Retina surgery can be essential for treating serious eye conditions such as retinal detachments, macular holes, scar tissue on the retina, and bleeding inside the eye. One of the most common retina procedures is called a pars plana vitrectomy, or PPV.
During a vitrectomy, a retina specialist removes the clear gel inside the eye, called the vitreous. This gives the surgeon access to the retina so that problems in the back of the eye can be repaired.
Although vitrectomy can save or improve vision, research suggests that it may also increase the long-term risk of developing high eye pressure and glaucoma.
What Happens After a Vitrectomy?
After vitrectomy, patients are usually monitored closely by their retina specialist during the recovery period.
One common long-term effect is cataract progression. In patients who still have their natural lens, cataracts often develop or worsen after vitrectomy, particularly in older adults.
Another less obvious concern is glaucoma.
Does Vitrectomy Increase Glaucoma Risk?
Several studies suggest that patients who have undergone vitrectomy have a higher risk of developing glaucoma compared with eyes that have not undergone the surgery.
A 2018 systematic review found that open-angle glaucoma developed in about 7.8% of vitrectomized eyes compared with 4.8% of untreated fellow eyes. This represented roughly a 67% increase in the odds of developing glaucoma.
Another large population-based study found that the 10-year risk of developing glaucoma was about 9% in surgically treated eyes compared with about 1% in fellow eyes. Among patients who underwent vitrectomy alone, the estimated 10-year risk of glaucoma was approximately 10%.
Other studies have also found that persistent high eye pressure is more common after vitrectomy. One study reported sustained elevated eye pressure in approximately 19% of vitrectomized eyes compared with about 5% of fellow eyes.
Not every study has shown the same degree of risk, and most patients who undergo vitrectomy will not develop glaucoma. However, the overall research suggests that previous retinal surgery should be considered a potential glaucoma risk factor.
Why Can Eye Pressure Increase After Retina Surgery?
Eye pressure can increase for several reasons after retina surgery.
In the weeks following surgery, pressure may rise because of inflammation, steroid eye drops, or the gas or silicone oil sometimes placed inside the eye.
Researchers also believe that removing the vitreous may change how oxygen circulates inside the eye. Over many years, this may contribute to damage of the eye's natural drainage system and increase the risk of open-angle glaucoma.
Why Monitoring Matters
Glaucoma usually develops slowly and often causes no symptoms in its early stages.
Patients generally cannot feel when their eye pressure is elevated, and central vision can remain normal even while glaucoma is damaging the optic nerve.
For this reason, patients who have undergone retina surgery should continue having routine eye examinations even after the retinal problem has stabilized.
Monitoring may include:
- Eye-pressure measurements
- Examination of the optic nerve
- OCT scans of the optic nerve
- Visual-field testing when appropriate
Patients who already have high eye pressure, a family history of glaucoma, suspicious optic nerves, or other glaucoma risk factors may need to be monitored more closely.
The Bottom Line
Vitrectomy is an important and often vision-saving operation. The possibility of glaucoma should not discourage someone from undergoing retina surgery when it is medically necessary.
However, research suggests that patients who have undergone vitrectomy may have a higher long-term risk of developing elevated eye pressure and glaucoma.
The key is continued monitoring. Glaucoma is much easier to manage when it is detected early, before significant and irreversible vision loss occurs.
Selected References
- Miele A, et al. Ocular Hypertension and Glaucoma Following Vitrectomy: A Systematic Review. Retina. 2018. Open-angle glaucoma occurred in 7.8% of vitrectomized eyes versus 4.8% of fellow eyes.
- Mansukhani SA, et al. The Risk of Primary Open-Angle Glaucoma Following Vitreoretinal Surgery—A Population-Based Study. American Journal of Ophthalmology. 2018. The estimated 10-year glaucoma risk was approximately 9% after vitreoretinal surgery versus about 1% in fellow eyes.
- Wu L, et al. Intraocular Pressure Elevation After Uncomplicated Pars Plana Vitrectomy. Retina. Sustained elevated eye pressure occurred in approximately 19% of operated eyes compared with about 5% of fellow eyes.
This article is intended for educational purposes and does not replace an individualized eye examination or medical advice from your ophthalmologist.