Retinal Detachment, Fellow Eye IOP are Risk Factors for Post-PPV Hypertension

IOP elevation in the post-op period may be due to early inflammation, silicone oil or gas use, steroid administration—whether intravitreal or topical—scleral buckling and post-op bleeding, while late OH risk factors could be triamcinolone use, higher pre-op IOP or longer axial length. Photo: Wikimedia Commons. Click image to enlarge. Pars plana vitrectomy (PPV), while vital in addressing various vitreoretinal pathologies, remains a risk factor for open-angle glaucoma. In a new study published in Scientific Reports, Portuguese researchers assessed intraocular pressure (IOP) changes and development of ocular hypertension following PPV.Included in the retrospective investigation were 216 patients (432 eyes) who had primary unilateral PPV with a follow-up of 12 or more months; median follow-up was 28 months. Early ocular hypertension occurred in 28.2% of vitrectomized eyes (vs. 1.4% fellow eyes), while late development only occurred in 15.3% (vs. 2.8% fellow eyes). Early ocular hypertension was coupled with a risk factor of retinal detachment, which increased the odds ratio (OR) of IOP rise fourfold OR: 4.16). Higher preoperative fellow eye IOP measurements predicted early (OR: 1.17) and late (OR: 1.18) hypertension, and postoperatively, vitrectomized eyes had higher IOP at all timepoints. Glaucoma developed more in those that underwent the procedure (6.5%) than in fellow eyes (1.4%).Due to these results, the authors of the study convey in their paper that vitrectomy raises short- and long-term IOP, and is linked with increased early and late ocular hypertension. They report that in clinical studies IOP is often used as a surrogate for open-angle glaucoma, being the only modifiable risk factor to help prevent or slow onset and progression. “Therefore,” they argue, “these findings highlight the importance of understanding the natural history of patients undergoing PPV, as monitoring their IOP trajectories could help mitigate the potential progression to open-angle glaucoma.”The observation that preoperative IOP in the fellow eye appears to be an important predictor in early and late hypertension may have one explanation related to retinal detachment. This set of data included a high proportion of retinal detachment cases (59%), and this condition is known to lower IOP transiently. As a result, the hypotensive effect may artificially mask true baseline IOP in affected eyes, while the fellow eye offers a more accurate picture of baseline IOP physiology and potential for pressure dysregulation. As such, the authors believe that “an elevated IOP in the fellow eye appears to increase the likelihood of ocular hypertension developing in the vitrectomized eye.”What’s more, it was found that patients needing multiple hypotensive medications during the early postoperative period were more likely to maintain this need over the long-term, suggestive of a potential predictive relationship with early post-op IOP dynamics and the persistence of late-onset ocular hypertension.Consequently, the researchers advocate that “these parallels reinforce the hypothesis that early IOP elevation after vitrectomy serves as a critical indicator for the long-term management of ocular hypertension, emphasizing the need for vigilant monitoring in high-risk patients.” Click here for the journal source. Pereira AF, Marques-Couto P, Teixeira-Martins R, et al. Effect of pars plana vitrectomy on early and long-term intraocular pressure and its determinants. Sci Rep. 2025;15(1):28796. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.