a late-onset IOP elevation. [9] [10] [11] Chang first reported the development and worsening of open angle glaucoma (OAG) during a long-term period following vitrectomy compared to the fellow eyes.[9] He hypothesized that an increase in the partial pressure of oxygen in the vitreous cavity after vitrectomy can cause oxidative stress on the trabecular meshwork resulting in an IOP elevation which is exacerbated by lens extraction. Koreen et al reported that lens extraction was a strong risk factor for the development of lateonset OAG after uncomplicated PPV [10], and Toyokawa et al reported an IOP elevation after vitrectomy in pseudophakic eyes. Koreen et al reported that lens extraction was a strong risk factor for the development of lateonset OAG after uncomplicated PPV [10], and Toyokawa et al reported an IOP elevation after vitrectomy in pseudophakic eyes. [11]

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