Immediate Postoperative Use of a Topical Agent to Prevent IntraocularPressure Elevation After Pars Plana Vitrectomy With Gas Tamponade

Abstract

To determine whether a single topical aqueous suppressant applied immediately after pars plana vitrectomy with long-acting gas tamponade prevents intraocular pressure (IOP) elevation. Methods: Fifty patients who met the inclusion criteria and underwent pars plana vitrectomy with long-acting gas tamponade were randomized to receive a combination of timolol maleate and dorzolamide hydrochloride, long-acting timolol alone, dorzolamide alone, or placebo at the conclusion of surgery. The IOP was checked by a portable, handheld tonometer (Tono-Pen) at the conclusion of surgery and at 5 hours, 1 day, and 1 week after surgery. Results: There were no significant differences in IOP among the groups at the conclusion of surgery. The IOP at 5 hours after surgery (27.0 vs 17.4 mm Hg; PϽ.001) and 1 day after surgery (26.1 vs 19.9 mm Hg; P = .01) showed a statistically significant difference between the placebo and timolol-dorzolamide groups. The timololdorzolamide group showed greater IOP control than either the timolol alone or the dorzolamide alone groups at 5 hours (P=.04 for both). Conclusion: The use of a single topical aqueous suppressant (timolol-dorzolamide) given after pars plana vitrectomy with long-acting gas tamponade effectively prevents significant postoperative IOP elevation at 5 hours and 1 day after surgery.

Intraocular pressure elevation in the early postoperative period after vitrectomy for rhegmatogenous retinal detachment

“…In patients undergoing combined vitrectomy and cataract surgery, IOP at 5 h was not associated with any parameter but at 1 day was significantly associated with circumferential dimension of retinal tears (P \ 0.05). [6] report that 75% of patients showed an IOP of C25 mmHg at 5 h after vitrectomy for RD. In our study, the incidence of IOP elevation was higher at 1 day than at 5 h postoperatively.…”

“…If a severe pressure spike develops, postoperative vision can be damaged, even after an otherwise successful vitrectomy [10]. Previous studies show that postoperative IOP spikes may be blunted by using prophylactic topical aqueous suppressants [5,6]. Topical prophylactic therapy may be considered in patients susceptible to IOP elevation or in eyes with higher risks of pressure rise, such as large size of retinal tears and long history of retinal detachment.…”

“…IOP elevation within 24 h after vitrectomy is reported in 8.4-75% of eyes [1][2][3][4][5][6]. An IOP spike can lead to severe visual loss from central retinal artery occlusion, optic nerve ischemia, or macular ischemia [7][8][9][10].…”

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

“…Lee et al 15 found that 4.8% of 89 patients undergoing 20G vitrectomy prophylactic anti-glaucoma medication was not used in either of these two studies, despite evidence in the literature that topical agents can be effective at preventing, or at least attenuating, the IOP spike. 13,14 In contrast, the study by Cochrane et al 16 of 81 patients undergoing 23G vitrectomy advocates the abandonment of the day-1 visit. The authors checked the IOP immediately postoperatively and found no patients with an IOP 430 mm Hg.…”

“…The reported incidence of high IOP at day 1 varies between 6 and 67%. [9][10][11][12] However, numerous groups have suggested that prophylactic topical treatment with apraclonidine 13 , dorzolamide, and/or timolol 14 are effective at preventing IOP spikes.…”