Long-Term Trends in Intraocular Pressure After Pars Plana Vitrectomy

Lalezary, Maziar; Kim, Stephen Jae; Jiramongkolchai, Kim; Recchia, Franco M.; Agarwal, Anita; Sternberg, Paul

doi:10.1097/iae.0b013e3181ff0d5a

Cited by 61 publications

(53 citation statements)

References 27 publications

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“…Subsequently, this traction on the ciliary body can also cause a cyclodialysis cleft [8]. Similar results were found after PPV without SOI [17], where pseudophakic diabetic patients developed less ocular hypertension than nondiabetic patients. This observation was attributed to the fact that diabetic eyes exhibit more ischemia, and have a lower rate of oxygen reaching the trabecular meshwork, and hence lower oxidative stress than nondiabetic eyes.…”

Section: Discussionsupporting

confidence: 74%

Incidence and Risk Factors of Ocular Hypertension following Pars Plana Vitrectomy and Silicone Oil Injection

et al. 2018

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Purpose: To evaluate the risk factors for elevated intraocular pressure (IOP) after pars plana vitrectomy (PPV) with silicone oil injection (SOI). Procedures: This prospective interventional study included 254 consecutive eyes receiving PPV with SOI. Results: Elevated IOP developed in 48% of the eyes postoperatively. The onset of IOP elevation was early (≤1 week) in 61.5% of the eyes, intermediate (1–6 weeks) in 28.7%, and late (> 6 weeks) in 9.8%. The incidence of IOP elevation was higher with primary uncomplicated rhegmatogenous retinal detachment than with tractional detachment (p = 0.01). Pseudophakia, high myopia, and high preoperative IOP were found to have higher incidences of ocular hypertension, whereas diabetic patients had a lower incidence. Conclusion: IOP elevation is a common complication following silicone oil (SO) tamponade. Risk factors for ocular hypertension development are pseudophakia, high myopia, high preoperative IOP, and low-viscosity SO.

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Section: Discussionsupporting

confidence: 74%

Incidence and Risk Factors of Ocular Hypertension following Pars Plana Vitrectomy and Silicone Oil Injection

et al. 2018

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“…37 Perhaps for similar reasons, eyes that had undergone pars plana vitrectomy for indications other than retinal detachment were also two and half times more likely to develop OHT, a finding that is similar to two other studies reporting on the increased risk of open angle glaucoma after vitrectomy. 38–40 Lower vision, need for cataract surgery, and need for vitrectomy likely all serve as indicators for more severe disease and thus higher risk of IOP elevation; hypotony may reflect extreme disease severity with ciliary body damage explaining the association with hypotony as well as OHT in this cohort. As expected, the presence of peripheral anterior synechiae (PAS) almost doubled the risk of developing OHT≥30 mmHg; a third of eyes which had evidence of PAS recorded by chart review developed OHT at 2 years.…”

