The Risk of Primary Open-Angle Glaucoma Following Vitreoretinal Surgery—A Population-based Study

Mansukhani, Sasha A.; Barkmeier, Andrew J.; Bakri, Sophie J.; Iezzi, Raymond; Pulido, José S.; Khanna, Cheryl L.; Bennett, Jeffrey R.; Hodge, David O.; Sit, Arthur J.

doi:10.1016/j.ajo.2018.12.012

Cited by 7 publications

(12 citation statements)

References 3 publications

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“…The incidence of elevated IOP was similar between SB and SB + PPV in the main analysis; however, out analyses revealed a significantly lower risk of IOP elevation with SB. This is consistent with previous studies reporting a higher rate of IOP elevation in vitrectomized eyes, which is usually transient but may also result in a long-term risk of glaucoma [76,77]. Causes for IOP elevation following retinal surgery are likely related to intraocular tamponade use (i.e., gas vs. silicone) and expansion properties of gas, encircling bands which can impair episcleral circulation or cause ciliary body congestion, synechiae, anterior choroidal swelling, and steroid use [29,43,[78][79][80].…”

Section: Table 3 (Continued)supporting

confidence: 93%

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

et al. 2022

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Purpose: The efficacy and safety of scleral buckling (SB) versus combination SB and pars plana vitrectomy (SB+PPV) for rhegmatogenous retinal detachment (RRD) repair remains unclear. Methods: A systematic review and meta-analysis was conducted to identify comparative studies published from Jan 2000-Jun 2021 that reported on the efficacy and/or safety following SB and SB+PPV for RRD repair. Final best-corrected visual acuity (BCVA) represented the primary endpoint, while reattachment rates and ocular adverse events were secondary endpoints. A random-effects meta-analysis was performed, and 95% confidence intervals were calculated. Results: Across 18 studies, 3912 SB and 3300 SB+PPV eyes were included. Final BCVA was non-significantly different between SB and SB+PPV (20/38 vs. 20/66 Snellen; WMD=–0.11 LogMAR; 95%CI [–0.29,0.07]; P=0.23). Primary reattachment rate was similar between procedures (P=0.74); however, SB alone achieved a significantly higher final reattachment rate (97.40% vs. 93.86%; RR=1.03; 95%CI [1.00,1.06]; P=0.04). Compared to SB+PPV, SB alone had a significantly lower risk of postoperative macular edema (RR=0.69; 95%CI [0.47,1.00]; P=0.05) and cataract formation (RR=0.34; 95%CI [0.12,0.96]; P=0.04). The incidence of macular hole, epiretinal membrane, residual subretinal fluid, proliferative vitreoretinopathy, elevated intraocular pressure, and extraocular muscle dysfunction were similar between SB and SB+PPV. Conclusions: There was no significant difference in final BCVA between SB+PPV and SB alone in RRD. SB alone offers a slightly higher final reattachment rate along with a reduced risk of macular edema and cataract. Primary reattachment rate and the incidence of other complications were similar between the two procedures.

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Section: Table 3 (Continued)supporting

confidence: 93%

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

et al. 2022

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“…Increased IOP is a common complication of vitrectomy during the early postoperative stage [1][2][3][4][5][6]. The risk factors for IOP include postoperative inflammation, the use of gaseous methods of endotamponade, excessive or poorly directed laser photocoagulation, and transient choroidal edema [1,[3][4][5][6][7][8]. Previous clinical studies have shown that up to half of the patients developed IOP within two weeks following vitrectomy for macular hole [2,4].…”

Section: Introductionmentioning

confidence: 99%

Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients

Lyssek-Boroń¹,

Krysik²,

Jankowska-Szmul³

et al. 2019

Med Sci Monit

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Departmental sources Background: Pars plana vitrectomy (PPV) is used to treat retinal conditions, including retinal detachment, and involves removal of the vitreous gel from the eye. Complications following PPV include raised intraocular pressure (IOP). This retrospective study aimed to compare methods of endotamponade used during 23-gauge PPV and the risk of raised IOP during 24-month follow-up at a single center. Material/Methods: The study included 196 patients (age, 15-86 years; mean, 63.5 years) (196 eyeballs). There were 93 patients (47.45%) with a preoperative history of type 2 diabetes mellitus and 14 patients (7.14%) with a history of myopia. IOP was measured with Goldmann applanation tonometry at one-, three-, six-, 12-, and 24-month follow-up. The outcome was compared following endotamponade with silicone oil, sulfur hexafluoride (SF6), and balanced salt solution (BSS). Results: Mean IOP at one-month follow-up was 17.2 mmHg (±3.61 mmHg; range, 9-45 mmHg), and at 24-month follow-up was 17.3 mmHg (±3.23 mmHg; range, 7-30 mmHg). IOP following PPV was significantly associated with the indication for PPV (P=0.023), and the type of endotamponade used (P=0.049). In patients with silicone oil endotamponade, the risk of IOP at 24 months was increased by 2.3 times compared with SF6 or BSS endotamponade. Patients with SF6 endotamponade had a risk of IOP that was 3.3 times lower than for silicone oil tamponade or BSS tamponade. Conclusions: Silicone oil endotamponade in PPV was associated with an increased risk of IOP at 24-month follow-up.

