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Lee, Lee, Seong, Byeon, Kim, Koh, Lee, and Kim: Effect of a Preservativefree Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy
Original Article

J Korean Ophthalmol Soc 2016;57(9):1386-1391.

Published online: 25 September 2016

DOI: https://doi.org/10.3341/jkos.2016.57.9.1386

Effect of a Preservativefree Dorzolamide/Timolol Fixed Combination on Elevated Intraocular Pressure after Vitrectomy

Sung Hoon Lee, MD, Wonseok Lee, MD, Gong Je Seong, MD, Suk Ho Byeon, MD, Sung Soo Kim, MD, Hyoung Jun Koh, MD2, Sung Chul Lee, MD2, Min Kim, MD1

1Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

2The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Min Kim, MD Department of Ophthalmology, Gangnam Severance Hospital, #211 Eonju-ro, Gangnam-gu, Seoul 06273, Korea Tel: 82-2-2019-3445, Fax: 82-2-3463-1049 E-mail: Minkim76@gmail.com

Received 10 March 2016       Revised 13 May 2016       Accepted 29 August 2016

Copyright © 2016 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To verify the effect of preservative-free Dorzolamide/Timolol fixed combination (PFDTC) on intraocular pressure (IOP) elevation after vitrectomy.

Methods

We retrospectively reviewed medical records of 33 patients who used PFDTC after pars plana vitrectomy. All patients' visual acuity and IOP was measured and symptoms of conjunctival irritation were investigated through survey and slit lamp examination.

Results

Before vitrectomy, the mean IOP was 13.6 ± 4.4 mm Hg which was elevated to 31.7 ± 5.4 mm Hg after vitrectomy (p < 0.001) and applying eyedrop lowered the mean IOP to 17.2 ± 7.0 mm Hg (p < 0.001). Regardless of tamponade material type, all elevated IOP decreased (p < 0.001) and the IOP of all 33 eyes did not rise to over 30 mm Hg again. No additional surgery for IOP control was needed during two-month follow-up period. Of the 33 patients using PFDTC, patients who felt discomfort were five (15.2%) and no patients showed side effects severe enough to stop use of eyedrop.

Conclusions

PFDTC is an anti-glaucomatic agent which can reduce the IOP by inhibiting aqueous humor production. Without need for additional surgery, the eyedrop can effectively lower elevated post-vitrectomy IOP, with expectation of good patient compliance due to low risk of conjunctival irritation.

Keywords: Cosopt-S®, Eyedrops, Intraocular pressure, Preservativefree, Vitrectomy

References

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Table 1.
Patient characteristics, surgery type and indication for surgery in the pars plana vitrectomy
  Data
Age (years) 55.4 ± 13.7 (26–78)
Sex (male/female) 26:7
Surgery type (n, %)  
 Vitrectomy without intraocular tamponade 16 (45.7)
 Vitrectomy with silicone oil tamponade 11 (31.4)
 Vitrectomy with gas tamponade 6 (17.1)
Indication for surgery (n, %)  
 Retinal detachment 18 (54.5)
 Epiretinal membrane 5 (15.2)
 IOL problem (IOL dislocation etc.) 5 (15.2)
 Diabetic retinopathy 4 (12.1)
 Vitreous hemorrhage 1 (3.0)

Values are presented as mean ± SD unless otherwise indicated.

n = number of eyes; IOL = intraocular lens.

Table 2.
Intraocular pressure change over time expressed as mean, standard deviation, range and pressure difference from preoperative pressure in patients undergoing pars plana vitrectomy
  Mean IOP ± SD (mm Hg) IOP range (mm Hg) Mean IOP difference from pre op. (p-value)* Mean IOP difference from immediate post op. (p-value)†
Pre op. 13.6 ± 4.4 7–29 – –
Immediate post op. 31.7 ± 5.4 18–45 17.9 ± 6.9 (p < 0.001) –
1 week after vitrectomy 17.2 ± 7.0 5–33 3.6 ± 7.2 (0.007) 14.5 ± 8.0 (p < 0.001)
1 month after vitrectomy 14.3 ± 4.8 8–28 0.6 ± 5.5 (0.511) 17.4 ± 6.7 (p < 0.001)
2 months after vitrectomy 13.4 ± 3.5 7–24 −0.3 ± 4.4 (0.725) 18.3 ± 6.2 (p < 0.001)

Values are presented as mean ± SD unless otherwise indicated.

IOP = intraocular pressure; SD = standard deviation; Pre op. = pre-operative status; Post op. = post-operative status.

* Significant difference (p < 0.05) in paired t-test between pre-operative IOP and post-operative IOPs

† Significant difference (p < 0.05) in paired t-test between immediate post-operative IOPs and post-operative IOPs.

Table 3.
Intraocular pressure change and duration of eye drop using in patients undergoing pars plana vitrectomy depending on tamponade material used
  Pre op. IOP Immediate post op. IOP Post op. IOP at 1 week Post op. IOP at 1 month Post op. IOP at 2 month Mean IOP ± SD change after using eyedrop (mm Hg)† p-value‡ Duration of eyedrop using (days)
SIO tamponade 13.0 ± 6.4 31.2 ± 5.6 17.7 ± 7.8 15.2 ± 5.9 14.0 ± 4.4 17.2 ± 7.3 p < 0.001 6.2 ± 3.4
Gas tamponade 11.3 ± 2.0 33.8 ± 6.9 16.8 ± 9.1 11.8 ± 4.1 12.7 ± 2.3 21.2 ± 5.8 p < 0.001 7.2 ± 1.7
TPPV without tamponade 14.9 ± 3.0 31.3 ± 4.0 17.1 ±5.9 14.6 ± 4.3 13.2 ± 3.1 18.1 ± 5.5 p < 0.001 6.8 ± 2.6
p-value among three groups* p = 0.056 p = 0.858 p = 0. 843 p = 0.335 p = 0.852 p = 0.314 – p = 0.245

Values are presented as mean ± SD unless otherwise indicated.

Pre op. = pre-operative status; IOP = intraocular pressure; Post op. = post-operative status; SD = standard deviation; SIO =silicone oil

TPPV = trans pars plana vitrectomy.

* Significant difference (p < 0.05) in Kruskal Wallis H test among SIO tamponade, Gas tamponade and TPPV without tamponade eyes

† Mean IOP ± SD change after using eyedrop was calculated between immediate post op. IOP and 2 month post op. IOP

‡ p-value was calculated by paired t-test between immediate post op. IOP and 2 month post op. IOP.

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