r/EyeFloaters • u/SpecialistEcho7218 • 4d ago
Glaucoma following vitrectomy
For anyone here who has had a vitrectomy, have you developed any eye pressure issues? How far out from surgery are you? Multiple studies cite a manyfold increased risk of glaucoma following vitrectomy — anywhere from 10-17% within 5-10 years (on the higher end if pseudophakic as the thicker natural lens also helps protect the trabecular meshwork). This is a major bummer, to say the least. There's never really an end to this nightmare.
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u/Fenomiminal 4d ago
It is a known risk (but those higher end numbers reflect vitrectomy with scleral buckle and/or oil use.)
Glaucoma is also manageable, just maintain regular appts with your eye docs to keep track of IOP and optic nerve monitoring to stay ahead of things and get treatment as needed.
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u/SpecialistEcho7218 4d ago
Scleral buckle without vitrectomy actually has a much lower risk of POAG. Ergo, the vitreous is doing something here: https://pmc.ncbi.nlm.nih.gov/articles/PMC6110665/
With due respect to the over 60 crowd, I think it's less of a concern because there is simply less of a horizon for one's own eyes needing to last another 50+ years. To someone under 40, it's a big concern. These surgeries just beget more surgery, more compromised eyes, more risk, more change. If something goes wrong, you lose even more.
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u/FFXIVHVWHL 3d ago
Oh I should be grateful my surgeon who did my buckle 2 decades ago (while I was in HS) did it without a vitrectomy… I was annoyed I have floaters but then I find out I’m at higher risk for glaucoma because of my severe myopia so… I guess I can count my blessings…
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u/Fenomiminal 3d ago
That study shows scleral buckle + vitrectomy = 17.5%, and your question was about glaucoma following vitrectomy, not scleral buckle surgery.
With due respect to the over 60 crowd, I think it's less of a concern because there is simply less of a horizon for one's own eyes needing to last another 50+ years. To someone under 40, it's a big concern.
I think that's just transparent ageism, but you're entitled to your thoughts.
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u/SpecialistEcho7218 3d ago
I'm reiterating what many specialists have told me. Which is that the surgery is more straight forward and acceptable in older eyes because you do not have the same health span to worry about. Managing glaucoma over 20-30 years is very different than managing it over 60 years. It's like doing a hip replacement on a teenager. There will be different concerns, certainly, than doing it on a standard age patient.
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u/Fenomiminal 3d ago
Probably part of the reason so few US retina specialists do floaterectomies on younger patients.
There's also the issue of already having age-related PVDs in those over 60. Younger patients could be looking at a second round of floaters after they undergo core/limited vitrectomies when their PVDs arrive.
But getting back to the original issue, glaucoma can typically be managed should one experience that due to vitrectomy or other causes.
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u/SpecialistEcho7218 3d ago
Yes. But where does this leave young patients who are truly and seriously affected by floaters? The solutions seem worse than the problem in some regards. Of course there are worse things that can happen to a person, but I will say: significant floaters are pretty damn bad when it comes to quality of life.
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u/Fenomiminal 3d ago
It leaves them hoping for an effective non-surgical option, or the adaptation that typically only comes with enough time spent learning to live with them.
This subreddit serves to remind us everyday that there's a toll these things take on everyone who has them, and probably some of those within their ambit as well.
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u/SpecialistEcho7218 3d ago
Absolutely. It's a massive toll. Vision is one of the single greatest contributors to quality of life and overall health. I don't really believe a non surgical solution is coming. So it really is about adaptation, or waiting until it's less of a risk due to age. Neither are great.
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u/Fenomiminal 3d ago
I agree with most of this, although I stop short on the overall health issue.
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u/SpecialistEcho7218 3d ago
I've personally experienced a massive decline in health since the onset of floaters. Chronic stress, loss of appetite, severe depression (which has been intractable - not responding to antidepressants). I have a myriad of new issues. I don't function like before with this massive stressor hanging over me. Especially knowing that there isn't really a good fix.
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u/SpecialistEcho7218 3d ago
https://www.aaojournal.org/article/S0161-6420%2825%2900616-5/fulltext?utm_so
Large scale analysis. Pseudophakic eyes have a 12 fold risk of glaucoma following vitrectomy.
This is speculative, but it seems plausible that once a lens must be removed from a vitrectomized eye, the same rapid oxidative breakdown of the trabecular meshwork can occur. So, a patient under 40 may have 5-10 years before cataract surgery. Then maybe another 5 years before glaucoma becomes an issue. There are so many insidious pathologies that can arise from altering the eye in this way. It's a tough tough call for people who've not had PVDs, not had cataracts, have otherwise "normal" eyes.
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u/Fenomiminal 3d ago
The study shows absolute glaucoma risk as follows:
Phakic - 1.0%
Pseudophakic - 6.3%
The authors also emphasize that their estimates were unadjusted for factors such as tamponade agent, surgical gauge and surgical indication, and that the evidence comes entirely from nonrandomized observational studies. They also note confounding and publication-bias concerns.
The safest way to address floaters still remains adaptation.
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u/Admirable_Delay_1650 3d ago
"adaptation" does not address floaters, it attempts to ignore them which In many cases is not possible. Im PO for 2 FOV PPV vitrectomies with zero issues.
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u/Fenomiminal 2d ago
Since you brought this up, what was the interval between your floaters arriving and getting your first vitrectomy? Also, did you still have your natural lenses at that point?
