Glaucoma after Surgery of an Idiopathic Macular Hole

Overview

The objective of the prospective randomized study is to evaluate the effect ofsurgery of an idiopathic macular hole (IMH) on intraocular pressure (IOP).The study comprised 60 primary pars plana vitrectomies (PPV) on account of IMHusing 16% perfluoropropane (C3F8). Stage III according to Gass predominated in65% and stage IV in 28.3%. Furthermore the authors enlisted in the study 15secondary PPV on account of a patent IMH. A total of 75 primary and secondaryPPV were performed. In 43 PPV an autologous thrombocyte concentrate (ATC)was used.With regard to the IOP after PPV the patients were subdivided into the followinggroups.Group A: IOP under 24 mm Hg was recorded throughout the investigation periodin 24 of 75 PPV (32%). The total mean value of IOP in group A was 17.4 mm Hg.Group B: Early increase of IOP during the first week after surgery was recordedin 51 of 75 PPV (68.0%) This group was divided into two sub-groups according tothe maximum postoperative deviation of IOP during that period.Sub-group B1 comprised a total of 34 PPV (45.3%) where the maximum postope-rative deviation of IOP was between 25-35 mm Hg. The total mean value of IOP insub-group B1 was 23.5 mm Hg.In sub-group B2 there was a total of 17 PPV (22.7%) and the maximum postopera-tive deviation of IOP was above 35 mm Hg. The total mean value of IOP in sub-groupB2 was 28.6 mm Hg.Moreover the authors investigated the effect of ATC administration on the IOPafter primary and secondary PPV. They did not reveal a significant relationshipbetween administration of ATC and postoperative glaucoma.Conclusion:1. Glaucoma after PPV in IMH can in indvidual cases cause deterioration of thefunctional results of the operation.PPV in IMH has an increased risk: a) in a monoculus, b) in advanced primaryglaucoma with an open angle, c) in primary glaucoma with a narrow angle.

Key words:
idiopathic macular hole, pars plana vitrectomy, glaucoma