The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Articles in Press Original Study - Clinical

Postoperative Adverse Events, Interventions, and the Utility of Routine Follow-Up After 23-, 25-, and 27-Gauge Pars Plana Vitrectomy

Shields, Ryan A.; Ludwig, Cassie A.; Powers, Matthew A.; Tran, Elaine M.T.; Smith, Stephen J.; Moshfeghi, Darius M.



Author Information


From the Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, CA, United States.


Reprints: Darius M. Moshfeghi, Horngren Family Vitreoretinal Center Byers Eye Institute, Department of Ophthalmology, Stanford University School of Medicine, 2452 Watson Ct, Palo Alto, CA, 94304, United States.
E-mail: dariusm@stanford.edu.



Abstract


Purpose: To evaluate the utility of standard postoperative visit (POV) intervals in pars plana vitrectomy (PPV) as a function of adverse events (AEs) identified.


Design: Retrospective case review.


Methods: The medical records of all patients undergoing 23-, 25-, and 27-gauge PPV from January 1, 2016 to December 31, 2016 were reviewed. Each POV was assessed as a standard (s-POV), physicianadjusted (a-POV), or patient-initiated visit (p-POV). Preoperative features, diagnoses, and surgical procedures were evaluated to determine protective and risk factors for AEs.


Results: A total of 256 patients (310 PPVs) were included in this study. The most common cumulative postoperative AEs were elevated intraocular pressure (>30 mm Hg) (12.3%), cystoid macular edema (6.1%), and retinal detachment (5.8%). Patients with the diagnosis of macular hole or epiretinal membrane had the lowest relative risk of AEs [0.30; 95% confidence interval (CI), 0.12−0.75 and 0.36; 95% CI, 0.21−0.63, respectively]. There was no difference in time to AE among different vitrectomy gauge sizes (P = 0.733). Patients in a-POV and p-POV groups had a statistically significant higher incidence of AEs in the POV day 5–10 window (P = 0.004).


Conclusions: The utility of standard POVs in detecting AEs is dependent on the indication for PPV. Specifically patients undergoing isolated macular surgery (epiretinal membrane peel or macular hole repair) had the lowest relative risk of postoperative AEs and may warrant a less-intensive follow-up regimen.




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