Analysis of risk factors for early elevated intraocular pressure after vitrectomy in patients with diabetes

This study aimed to investigate the incidence and independent risk factors of early elevated intraocular pressure (IOP) after vitrectomy in patients with diabetes and establish a clinical risk prediction model. A retrospective case study was conducted, including 130 patients (130 eyes) who underwent vitrectomy for diabetic retinopathy from June 2022 to June 2024. Patients were divided into 2 groups based on whether early postoperative elevated IOP occurred within 1 week after surgery (defined as IOP ≥25 mm Hg or an increase ≥10 mm Hg compared with preoperative values). Demographic data, systemic conditions, preoperative ocular characteristics, and intraoperative parameters were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A risk scoring system was constructed accordingly, and its predictive performance was evaluated using the receiver operating characteristic curve. The incidence of early postoperative elevated IOP was 30.0% (39/130). Multivariate logistic regression analysis showed that higher preoperative glycated hemoglobin (odds ratio [OR] = 1.57, 95% confidence interval [CI]: 1.17-2.11), combined cataract surgery (OR = 3.47, 95% CI: 1.19-10.15), use of intraocular tamponade (expansile gas: OR = 4.96; silicone oil: OR = 10.15), and longer operative time (OR = 1.23) were independent risk factors for early postoperative elevated IOP (all P < .05). The clinical risk scoring system (total score 0-9) based on these factors had an area under the receiver operating characteristic curve of 0.86 (95% CI: 0.79-0.93). With a cutoff value of ≥4 points, the sensitivity was 82.10% and the specificity was 78.00%. According to the score, patients were classified into low-, medium-, and high-risk groups, with actual incidences of elevated IOP of 8.1%, 28.3%, and 63.2%, respectively. The incidence of early postoperative elevated IOP after vitrectomy is high in patients with diabetes. High preoperative glycated hemoglobin, combined cataract surgery, use of silicone oil or gas tamponade, and prolonged operative time are independent risk factors. The clinical risk scoring system established in this study demonstrates good predictive ability and may facilitate early identification of high-risk patients for targeted intervention.