Stanley Chang, M.D.
Edward S. Harkness Eye Institute
Columbia University
New York, New York

PURPOSE:  To present data and a hypothesis for the late development of open angle glaucoma (OAG) following vitrectomy.
DESIGN:  A retrospective observational case series.
METHODS:  The records of 453 eyes undergoing vitrectomy were reviewed for postoperative OAG.  Eyes with confounding factors were excluded.  Sixty-eight eyes of 65 patients that underwent routine vitrectomy were followed for a mean of 56.9 months (range, 7-192 months).  For the main outcome measures, patients were classified into three groups: glaucoma suspects, those developing glaucoma postoperatively, and those with preexisting glaucoma. 
RESULTS:  In glaucoma suspects, the mean intraocular pressure (IOP) was significantly higher in the operated eye compared to the fellow eye (P=0.0001).  In eyes with new onset glaucoma, 23 of 34 (67.6%) eyes developed it in the vitrectomized eye only.  In phakic eyes, the time interval between vitrectomy and the development of glaucoma (mean 45.95 months) was significantly longer than eyes that were nonphakic at the time of vitrectomy (mean, 18.39 months) (P=0.0115).  When the interval between cataract surgery in phakic eyes to the development of glaucoma was compared to the interval from vitrectomy to glaucoma diagnosis in the nonphakic group, the difference was not statistically significant.  In eyes with glaucoma preoperatively, the mean number of antiglaucoma medications required to control the IOP was significantly higher in the vitrectomized eye compared to the fellow eye (2.9 + 1.2 vs 2.0 + 1.4, P=0.0215, n=14).
CONCLUSIONS:  There is an increased risk of OAG following vitrectomy.  The presence of the lens may be protective.  In established OAG preoperatively, the number of antiglaucoma medications may increase after surgery. Oxidative stress is hypothesized to have a role in the pathogenesis.

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