Intraocular pressure changes following vitrectomy with and without phacoemulsification: an American Academy of Ophthalmology IRIS® registry analysis.

Abstract

Objective: To describe observed intraocular pressure (IOP) changes following vitrectomy (PPV) surgery and PPV combined with phacoemulsification in eyes with and without glaucoma.

Methods: A total of 20,894 patients from the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) who underwent vitrectomy surgery for epiretinal membrane or vitreous opacities from January 2016 to March 2023 were included. Mean IOPs from postoperative day 1, days 2-10, days 11-30, and then monthly through 6 months were compared to baseline. The IOP spike was defined as having an IOP >30 mm Hg and an increase >10 mm Hg from baseline.

Results: While IOP spikes were uncommon (<1%), a higher proportion of subjects demonstrated an IOP spike (0.8% vs 0.1%; p < 0.001) in the group with pre-existing glaucoma compared to the group without glaucoma, respectively. At 3 months post-surgery, the probability of an IOP spike was higher in this group (OR = 5.38, 95% CI [3.25 - 9.16]; p < 0.001). Eyes that underwent PPV only showed an increase in postoperative IOP, whereas those that underwent PPV combined with phacoemulsification showed a decrease in postoperative IOP. Longitudinal analysis of IOP showed an initial sharp decline in IOP on day 1, followed by an increase in IOP from week 1 through month 1 and a gradual decrease to postoperative month 3. Overall, eyes that underwent PPV combined with phacoemulsification showed a decrease in postoperative IOP relative to those with PPV alone.

Conclusions: For the entire post-vitrectomy cohort, there was an initial decrease in IOP at postoperative day 1, followed by a transient rise near postoperative month 1, and subsequently a decline to near-baseline level by month 3. Overall, IOP spikes were more frequent and more severe (>40) in the glaucoma/suspect group compared to the group without glaucoma. Ninety-day IOP decreases slightly following vitrectomy surgery in eyes without pre-existing glaucoma, while it increases in eyes with glaucoma, with differences not clinically significant.