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Day 1 postoperative review may not be necessary after small-gauge pars plana vitrectomy
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VIENNA — Day 1 postoperative assessment may no longer be required in patients who undergo pars plana vitrectomy.
“With the expanded use of local anesthesia and small-gauge surgery, the actual rate of first day intervention is almost negligible and the need for routine day 1 review is questionable,” Philip Alexander, MD, FRCOphth, said at the Advanced Retinal Therapy meeting.
In a study, 273 patients who underwent PPV for various indications were reviewed at day 1. They had undergone either 20-gauge or 23-gauge surgery, different types of tamponade were used, and combined phacovitrectomy was performed in 51 cases.
“Only 10 patients out of 273 (3.7%) required unexpected intervention. IOP increase above 30 mm Hg was found in two cases, decrease below 6 mm Hg in five cases, and [anterior chamber] washout was required in three cases,” Alexander said.
With a complication rate of less than 5%, the day 1 visit may be unnecessary, although it may still have value in patients with glaucoma, he said. And while postoperative IOP increase is common after PPV surgery even in healthy eyes, it can be prevented with prophylactic medications, he said.
In the study, no difference in intervention rate was found between 20-gauge and 23-gauge cases, while the use of gas was related to a lower risk of hypotony.
“In the U.K., one in three centers have already abandoned the routine of day 1 visits. However, resistance to change and possible medicolegal implications may still be hurdles,” he said. – by Michela Cimberle
Reference:
Alexander P. Is day-1 postoperative review necessary after pars plana vitrectomy? Presented at Advanced Retinal Therapy meeting; Dec. 3, 2016; Vienna.
Disclosure: Alexander reports no relevant financial disclosures.