Hypotony after 25-gauge vitrectomy

Giulio Bamonte, Marco Mura, H. Stevie Tan

Research output: Contribution to journalArticle

Abstract

Purpose To describe the incidence of hypotony after 25-gauge vitrectomy and to identify preoperative and intraoperative factors that influence the occurrence of hypotony. Design Retrospective, nonrandomized, interventional case series. Methods We reviewed 122 consecutive cases of 25-gauge vitrectomy for all surgical indications. The primary outcome measure was intraocular pressure (IOP) at postoperative day 1, measured with Goldmann tonometry. Secondary outcome measures were clinical signs of hypotony and other complications. Results Hypotony, defined as an IOP of 5 mm Hg or less, was found in 13.1% of cases on postoperative day 1. Clinical signs of hypotony were encountered in 7 eyes (5.7%). The risk of hypotony was significantly lower in cases with air or gas tamponade (3.3%) than in cases without tamponade (22.4%). Hypotony was encountered more often in reoperations (29.9%) than in primary operations (9.2%; statistically significant difference). In cases in which intravitreal triamcinolone was used, the risk of hypotony was significantly higher (35.3%) than in cases without triamcinolone (10.3%). Phakic eyes had significantly less chance of hypotony (6.7%) than pseudophakic eyes (15.6%) and eyes undergoing combined phacoemulsification and vitrectomy (25.0%). At postoperative day 7, all cases of hypotony recovered spontaneously. None of our cases developed endophthalmitis. Conclusion Our results show that a transient hypotony occurs commonly after 25-gauge vitrectomy. Hypotony was significantly influenced by tamponade, reoperation, intraoperative lens status, and use of intravitreal triamcinolone. Although all cases of hypotony recovered spontaneously without permanent damage, the high frequency of hypotony does impose potential risks. Increased vigilance with focus on perioperative antisepsis and low tolerance of sclerotomy leakage are important for the prevention of endophthalmitis. Strategies aimed at lowering the risk of hypotony are needed to improve the safety of this promising technique.

Original languageEnglish (US)
Pages (from-to)156-160
Number of pages5
JournalAmerican Journal of Ophthalmology
Volume151
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

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Vitrectomy
Triamcinolone
Endophthalmitis
Intraocular Pressure
Reoperation
Antisepsis
Outcome Assessment (Health Care)
Phacoemulsification
Manometry
Lenses
Gases
Air
Safety
Incidence

ASJC Scopus subject areas

  • Ophthalmology

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Hypotony after 25-gauge vitrectomy. / Bamonte, Giulio; Mura, Marco; Stevie Tan, H.

In: American Journal of Ophthalmology, Vol. 151, No. 1, 01.2011, p. 156-160.

Research output: Contribution to journalArticle

Bamonte, G, Mura, M & Stevie Tan, H 2011, 'Hypotony after 25-gauge vitrectomy', American Journal of Ophthalmology, vol. 151, no. 1, pp. 156-160. https://doi.org/10.1016/j.ajo.2010.06.042
Bamonte, Giulio ; Mura, Marco ; Stevie Tan, H. / Hypotony after 25-gauge vitrectomy. In: American Journal of Ophthalmology. 2011 ; Vol. 151, No. 1. pp. 156-160.
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abstract = "Purpose To describe the incidence of hypotony after 25-gauge vitrectomy and to identify preoperative and intraoperative factors that influence the occurrence of hypotony. Design Retrospective, nonrandomized, interventional case series. Methods We reviewed 122 consecutive cases of 25-gauge vitrectomy for all surgical indications. The primary outcome measure was intraocular pressure (IOP) at postoperative day 1, measured with Goldmann tonometry. Secondary outcome measures were clinical signs of hypotony and other complications. Results Hypotony, defined as an IOP of 5 mm Hg or less, was found in 13.1{\%} of cases on postoperative day 1. Clinical signs of hypotony were encountered in 7 eyes (5.7{\%}). The risk of hypotony was significantly lower in cases with air or gas tamponade (3.3{\%}) than in cases without tamponade (22.4{\%}). Hypotony was encountered more often in reoperations (29.9{\%}) than in primary operations (9.2{\%}; statistically significant difference). In cases in which intravitreal triamcinolone was used, the risk of hypotony was significantly higher (35.3{\%}) than in cases without triamcinolone (10.3{\%}). Phakic eyes had significantly less chance of hypotony (6.7{\%}) than pseudophakic eyes (15.6{\%}) and eyes undergoing combined phacoemulsification and vitrectomy (25.0{\%}). At postoperative day 7, all cases of hypotony recovered spontaneously. None of our cases developed endophthalmitis. Conclusion Our results show that a transient hypotony occurs commonly after 25-gauge vitrectomy. Hypotony was significantly influenced by tamponade, reoperation, intraoperative lens status, and use of intravitreal triamcinolone. Although all cases of hypotony recovered spontaneously without permanent damage, the high frequency of hypotony does impose potential risks. Increased vigilance with focus on perioperative antisepsis and low tolerance of sclerotomy leakage are important for the prevention of endophthalmitis. Strategies aimed at lowering the risk of hypotony are needed to improve the safety of this promising technique.",
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