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Researchers find increased risk of OAG after vitrectomy
Govetto and colleagues found a higher prevalence of open-angle glaucoma in vitrectomized vs. nonvitrectomized eyes, and no significant difference among those that were phakic and pseudophakic or aphakic at the time of vitrectomy.
As reported in Retina, researchers designed a cross-sectional prevalence study, contacting patients who underwent a vitrectomy between January 2006 and December 2011 and had not been diagnosed with open-angle glaucoma (OAG) beforehand. Each participant underwent a comprehensive assessment, which included Perkins tonometry, gonioscopy, examination of the optic disc and a spectral-domain optical coherence tomography scan of the optic nerve head.
Results showed that 8.9% of vitrectomized eyes and 2% of nonvitrectomized eyes were diagnosed with OAG.
"Our study supports the hypothesis of an increased risk of OAG after vitrectomy," the authors concluded. "We were unable to demonstrate significant difference in OAG prevalence between phakic/aphakic and pseudophakic eyes. However, our results should be taken cautiously because of the nonrandomized nature of our survey, which may facilitate possible bias. Further larger, prospective, randomized studies are necessary to reduce bias and confirm our conclusions, while further investigation is also needed to understand how and to what extent pars plana vitrectomy may increase the risk of OAG."
Perspective
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This study provides further evidence that vitrectomy likely increases the risk of iatrogenic open-angle glaucoma. Despite the weaknesses of the study outlined by the authors (e.g., small sample size, potential selection bias, criteria for diagnosing glaucoma), their findings suggest that vitrectomy may initiate or exacerbate underlying glaucoma in some patients. Interestingly, the IOP was normal in the patients that went on to develop glaucoma, suggesting IOP-independent mechanisms at play.
Clearly the need for vitrectomy supersedes the inherent risk of glaucoma in most cases. However, this study is a good clinical reminder of the importance of vetting the surgical history in normal-tension glaucoma patients during the diagnostic process and monitoring carefully for glaucomatous changes in vitrectomized eyes.
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