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“…41 A recently published retrospective, population-based cohort study confirmed these findings of increased 10-year risk of POAG in post-vitrectomy eyes at 10.0% (95% confidence interval [CI]: 3.0-17.0%) and following vitrectomy combined with scleral buckle at 17.5% (95% CI: 0-34.9%) compared to the nonoperative group at 1% (95% CI: 1%). 47 Of the patients in the VIT group who underwent glaucoma surgery, 5 of 10 (50%) had a history of controlled glaucoma prior to PPV surgery and subsequent lens extraction. The mean time from PPV to glaucoma surgery was 51.3 6 39.4 months (range ¼ 12-118 months).…”

Section: Vitrectomy and Risk Of Open-angle Glaucomamentioning

confidence: 99%

“…38 Importantly, PPV has also been associated with increased pO 2 exposure to the microenvironment of the TM and outflow pathways 40 and increased risk of developing open-angle glaucoma in several retrospective clinical studies [41][42][43][44][45][46] and a recent population-based study. 47 The present study was undertaken to provide further understanding of the impact of exposure to increased pO 2 and/or its metabolites in the local environment of the aqueous outflow pathways following vitrectomy. We hypothesized that increased pO 2 in these cases may contribute to alterations of oxidant-antioxidant balance leading to increased oxidative stress and damage of the TM.…”

mentioning

confidence: 99%

Intraocular Oxygen and Antioxidant Status: New Insights on the Effect of Vitrectomy and Glaucoma Pathogenesis

Siegfried

Shui

2019

American Journal of Ophthalmology

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The purpose of this study was to investigate correlations of partial pressure of oxygen (pO 2 ) in the ocular anterior segment of human eyes and aqueous humor antioxidant levels of ascorbate (AsA) and total reactive antioxidant potential (TRAP) with glaucoma and vitreous status.METHODS: This prospective, cross-sectional study stratified patients (n [ 288 eyes) by lens and vitreous status and the presence of primary open-angle glaucoma for statistical analyses. Intraocular pO 2 concentrations were measured using a fiberoptic probe in patients at the beginning of planned glaucoma and/or cataract surgery. Aqueous humor specimens were obtained for antioxidant analysis of AsA and TRAP.RESULTS: Following prior pars plana vitrectomy, pO 2 levels were significantly higher than in the reference group of cataract surgery in the anterior chamber angle (16.2 ± 5.0 vs. 13.0 ± 3.9 mm Hg; P [ .0171) and in the posterior chamber (7.6 ± 3.1 vs. 3.9 ± 2.7 mm Hg; P < .0001). AsA and TRAP levels were significantly lower (1.1 ± 0.4 vs. 1.4 ± 0.5 mM, respectively; 403.3 ±116.5 vs. 479.0 ± 146.7 Trolox units, respectively; P [ .004 and P [ .024, respectively) in patients after vitrectomy. In patients with an intact vitreous, neither pO 2 nor antioxidant status correlated with lens status or glaucoma.CONCLUSIONS: Increased pO 2 and antioxidant depletion following vitrectomy suggests an alteration of the intraocular oxidant-antioxidant balance. Our study links physiologic factors such as increased pO 2 in the anterior chamber angle and the posterior chamber to decreased antioxidant levels in aqueous humor following vitrectomy. Oxidative stress/ damage to the trabecular meshwork in such postvitrectomy cases may contribute to intraocular pressure elevation and increased risk of glaucoma. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

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The Risk of Primary Open-Angle Glaucoma Following Vitreoretinal Surgery—A Population-based Study

Cited by 7 publications

References 3 publications

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

Scleral Buckling Alone or in Combination with Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of 7,212 Eyes

Comparison of Methods of Endotamponade Used During 23-Gauge Pars Plana Vitrectomy and the Risk of Raised Intraocular Pressure During 24-Month Follow-Up: A Retrospective Study of 196 Patients

Intraocular Oxygen and Antioxidant Status: New Insights on the Effect of Vitrectomy and Glaucoma Pathogenesis

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