Abstract
Purpose
This study aimed to determine the proportion of patients requiring alteration in management based on the findings of the day-1 postoperative visit after pars plana vitrectomy, and to identify clinical characteristics that predict the need for unexpected intervention.
Patients and methods
A retrospective case note review was conducted of all patients who underwent pars plana vitrectomy and who then attended for review on the first postoperative day. All patients received routine prophylactic anti-glaucoma medication.
Results
Two hundred and seventy-three patients examined on day 1 following vitrectomy were studied. Indications for surgery included retinal detachment, epiretinal membrane, macular hole, vitreous haemorrhage, diabetic eye disease, and floaters. Twenty-gauge (20G) vitrectomy was performed in 124 eyes (45%); 23-gauge (23G) vitrectomy was performed in 149 eyes (55%). Phacoemulsification was performed concurrently in 51/273 (19%) eyes. Ten patients (3.7%) required unexpected intervention on day 1 owing to intraocular pressure (IOP) >30 (2/273), IOP <6 (5/273), or unexpected return to theatre for anterior chamber washout (3/273). There was no difference in intervention rate or day-1 IOP between 20G and 23G cases. Hypotony was less common if gas tamponade was used (χ2-test, P<0.001). Patients undergoing combined phacoemulsification and 20G vitrectomy were significantly more likely to require intervention on day 1 than patients undergoing 20G vitrectomy alone (15.0 vs 1.9%, P=0.029, Fisher’s exact test) but this was not the case for patients undergoing 23G vitrectomy (0 vs 4.2%, Fisher’s exact test, P=0.58).
Conclusions
The intervention rate on the first day after vitrectomy is low and day-1 postoperative review can be safely omitted in the majority of patients undergoing vitrectomy.
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This work has been partially presented at the 2013 annual meeting of the British and Eire Association of Vitreoretinal Surgeons (BEAVRS), Bristol, UK, and at the Royal Society of Medicine Annual Student and Trainee Ophthalmology Conference (ASTOC) (Poster Prize).
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Alexander, P., Michaels, L. & Newsom, R. Is day-1 postoperative review necessary after pars plana vitrectomy?. Eye 29, 1489–1494 (2015). https://doi.org/10.1038/eye.2015.134
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DOI: https://doi.org/10.1038/eye.2015.134
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