Intraocular pressure instability after 23-gauge vitrectomy

Purpose: The purpose of this study was to describe outcomes, trends, risk factors, and protective factors for intraocular pressure (IOP) spikes in patients undergoing 23-gauge pars plana vitrectomy. Methods: A retrospective review in an academic institution was performed on all eyes undergoing 23-gauge vitrectomy with at least 1-month follow-up. The main outcome measures included IOP and operative complications. Results: Ninety-seven eyes of 93 patients were included. Intraocular pressure spikes >22 in the first month occurred in 73% of eyes with or suspect for glaucoma versus 46% of eyes without (P = 0.017); 76% of eyes with a gas fill versus 44% of eyes with a fluid fill (P = 0.0036); and 21% of eyes started on IOP-lowering drops on postoperative day 1 versus 49% of eyes who were not (P = 0.0033). Complications included retinal tears (3%), intraoperative retinal detachment (2%), and postoperative retinal detachment (2%). Fifteen percent of eyes required suturing of at least one sclerotomy. There were no cases of postoperative hypotony or endophthalmitis. Conclusion: Patients with or suspect for glaucoma or those with a gas fill may be at risk for high postoperative IOP during the first month. Aggressive early treatment of IOP may prevent IOP spikes in the early postoperative period.