A novel drop regimen reduces ocular hypertension risk after pars plana vitrectomy

It is already known that postoperative steroid/antibiotic drop regimens effectively suppress inflammation and infection following Pars Plana Vitrectomy. However, steroid induces OHT frequently. This requires additional treatment and more frequent hospital visits in the postoperative period.

To address the concern mentioned above, a cohort-control study was conducted led by Orlans et al. to assess the safety and efficacy of a novel post-PPV drop regimen.

The study points are:

· The relevant electronic case notes were reviewed between December 2020-April 2021 of those patients who underwent PPV.

· The study was conducted at Vitreoretinal Service, St. Thomas' Hospital, London, UK

· The intervention cohort had 58 (28 %) patients given postoperative drops of one-week dexamethasone 0.1%/antibiotic QDS and one-month g. ketorolac TDS.

· Standard care controls included 151 (72 %) patients who received one-month g. dexamethasone 0.1%/antibiotic QDS.

· Total of 209 eyes from 192 patients were included.

· IOP≥30 mmHg two weeks postoperatively was the primary outcome measured by the researchers.

· Secondary outcomes were rates of anterior uveitis, cystoid macular oedema, endophthalmitis, and the number of eye hospital visits.

· Similarities were reported between baseline and <72hr postoperative IOPs between groups.

· IOP ≥ 30 mmHg at the two-week postoperative visit (primary outcome measure) occurred in none of the intervention groups but in 21 (14%) of the controls.

· The difference in IOP change distribution between the two groups was highly significant.

· There was no significant difference reported in secondary outcomes between the groups.

· There were no cases of endophthalmitis in either cohort.

· The intervention cohort had fewer all-cause eye hospital visits in the three months immediately following PPV.

The novel regimen used in the study reduced rate of subsequent OHT, a lesser need for additional topical antihypertensive treatment, and fewer patient visits to the eye hospital in the postoperative period.

Further reading:

Orlans HO, Yazdouni S, Williamson TH, Wong RS, Laidlaw DAH. A novel postoperative drop regimen reduces the risk of ocular hypertension following pars plana vitrectomy. Ophthalmologica. 2022 Dec 23. DOI: 10.1159/000528037