The role of day one postoperative review of intraocular pressure in modern vitrectomy surgery

With the introduction of sutureless 23-gauge (23G) vitrectomy, the risks for elevated intraocular pressure (IOP) and the need for day 1 review of IOP are less certain.

To assess current practice for postoperative review in the vitreoretinal service at a large tertiary referral centre; to assess whether day 1 review detected complications altering patient management; to identify risk factors for IOP spikes postvitrectomy.

Retrospective, consecutive case note review of all patients undergoing 23G vitrectomy at the study institution between April and June 2013. Patients had assessment at either day 1, week 2 and month 2 or week 2 and month 2. Linear regression analysis was performed to identify risk factors for IOP elevation.

200 (89%) cases met inclusion criteria. Of these, 176 (89.3%) had day 1 review, 24 (12%) were seen at week 2. Mean follow-up was 120 days (range 20–360). Two cases (1%) required urgent surgical intervention due to early IOP complications. Combined laser was the only risk factor for a day 1 IOP spike (p=0.005). In total, 44 patients (22%) were treated for elevated IOP within 2 weeks following vitrectomy. No long-term complications were detected in these patients.

Day 1 review detected adverse events in 0.5% of study patients. No long-term complications were reported in the 22% of patients who received treatment for early postoperative IOP elevation. This observation has led to the removal of routine day 1 review from the surgical care pathway following routine uncomplicated vitrectomy at the study institution.