Section: Discussionmentioning

confidence: 94%

Risk of Ocular Hypertension in Adults with Noninfectious Uveitis

et al. 2017

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Objective To describe the risk and risk factors for ocular hypertension (OHT) in adults with non-infectious uveitis. Design Retrospective, multicenter, cohort study. Participants Patients aged ≥ 18 years with non-infectious uveitis seen between 1979 and 2007 at 5 tertiary uveitis clinics. Methods Demographic, ocular and treatment data were extracted from medical records of uveitis cases. Main outcome measures Prevalent and incident OHT with intraocular pressures (IOP) of ≥21 mmHg, ≥30mmHg and rise of ≥10 mmHg from documented IOP recordings (or use of treatment for OHT). Results Among 5270 uveitic eyes of 3308 patients followed for OHT, the mean annual incidence rates for OHT ≥21mmHg and OHT ≥30mmHg are 14.4% (95%CI: 13.4%, 15.5%) and 5.1% (95% CI: 4.7%, 5.6%) per year, respectively. Statistically significant risk factors for incident OHT ≥30mmHg included: systemic hypertension (adjusted hazard ratio (aHR) = 1.29); worse presenting visual acuity (20/200 or worse vs 20/40 or better, aHR = 1.47); pars plana vitrectomy (aHR = 1.87); prior history of OHT in the other eye: IOP ≥ 21 mmHg (aHR = 2.68), ≥30 mmHg (aHR=4.86), and prior/current use of IOP-lowering drops or surgery in the other eye (aHR = 4.17); anterior chamber cells: 1+ (aHR = 1.43) and ≥2+ (aHR = 1.59) vs none; epiretinal membrane (aHR=1.25); peripheral anterior synechiae (aHR = 1.81); current use of prednisone>7.5 mg/day (aHR = 1.86); periocular corticosteroids in the last three months (aHR = 2.23); current topical corticosteroid use [≥ 8X/day vs. none] (aHR=2.58); and prior use of fluocinolone acetonide implants (aHR = 9.75). Bilateral uveitis (aHR = 0.69) and previous hypotony (aHR=0.43) were associated with statistically significantly lower risk of OHT. Conclusions OHT is sufficiently common in eyes treated for uveitis that surveillance for OHT is essential at all visits for all cases. Patients with one or more of the several risk factors identified are at particularly high risk, and must be carefully managed. Modifiable risk factors, such as use of corticosteroids, suggest opportunities to reduce OHT risk, within the constraints of the overriding need to control the primary ocular inflammatory disease.

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“…Although these data did not reach statistical significance, it was pointed out that because the data were nearly statistically significant, enrolling a larger number of patients would probably reveal the risk of glaucoma after these surgeries [21]. In another study, after a mean follow-up of two years, no evidence of increased risk of OHT or OAG was detected, even in pseudophakic patients [22]. Chang and Smith [21] concluded that it is necessary to collect more long-term data to better assess this risk.…”

Section: Vitrectomy Cataract and Glaucomamentioning

confidence: 92%

Preserve the (intraocular) environment: the importance of maintaining normal oxygen gradients in the eye

et al. 2014

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Oxygen levels in the eye are generally low and tightly regulated. Oxygen enters the eye largely by diffusion from retinal arterioles and through the cornea. In intact eyes, oxygen from the retinal arterioles diffuses into the vitreous body. There is a decreasing oxygen gradient from the retina to the lens, established by oxygen consumption by ascorbate in the vitreous fluid and lens metabolism. Age-related degeneration of the vitreous body or removal during vitrectomy exposes the posterior of the lens to increased oxygen, causing nuclear sclerotic cataracts. Lowering oxygen in the vitreous, as occurs in patients with ischemic diabetic retinopathy, protects against cataracts after vitrectomy. Vitrectomy and cataract surgery increase oxygen levels at the trabecular meshwork and with it the risk of open angle glaucoma. Two additional risk factors for glaucoma, African heritage and having a thinner cornea, are also associated with increased oxygen in the anterior chamber angle. Preservation of the vitreous body and the lens, two important oxygen consumers, would protect against nuclear sclerotic cataracts and open angle glaucoma. Delaying removal of the lens for as long as possible after vitrectomy would be an important step in delaying ocular hypertension and glaucoma progression.

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Long-Term Trends in Intraocular Pressure After Pars Plana Vitrectomy

Abstract: In this series, vitrectomy does not appear to increase IOP even after removal of the crystalline lens.

Cited by 61 publications

References 27 publications

Incidence and Risk Factors of Ocular Hypertension following Pars Plana Vitrectomy and Silicone Oil Injection

Incidence and Risk Factors of Ocular Hypertension following Pars Plana Vitrectomy and Silicone Oil Injection

Risk of Ocular Hypertension in Adults with Noninfectious Uveitis

Preserve the (intraocular) environment: the importance of maintaining normal oxygen gradients in the eye

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