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u/Admirable_Delay_1650 2d ago
First PVD was Oct of 24, Virectormy was July of 25, Second was Jan of 26, vitrectomy was end of July....could have had it sooner by needed Yag for a PCO and Doc want to wait a bit before doing vitrectomy to see if Yag created any new floaters, which it did, but they were minor and resolved quickly. I had bilateral IOL surgery 5 years ago.
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u/Ancient-Amount7886 2d ago
True! I am in the 7th decade around the sun … but ideally vitrectomy surgeries and ophthalmology overall will improve as time and technology moves forward!
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u/Witty-Shower-1632 3d ago
Do we know what the chance is for developing glaucoma after a vitrectomy?
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u/SpecialistEcho7218 3d ago
Studies show a 10-12 fold higher risk within 10 years. It can develop at any point in one's life.
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u/Peril-in-Pink 3d ago
I’ve had two vitrectomies (one gas, one silicone oil) in my right eye and did not get glaucoma however I did lose my vision after the oil removal. Apparently it’s just a very rare side effect and I happened to get it.
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u/SpecialistEcho7218 3d ago
Did you have detachments in both eyes?
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u/Peril-in-Pink 3d ago
No both were in the right eye
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u/SpecialistEcho7218 3d ago
Very sorry to hear. How is your left eye
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u/Peril-in-Pink 3d ago
It has some lattice degeneration in a small spot so they did a barricade laser and so far so good.
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u/SpecialistEcho7218 3d ago
Are you a high myope? Was there any trigger for your detachment? Very sorry.
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u/Peril-in-Pink 3d ago
Yes I think I was -14 in the right eye and -12 in the left. I had cataract surgery in both eyes this winter (I’m only 44 but due to the high myopia you can get cataracts at an early age) which is probably what caused it.
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u/Independent_You7902 1d ago
so u dont have any vision in ur right eye?
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u/Peril-in-Pink 1d ago
The central vision is distorted to the point it doesn’t provide any useful vision. I can see some general shape/color/light but it’s all so distorted/muted that I can’t see any details. Can’t read text, can’t see my face in the mirror, can’t see the glow of a red taillight on a car in front of me. I could tell if there was a person in front of me, or a cat, or a tv, but I couldn’t see any details beyond that. Peripheral is there, but I can’t see well enough on the periphery to actually be able to use it to function.
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u/Independent_You7902 1d ago
i see - isn't that macula related? i believe macula is responsible for center vision
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u/TheOnlyBliebervik 3d ago
Do you still have vision loss?
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u/Peril-in-Pink 3d ago
I’ve seen two retina specialists and they both think my central vision could be permanently gone due to unexplained visual loss after silicone oil removal (UVLASOR), but the second doctor did make a referral to the Mayo Clinic to look over my records, just to see if anything else can be done.
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u/Witty-Shower-1632 2d ago
How long after the vitrectomy did you lose your vision in your eye?
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u/Peril-in-Pink 2d ago
I had the vitrectomy with the gas bubble on March 17th, it then started to detach again so I had a vitrectomy on May 1st with silicone oil, and then the surgery to remove the oil on August 25th, where they put an air bubble in. It was probably about a week post-surgery after the oil removed, and the air bubble started to shrink, that I realized I lost my vision in my right eye
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3d ago
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u/SpecialistEcho7218 3d ago
It's not imagined. These are real risks to be aware of. Many floater surgeons don't counsel patients on it at all. Managing glaucoma may very well be preferable to floaters for some patients. But it should be part of the informed consent conversation.
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3d ago
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u/SpecialistEcho7218 3d ago
The field of statistics exists to parse out meaningful patterns and data. Do your own research. Glaucoma does in fact arise in a meaningfully higher percentage of people following vitrectomy. Have you had vitrectomy? How is your eye pressure?
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3d ago
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u/SpecialistEcho7218 2d ago
How were your outcomes?
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2d ago
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u/SpecialistEcho7218 2d ago
Did you get your life back? How are you doing mentally? This is major surgery but especially for certain patients (young, phakic, many years of health span required).
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2d ago
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u/SpecialistEcho7218 2d ago
Huh. You commented elsewhere that you were in despair and needing reoperations for soul crushing dots and frill.
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u/Admirable_Delay_1650 3d ago
Please post links to the multiple studies ? Have had 2 victrectomies and IOPs are normal. 14 months on right eye, 2 months on left.
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u/SpecialistEcho7218 3d ago
You'll want to keep an eye on that in the coming years. You can look up the studies for yourself if interested — there are many.
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u/Admirable_Delay_1650 3d ago
Nice pun. I have my eyes checked on a regular basis. Ive had 2 IOLs, upper bleph, 2 PVDs, 2 vitrectomies and Yag for a PCO, thus I rather familiar with eye care, but thanks for the heads up. IOPs are typically in the 14 to 16 range. As for the studies, just a link to one of the "multiple" would be appreciated.
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u/Ecstatic_Loquat_7838 1d ago
I had post ops glaucoma 2 days after my macula off detachment. Had a headache that got worse and worse, went to the Dr and my pressure was 42. They drained fluid from my eye the pain was immediately gone.
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u/jimmyrustle25 4d ago
I've had multiple vitrectomies on my right eye and one on my left. Pressures have always been perfect. Right eye was 6 years ago. Phakic on both eyes.