Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy

Hun Jin Choi; Do Hyung Lee; Jin Hyoung Kim; Joo Youn Shin; Jong Hyun Lee

doi:10.3341/jkos.2016.57.1.80

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Choi, Lee, Kim, Shin, and Lee: Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy

Original Article

J Korean Ophthalmol Soc 2015;57(1):80-85.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2016.57.1.80

Long Term Incidence Rate of Glaucoma after Pars Plana Vitrectomy

Hun Jin Choi, M.D, Do Hyung Lee, M.D, PhD, Jin Hyoung Kim, M.D, PhD, Joo Youn Shin, M.D, Jong Hyun Lee, M.D, PhD

Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

Address reprint requests to Jong Hyun Lee, MD, PhD Department of Ophthalmology, Inje University Ilsan Paik Hospital , #170 Juhwa-ro, Ilsanseo-gu, Goyang 10380, Korea Tel: 82-31-910-7240, Fax: 82-31-911-7241 E-mail: ophtha@naver.com

Received 17 July 20153 September 2015 Accepted 11 November 2015

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 evaluate the incidence rate of postoperative glaucoma after pars plana vitrectomy (PPV) and to compare incidence rate of glaucoma between phakic and pseudophakic eyes.

Methods

Retrospective chart review of patients who underwent PPV between January 2007 and May 2014. The outcome meas-ure was the presence or absence of postoperative glaucoma, defined as definitive loss of neuro-retinal rim defect on fundus ex-am or showing glaucomatous change on a visual field test that warranted maintenance of ocular hypotensive therapy.

Results

There were 333 patients average age 57.09 ± 13.43 included this study. Patients were followed for an average of 56.23 ± 10.85 months. There was no significant difference in mean intra ocular pressure (IOP) between the vitretomized eyes with un-operative eyes, except in mean IOP at one day postoperatively ( p = 0.012). In unoperative eyes, 10 of 315 (3.1%) were newly di-agnosed as postoperative glaucoma. For the vitrectomized eyes, 69 of the 351 (19.6%) were newly diagnosed as postoperative glaucoma. There was a significant difference in incidence rate of glaucoma between the two groups ( p < 0.001, chi-square test). There was a significantly higher IOP in glaucoma eyes compared with normal eyes ( p < 0.001, Repeated Measures Analysis of variance [RM-ANOVA]). A possible risk factor for the development of glaucoma after PPV was cataract surgery ( p = 0.0497, chi-square test).

Conclusions

The incidence of glaucoma in patients with PPV is higher than in normal eyes. The incidence seems to increase particularly in those who have a pesudophakic eye. Patients who underwent PPV, especially in the pseudophakic state, need to have their IOP monitored carefully and managed properly by an ophthalmologist.

Keywords: Glaucoma, Intraocular pressure, Pars plana vitrectomy, Phacoemulsification

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Figure 1.

Mean IOP of the vitrectomized eyes compared with the unoperative fellow eyes at baseline and postoperatively. IOP = intra ocular pressure. ^* There is no significant differ-ence in mean IOP between the two groups, except in mean IOP at postoperative 1 day ( p = 0.012).

Figure 2.

Distribution of newly diagnosed glaucoma after PPV. PPV = pars plana vitrectomy; NVG = neovascular glau-coma; POAG = primary open-angle glaucoma.

Figure 3.

Postoperative mean IOP changes in normal and glau-coma group (RM-ANOVA by Greenhouse-Geisser method: between p < 0.001, within p = 0.167). Statistically significant higher IOP in glaucoma group than in normal group. IOP = in-tra ocular pressure; RM-ANOVA = repeated measures analysis of variance; op = operative.

Table 1.

Baseline characteristics

	Vitrectomy eye (n = 351, 52.7%)	Unoperative eye (n = 315, 47.3%)	) p-value^*
Age at the time of surgery (years)	57.06 ± 13.43	54.24 ± 13.76	0.649
Gender (male/female)^†	174/177	158/157	0.883
Preoperative BCVA (decimal)	0.21 ± 0.26	0.71 ± 0.33	<0.001^‡
Preoperative IOP (mm Hg)	15.03 ± 4.13	15.31 ± 3.25	0.285

Values are presented as mean ± SD unless otherwise indicated. BCVA is statistically significant higher in unoperative eye group.

BCVA = best corrected visual acuity; IOP = intra ocular pressure.

^* p-value less than 0.05 is considered statistically significant

^† Chi square test, the other parameters, independent t-test

^‡ Statistically significant difference was shown by independent t-test.

Table 2.

Comparison of incidence rate of glaucoma after vi-trectomy among vitreoretinal disorder

Type of disorder	Incidence rate (incidence/total, %)
RRD	27/140 (19%)
PDR	27/99 (27%)
ERM RVO	7/75 (9%) 3/12 (25%)
MH	2/10 (20%)
PVR	1/7 (14%)

RRD = regmatogenous retinal detachment; PDR = proliferative diabetic retinopathy; ERM = epiretinal membrane; RVO = retinal vein occlusion; MH = macular hole; PVR = proliferative vitreous retinopathy.

Table 3.

Risk factors for the development of glaucoma after PPV

Patient	Normal (n = 282)	Glaucoma (n = 69)	p-value^*	Odd ratio	95% CI
Age at the time of surgery (years)	57.64 ± 12.90	54.84 ± 15.36	0.1202
Gender (male/female, n)^†	133/149	41/28	0.0908	1.6404	0.9613-2.7992
Preoperative BCVA (decimal)	0.22 ± 0.27	0.17 ± 0.25	0.0957
Preoperative IOP (mm Hg)	14.72 ± 4.01	15.30 ± 4.59	0.2963
ILM peeling (Y/N)	73/209	7/62	0.0523	0.323	0.2083-1.2680
Presence of crystalline lens^†			0.0497^*	4.2880^‡	1.0020-18.3500
Pseudophakia	254	67
Phakia	28	2
Gauge of trocar (20 G/23 G)^†	76/206	22/47	0.5034	1.2688	0.7171-2.2448

Values are presented as mean ± SD unless otherwise indicated.

PPV = pars plana vitrectomy; CI = confidence Interval; BCVA = best corrected visual acuity; IOP = intra ocular pressure; ILM = internal limiting membrane; Y = yes; N = no.

^* Statistically significant difference is shown by independent t-test;

^† Chi square test, other parameters, independent t-test

^‡ Pseudophakia was identified as a risk factor for the development of postoperative glaucoma with and odds ratio of 4.2880 ( p = 0.0497).

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