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INCIDENCE OF, RISK FACTORS FOR, AND COMBINED MECHANISM OF LATE-ONSET OPEN-ANGLE GLAUCOMA AFTER VITRECTOMY

Koreen, Larry MD, PhD, MPH*†; Yoshida, Norihiko MD*; Escariao, Paulo MD*; Niziol, Leslie M MS; Koreen, Irina V MD, PhD; Musch, David C PhD, MPH†‡; Chang, Stanley MD*

doi: 10.1097/IAE.0b013e318217fffb
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Purpose: To estimate the incidence of and identify the risk factors for late-onset open-angle glaucoma (OAG) after uncomplicated pars plana vitrectomy (PPV).

Methods: All patients who underwent PPV at the Edward Harkness Eye Institute between January 1998 and January 2004 had at least 6 months of follow-up and did not have preexisting glaucoma or reason for secondary development of glaucoma were included. Retrospective cohort and matched case–control study designs were used.

Results: Of 285 vitrectomized eyes that met enrollment criteria, 11.6% (n = 33) developed glaucoma after vitrectomy. In the matched case–control analysis, the only variable that had a statistically significant association with the development of OAG was cataract extraction (CE), as compared with phakic status at the last follow-up (odds ratio = 16.4; 95% confidence interval, 2.1–127.4; P = 0.007). There was no difference in OAG development between eyes that had CE before or at the time of PPV and those that had it after PPV. The overall incidence of OAG development after PPV among all eyes, phakic eyes, and nonphakic eyes was 11.6%, 1.4%, and 15.0%, respectively. The difference in incidence between phakic and nonphakic eyes was statistically significant (P = 0.001).

Conclusion: Lens extraction is a strong risk factor for the development of late-onset OAG after uncomplicated PPV. While the overall incidence of OAG development after PPV is substantial, it is more so among eyes that have had CE. The absence of substantial OAG incidence in phakic patients points toward a combined mechanism for late-onset post-PPV OAG involving PPV and CE at any time. Preoperative PPV counseling should include the risk of glaucoma development in addition to cataract development and the connection between the two. Patients who have undergone PPV, and especially those who also had CE in the same eye, should be carefully monitored for glaucoma.

Cataract extraction was a significant risk factor for the development of open-angle glaucoma after uncomplicated pars plana vitrectomy. In this retrospective cohort, the incidence of late-onset glaucoma development among vitrectomized nonphakic eyes was 15%.

From the *Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, New York; †Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan; and ‡Department of Epidemiology, University of Michigan, Ann Arbor, Michigan. L. Koreen is now with the Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina. N. Yoshida is now with the Department of Ophthalmology, Social Insurance Chukyo Hospital, Nagoya, Japan. P. Escariao is now with the Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil and Doctoral Program, Federal University of Pernambuco, Recife, Brazil. I. V. Koreen is now with the Department of Ophthalmology, Wake Forest Eye Center, Wake Forest University, Winston-Salem, North Carolina.

Supported in part by unrestricted departmental research grants from the Research to Prevent Blindness, Inc, New York, NY (S.C. and D.C.M.) and the Alcon Research Institute (S.C.).

Presented, in part, as an original paper in oral presentation at the American Academy of Ophthalmology Annual Meeting, San Francisco, CA, October 25, 2009.

D. C. Musch is a recipient of the Research to Prevent Blindness Lew R. Wasserman Merit Award. The sponsors had no role in the design or conduct of this research.

The authors have no conflict of interest or proprietary interest in any materials discussed in this article.

Reprint requests: Larry Koreen, MD, PhD, MPH, Department of Ophthalmology, Duke Eye Center, Duke University, 2351 Erwin Road, Durham, NC 27705; e-mail: larry.koreen@gmail.com

© The Ophthalmic Communications Society, Inc.