First postoperative day review in eyes undergoing pars plana vitrectomy, encirclement and endotamponade to check intraoc
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ORIGINAL PAPER
First postoperative day review in eyes undergoing pars plana vitrectomy, encirclement and endotamponade to check intraocular pressure: Is it necessary? Craig Wilde . Palvi Bhardwaj . Anthony King . Dharmalingam Kumudhan . Alex Foss . Gavin Orr . Anwar Zaman
Received: 17 October 2019 / Accepted: 22 May 2020 Springer Nature B.V. 2020
Abstract Purpose To assess the proportion of patients with raised intraocular pressure (IOP) (C 30 mmHg) on the first postoperative day following pars plana vitrectomy (PPV), encirclement and endotamponade and assess the number requiring alteration in management to address elevated IOP. To establish whether review on day one is required. Methods Retrospective case note review of consecutive patients who underwent 23-gauge PPV, 276-encirclement and endotamponade under the care of a single surgeon. All patients as standard received prophylactic anti-glaucoma medication post-surgery (eye drops) to take home but initiate only after day-one review. Statistical analysis was carried out using student t tests and Fisher’s exact tests. Results Sixty-six patients were examined over a 2-year period. Mean day-one IOP was 22.2 mmHg (SD 7.3, 95% CI 20.4–24.0). Eleven patients (16.7%) had IOP C 30 mmHg. Five patients (7.6%) had management changing decisions made at the dayone postoperative visit. Lens status, endotamponade, preoperative IOP, surgeon grade, cryopexy versus laser retinopexy or preoperative administration of once only 500 mg dose of intravenous acetazolamide
C. Wilde (&) P. Bhardwaj A. King D. Kumudhan A. Foss G. Orr A. Zaman Ophthalmology Department, B Floor, EENT Centre, Queen’s Medical Centre, Nottingham, UK e-mail: [email protected]
did not influence IOP, with no significant difference between these subgroups. No cases of hypotony occurred. Conclusions A significant minority of patients had elevation of IOP above 30 mmHg, a number of whom required treatment changes to address this. No preoperative risk factors were identified indicating those at risk of high IOP. It is important to identify these potentially harmful IOP elevations, and therefore dayone review is imperative and should be continued. Keywords Vitrectomy Encirclement Intraocular pressure Retinal detachment Postoperative review
Introduction The necessity of day-one postoperative review following pars plana vitrectomy (PPV) has been questioned [1–3], with the primary concern being raised intraocular pressure (IOP). No universal consensus for best practice exists but some available literature concludes that for the majority of uncomplicated patients undergoing PPV, first day review can safely be omitted, with or without use of prophylactic antiglaucoma medication [1, 2]. However, these publications generally exclude patients deemed high risk of raised IOP, including those with ocular hypertension (OHT) or glaucoma, those with surgical complications and patients undergoing combined PPV and
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Int Ophthalmol
encirclement/scleral
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