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Increased intraocular pressure after macular hole surgery
J T Thompson1, R N Sjaarda, B M Glaser
1Retina Institute of Maryland, Baltimore, USA.
American Journal of Ophthalmology
|June 1, 1996
Summary
Increased intraocular pressure after macular hole surgery is common, especially with recombinant transforming growth factor-beta 2 (TGF-beta 2). Careful monitoring is crucial due to potential risks associated with growth factor treatments.
Area of Science:
- Ophthalmology
- Regenerative Medicine
- Surgical Innovation
Background:
- Idiopathic macular holes are a significant cause of vision loss.
- Vitrectomy is a standard surgical treatment for macular holes.
- Transforming growth factor-beta 2 (TGF-beta 2) has been investigated as an adjunctive therapy.
Purpose of the Study:
- To assess the incidence and timing of elevated intraocular pressure (IOP) after macular hole surgery.
- To compare IOP changes with different intraocular gas concentrations and TGF-beta 2 formulations (bovine vs. recombinant).
- To evaluate the safety of TGF-beta 2 in conjunction with vitrectomy for macular hole repair.
Main Methods:
- Two prospective studies involving vitrectomy for idiopathic macular holes were conducted.
- Intraocular pressure was monitored preoperatively and at multiple postoperative time points (2 days, 2 weeks, 6 weeks, 3 months).
- Groups received either bovine TGF-beta 2 with varying gas concentrations (air, 5%, 10%, 16% C3F8) or recombinant TGF-beta 2 with 16% C3F8, alongside a placebo control group.
Main Results:
- Elevated IOP (>30 mm Hg) at two weeks was observed in 26.7% of eyes treated with air and 19.1% with 16% C3F8 and bovine TGF-beta 2.
- No significant difference in IOP risk was found with different gas durations using bovine TGF-beta 2.
- Recombinant TGF-beta 2 showed a significantly higher incidence of elevated IOP (39.3%) compared to placebo (4.3%) at two weeks (P = .006).
Conclusions:
- Increased intraocular pressure post-vitrectomy for macular holes typically occurs between two days and two weeks.
- Bovine TGF-beta 2 showed a slight increase in IOP risk, while recombinant TGF-beta 2 markedly elevated IOP.
- Potential impurities in recombinant TGF-beta 2 may contribute to the observed increase in intraocular pressure, highlighting risks of growth factor therapies.