Ocular Hypertension Following Open Globe Injury in Patients Undergoing Pars Plana Vitrectomy

To identify risk factors and rates of post-traumatic ocular hypertension (OHT) in patients undergoing pars plana vitrectomy (PPV) for open-globe injuries.

Retrospective chart study including 98 eyes from 98 patients between 2008 and 2022 with open globe injuries who were hospitalized at a single academic institution and received first repair or exploration followed by PPV. Variables recorded included timing to the first PPV, best-corrected final visual acuity (VA) at the last follow-up, incidence of enucleation, type of injury, use of intravitreal antibiotics, number of eye surgeries, use of oral steroids, acetazolamide use, topical steroid use, lens status, silicone oil placement, and zone of injury (1-3). The ocular trauma score (OTS) was calculated using the variables globe rupture, development of endophthalmitis, initial VA, globe perforation, retinal detachment, and the presence of a relative afferent pupillary defect (RAPD). The primary endpoint was elevated intraocular pressure (IOP) sustained for more than six weeks following PPV. We performed a logistic regression to determine the factors that predicted the development of OHT post-PPV.

Of 98 eyes included in the primary analysis, a total of 34 (34.69%) were diagnosed with sustained ocular hypertension (OHT) and 64 (65.31%) remained normotensive. The mean final IOP in the OHT group was 16.96 mmHg and 12.11 mmHg in the normotensive group (P < 0.01). Sex, age, OTS, injury type, zone of injury, preoperative IOP, and final VA were comparable between the OHT and normotensive groups. When adjusting for OTS, the use of silicone oil significantly predicted the development of ocular hypertension (odds ratio [95% CI], 5.63 [1.57-20.11]).

The incidence of ocular hypertension in our cohort was slightly higher than previously reported at 34.69%. PPV has been independently associated with elevated IOP post-operatively, but the need for PPV surgery can indicate more severe trauma leading to higher rates of increased IOP. Patients who had silicone oil utilized in their PPV had an approximately 5.63-fold increased odds of developing OHT, suggesting that silicone oil use may be a potent predictor of post-PPV OHT.