Increased incidence of glaucoma and intraocular pressure fluctuation after vitrectomy for macular hole and macular pucker

Abstract: PURPOSE: To investigate the incidence of glaucoma and changes in intraocular pressure fluctuation (IOPF) after vitrectomy for macular pucker (MP) and macular hole (MH). MATERIALS AND METHODS: In this multicenter retrospective cohort study, 778 patients who underwent only one vitrectomy for MP or MH were enrolled from the Chang Gung Research Database. Glaucoma development was defined as the continuous prescription of anti-glaucoma medication for more than 3 months, and the diagnosis was made later than 60 days postoperatively (index date). Postoperative IOPF was defined as the standard deviation (SD) of IOP measurements after the index date, whereas postoperative pretreatment IOPF was defined as the SD of IOP measured from the index date until the initiation of glaucoma treatment. The incidence of postoperative glaucoma and IOPF in vitrectomized eyes was compared with those in the nonvitrectomized fellow eyes. RESULTS: Forty vitrectomized and 17 fellow eyes developed glaucoma after the index date during the follow-up period (60 months). The vitrectomized eyes showed a higher glaucoma incidence (9.06, 95% confidence interval [CI]: 6.25–11.86) than fellow eyes (3.75, 95% CI: 1.97–5.53), along with higher postoperative IOPF (1.93 vs. 1.74 mmHg, P = 0.004) and higher postoperative pretreatment IOPF (1.88 vs. 1.72 mmHg, P = 0.001). Among vitrectomized eyes, those with glaucoma development had higher postoperative IOPF (2.79 vs. 1.85 mmHg, P < 0.0001) and postoperative pretreatment IOPF (2.32 vs. 1.85 mmHg, P = 0.04) than those without. CONCLUSION: Higher postoperative IOPF and higher glaucoma incidence were observed in eyes that underwent vitrectomy for MP or MH.