Sir,
We read with interest the article published by Alexander et al1 assessing the necessity of day-1 postoperative review of patients undergoing pars plana vitrectomy (PPV). We have certain observations to make. All patients in this study have been given prophylactic antiglaucoma medications (AGMs). These do reduce the intraocular pressure (IOP) spike postoperatively2 but, conversely, they can mask the true cause of postoperative hypotony. The cause of hypotony in the cases where AGMs were stopped has not been described. Depending on that, management can vary from intensive topical steroids to re-surgery, which is a change in routine treatment.3 Thus, the empirical use of AGMs and their subsequent cessation without investigating the true cause for hypotony is questionable.
Second, the rate of intervention is unassociated with the indication of surgery in this study. It is obvious that a complex and challenging case would be expected to develop a higher rate of intraoperative and postoperative complications. A larger study sample and subgroup analysis of the indications of surgery should give more meaningful results.
Finally, the entire article seems to center on postoperative IOP management. There are complications like corneal epithelial defects, fibrin membrane, postoperative vitreous hemorrhage, silicone oil in the anterior chamber, postoperative emesis, and most importantly, infection,4 to name a few, which require either deviation from the routine management or additional and extensive postoperative counseling. Also, what are the medico-legal implications of omitting day 1 review in case a sight threatening complication develops? Though the authors have addressed these issues in the discussion, the emphasis in the study per se seems light handed and therefore the article title, conclusion, and summary are rather controversial. It makes the reader believe that postoperative day 1 review could be omitted in most cases of vitrectomy; however, it does not take into account a lot of variables as pointed out earlier. Perhaps as far as IOP control is concerned the postoperative day 1 visit could be spared in selected cases but, it would be interesting to see a study with a larger sample size and varied surgical cases to arrive at a conclusive guideline.
The authors declare no conflict of interest.
References
- Alexander P, Michaels L, Newsom R. Is day-1 postoperative review necessary after pars plana vitrectomy? Eye 2015; 29: 1489–1494. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Benz MS, Escalona-Benz EM, Murray TG, Eifrig CW, Yoder DM, Moore JK et al. Immediate postoperative use of a topical agent to prevent intraocular pressure elevation after pars plana vitrectomy with gas tamponade. Arch Ophthalmol 2004; 122(5): 705–709. [DOI] [PubMed] [Google Scholar]
- Schubert HD. Postsurgical hypotony: relationship to fistulization, inflammation, chorioretinal lesions, and the vitreous. Surv Ophthalmol 1996; 41(2): 97–125. [DOI] [PubMed] [Google Scholar]
- Peyman GA, Meffert SA, Conway MD (eds). Vitreoretinal Surgical Techniques, 2nd edn. Informa Healthcare: London, UK, 2008. [Google Scholar]