Characteristic analysis of intraocular hypertension in patients with high myopia after vitrectomy combined with silicone oil tamponade

Abstract

Abstract Aim: To examine the characteristics and outcomes of intraocular hypertension in patients with high myopia following vitrectomy combined with silicone oil tamponade, while also analyzing the correlated risk factors. Methods: In this retrospective study, a total of 98 patients (98 eyes) diagnosed with high myopia rhegmatogenous retinal detachment (RRD) who received their initial pars plana vitrectomy (PPV) procedure combined with silicone oil tamponade at Hebei Eye Hospital between October 2020 and November 2022 were included. In all cases, all the affected eyes received 25G standard three-channel PPV through the flat part of the ciliary body, and the retina of the affected eyes was back in place after surgery. The basic information of the patient, such as gender, eye type, diopter, and extent of net detachment were duly documented after surgery. Following the surgical procedure, a series of standard assessments were conducted, including routine visual acuity examination, anterior segment examination using a slit-lamp indirect ophthalmoscopy, and fundus examination using slit lamp indirect ophthalmoscopy. The measurement of intraocular pressure (IOP) was performed on a daily basis for a duration of one week following the surgical procedure. After that, outpatient follow-up appointments were scheduled on a monthly basis to assess IOP and conduct fundus examination using slit lamp indirect ophthalmoscopy. A minimum follow-up period of 6 months was conducted for all patients subsequent to their surgical procedures. Initially, a univariate analysis was performed to examine relevant factors, followed by a multivariate Logistic regression analysis to assess variables that had statistical significance. Results: Within the cohort of 98 patients diagnosed with high myopia and experiencing retinal detachment, there were 52 male and 46 female with the average age of (42.02±14.733) years. A total of 59 eyes (60.20%) experienced elevated IOP subsequent to PPV. 52 patients, comprising 53.06% of the participants, were seen that the administration of IOP lowering drugs resulted in the normalization of IOP. Conversely, a subset of 7 patients, accounting for 7.14% of the cohort, exhibited an inability to effectively manage IOP levels with therapeutic intervention. Among them, 5 underwent anti-glaucoma surgery (5.12%), and 2 patients (2.04%) declined the recommended surgical procedure, resulting in the persistence of elevated IOP. Patients were shown to have the highest likelihood of developing intraocular hypertension on the first, seventh, and fifth day following PPV, with corresponding probabilities of 11.00%, 11.00%, and 10.00% respectively. The results of the univariate analysis indicated significant differences in gender, IOP of the retinal detachment eye compared to the contralateral eye, and the difference in pre-operative IOP between both eyes being ≥5 mmHg (P < 0.05). No statistically significant differences were seen in terms of age, diopter, range of retinal detachment, period of retinal detachment, eye type, and whether cataract phacoemulsification was combined (P < 0.05). Binary Logistic regression analysis showed that male and preoperative binocular pressure difference ≥5mmHg were independent risk factors for early intraocular hypertension after vitrectomy, and the OR values were 2.724 and 2.52, respectively (P < 0.05). There was significant difference between the occurrence time of intraocular hypertension and the occurrence of persistent intraocular hypertension. The majority of patients who experienced intraocular hypertension within one day following surgery exhibited a temporary condition, but patients who developed intraocular hypertension between six to eight days after surgery were found to have a higher likelihood of developing permanent intraocular hypertension. Conclusions: High myopia patients diagnosed with RRD who underwent PPV together with silicone oil tamponade exhibited a higher propensity for intraocular hypertension. The majority of patients could be effectively managed with the administration of IOP lowering drugs. Males and preoperative binocular pressure difference ≥5mmHg were risk factors for intraocular hypertension. Long-term monitoring of IOP is necessary for postoperative patients in order to prevent visual damage resulting from both short-term post-operative elevation of IOP and persistent intraocular hypertension.