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

Abstract

Purpose This study aimed to determine the proportion of patients requiring alteration in management based on the findings of the day-1 postoperative visit after pars plana vitrectomy, and to identify clinical characteristics that predict the need for unexpected intervention. Patients and methods A retrospective case note review was conducted of all patients who underwent pars plana vitrectomy and who then attended for review on the first postoperative day. All patients received routine prophylactic anti-glaucoma medication.Results Two hundred and seventy-three patients examined on day 1 following vitrectomy were studied. Indications for surgery included retinal detachment, epiretinal membrane, macular hole, vitreous haemorrhage, diabetic eye disease, and floaters. Twenty-gauge (20G) vitrectomy was performed in 124 eyes (45%); 23-gauge (23G) vitrectomy was performed in 149 eyes (55%). Phacoemulsification was performed concurrently in 51/273 (19%) eyes. Ten patients (3.7%) required unexpected intervention on day 1 owing to intraocular pressure (IOP) 430 (2/273), IOP o6 (5/273), or unexpected return to theatre for anterior chamber washout (3/273). There was no difference in intervention rate or day-1 IOP between 20G and 23G cases. Hypotony was less common if gas tamponade was used (χ 2 -test, Po0.001). Patients undergoing combined phacoemulsification and 20G vitrectomy were significantly more likely to require intervention on day 1 than patients undergoing 20G vitrectomy alone (15.0 vs 1.9%, P = 0.029, Fisher's exact test) but this was not the case for patients undergoing 23G vitrectomy (0 vs 4.2%, Fisher's exact test, P = 0.58). Conclusions The intervention rate on the first day after vitrectomy is low and day-1 postoperative review can be safely omitted in the majority of patients undergoing vitrectomy.

Incidence of Management Changes at the Postoperative Day One Visit After Pars Plana Vitrectomy for Retinal Detachment

“…While there have been a few studies evaluating the utility of a postoperative day one visit, additional evidence is needed. 2 , 3 , 4 However, there is interest in increasing postoperative visit efficiency. This interest is highlighted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.…”

“…1 Complications screened for at the POD1 visit include elevated intraocular pressure (IOP), endophthalmitis, wound leaks, hypotony, choroidal detachments, corneal decompensation, and failure of retinal reattachment. 2 , 3 All of these adverse effects could have serious long-term consequences on vision if left untreated. However, anecdotal evidence and prior smaller studies suggest that the primary problem detected at the POD1 visit is an elevation in IOP, especially in eyes treated with silicone oil and gas tamponade.…”

Risk Factors for Elevated Intraocular Pressure on First Day Postoperative Review Following Pars Plana Vitrectomy

“…A recent study by Alexander et al reported that the incidence of day 1 postvitrectomy raised IOP is low with the use of postoperative prophylactic antiglaucoma treatment. 6 Therefore, a current trend is to use immediate prophylactic oral or topical antiglaucoma medication to justify avoidance of day 1 postoperative review. However, the evidence to support this approach is currently deficient and it remains questionable whether prophylactic treatment is essential in all vitreoretinal cases.…”

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

“…Similar trends in visual outcomes have been reported in patients with wet AMD who were similarly switched to aflibercept. 5,6 Conflict of interest…”