Long-term changes in intraocular pressure after vitrectomy for rhegmatogenous retinal detachment, epi-retinal membrane, or macular hole

Abstract

Purpose: To 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. Methods: This 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. Results: The 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). Conclusions: A 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.