Korean J Ophthalmol.  2010 Dec;24(6):341-346. 10.3341/kjo.2010.24.6.341.

Intraocular Pressure Changes after Vitrectomy with and without Combined Phacoemulsification and Intraocular Lens Implantation

• Yang HK
• Woo SJ
• Park KH
• Park KH

• KMID: 1769087
• DOI: http://doi.org/10.3341/kjo.2010.24.6.341

Abstract

PURPOSE
To determine sequential intraocular pressure (IOP) changes after pars plana vitrectomy (PPV) with or without combined phacoemulsification and intraocular lens implantation (PE & IOL).
METHODS
Consecutive patients who underwent PPV with PE & IOL (combined group) or without PE & IOL (vitrectomy group) were reviewed for postoperative sequential IOPs and the number of IOP lowering medications used. Of the 68 patients (68 eyes) who underwent simple PPV, 41 eyes were allocated to the vitrectomy group, and 27 eyes to the combined group.
RESULTS
The mean IOPs were higher on postoperative days one and two, as compared to preoperative values, in both groups. The mean IOP changes on postoperative day one (10.0 mmHg vs. 5.3 mmHg, p = 0.02) and day two (3.7 mmHg vs. 1.3 mmHg, p = 0.02) were significantly higher in the combined group.
CONCLUSIONS
Phacovitrectomy is associated with a higher risk of IOP elevation during the early postoperative period than PPV alone. Caution should be exercised in patients who are vulnerable to IOP fluctuations when combined surgery is indicated.

Keyword

Intraocular lens implantation; Intraocular pressure; Pars plana vitrectomy; Phacoemulsification

MeSH Terms

Aged
Female
Humans
*Intraocular Pressure
*Lens Implantation, Intraocular
Male
Middle Aged
Phacoemulsification/*adverse effects
*Postoperative Complications
Risk Assessment
Vitrectomy/*adverse effects/methods

Figure

• 

  Fig. 1 Sequential changes of postoperative intraocular pressure (IOP) after surgery in the vitrectomy group and combined group. Compared to the preoperative IOP values, postoperative IOP showed significant difference in early and late postoperative periods in the vitrectomy group and combined group. *p<0.05 by paired t-test in the vitrectomy group; †p<0.05 by paired t-test in the combined group.

• 

  Fig. 2 Comparison of the sequential changes of intraocular pressure (IOP) ratio between the vitrectomy group and combined group. The IOP ratios (postoperative IOP/preoperative IOP) were significantly higher in the combined group on postoperative days one and two. *p<0.05 by independent t-test.

Reference

1. Cherfan GM, Michels RG, de Bustros S, et al. Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker. Am J Ophthalmol. 1991. 111:434–438.

2. Thompson JT. The role of patient age and intraocular gas use in cataract progression after vitrectomy for macular holes and epiretinal membranes. Am J Ophthalmol. 2004. 137:250–257.

3. Hurley C, Barry P. Combined endocapsular phacoemulsification, pars plana vitrectomy, and intraocular lens implantation. J Cataract Refract Surg. 1996. 22:462–466.

4. Chung TY, Chung H, Lee JH. Combined surgery and sequential surgery comprising phacoemulsification, pars plana vitrectomy, and intraocular lens implantation: comparison of clinical outcomes. J Cataract Refract Surg. 2002. 28:2001–2005.

5. Desai UR, Alhalel AA, Schiffman RM, et al. Intraocular pressure elevation after simple pars plana vitrectomy. Ophthalmology. 1997. 104:781–786.

6. Anderson NG, Fineman MS, Brown GC. Incidence of intraocular pressure spike and other adverse events after vitreoretinal surgery. Ophthalmology. 2006. 113:42–47.

7. Demetriades AM, Gottsch JD, Thomsen R, et al. Combined phacoemulsification, intraocular lens implantation, and vitrectomy for eyes with coexisting cataract and vitreoretinal pathology. Am J Ophthalmol. 2003. 135:291–296.

8. Treumer F, Bunse A, Rudolf M, Roider J. Pars plana vitrectomy, phacoemulsification and intraocular lens implantation. Comparison of clinical complications in a combined versus two-step surgical approach. Graefes Arch Clin Exp Ophthalmol. 2006. 244:808–815.

9. Kokame GT, Flynn HW Jr, Blankenship GW. Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy. Ophthalmology. 1989. 96:603–610.

10. Scharwey K, Pavlovic S, Jacobi KW. Combined clear corneal phacoemulsification, vitreoretinal surgery, and intraocular lens implantation. J Cataract Refract Surg. 1999. 25:693–698.

11. Lahey JM, Francis RR, Kearney JJ. Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases. Ophthalmology. 2003. 110:1335–1339.

12. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand. 2001. 79:313–316.

13. Han DP, Lewis H, Lambrou FH Jr, et al. Mechanisms of intraocular pressure elevation after pars plana vitrectomy. Ophthalmology. 1989. 96:1357–1362.

14. Stifter E, Sacu S, Benesch T, Weghaupt H. Impairment of visual acuity and reading performance and the relationship with cataract type and density. Invest Ophthalmol Vis Sci. 2005. 46:2071–2075.

15. Lee GH, Ahn JK, Park YG. Intravitreal triamcinolone reduces the morphologic changes of ciliary body after pars plana vitrectomy for retinal vascular diseases. Am J Ophthalmol. 2008. 145:1037–1044.

16. Laurell CG. Inflammatory response after cataract surgery. Acta Ophthalmol Scand. 1998. 76:632–633.

17. Laurell CG, Zetterström C. Inflammation and blood-aqueous barrier disruption. J Cataract Refract Surg. 2000. 26:306–307.

18. Shingleton BJ, Rosenberg RB, Teixeira R, O'Donoghue MW. Evaluation of intraocular pressure in the immediate postoperative period after phacoemulsification. J Cataract Refract Surg. 2007. 33:1953–1957.

19. Thirumalai B, Baranyovits PR. Intraocular pressure changes and the implications on patient review after phacoemulsification. J Cataract Refract Surg. 2003. 29:504–507.

20. Yasutani H, Hayashi K, Hayashi H, Hayashi F. Intraocular pressure rise after phacoemulsification surgery in glaucoma patients. J Cataract Refract Surg. 2004. 30:1219–1224.

21. Włodarczyk M, Wesołek-Czernik A, Synder A, et al. Intraocular pressure in early postoperative period after cataract phacoemulsification. Klin Oczna. 2004. 106:1-2 Suppl. 194–195.

22. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation. J Cataract Refract Surg. 2001. 27:426–431.

23. Aaberg TM, Van Horn DL. Late complications of pars plana vitreous surgery. Ophthalmology. 1978. 85:126–140.

24. Meyer MA, Savitt ML, Kopitas E. The effect of phacoemulsification on aqueous outflow facility. Ophthalmology. 1997. 104:1221–1227.

25. Steuhl KP, Marahrens P, Frohn C, Frohn A. Intraocular pressure and anterior chamber depth before and after extracapsular cataract extraction with posterior chamber lens implantation. Ophthalmic Surg. 1992. 23:233–237.

26. Barak A, Desatnik H, Ma-Naim T, et al. Early postoperative intraocular pressure pattern in glaucomatous and nonglaucomatous patients. J Cataract Refract Surg. 1996. 22:607–611.

27. West J, Burke J, Cunliffe I, Longstaff S. Prevention of acute postoperative pressure rises in glaucoma patients undergoing cataract extraction with posterior chamber lens implant. Br J Ophthalmol. 1992. 76:534–537.