Lens Status As A Risk Modifier For Ocular Hypertension And Glaucoma After Pars Plana Vitrectomy: A Systematic Review And Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: FP16.08 | Type: Free paper | DOI: 10.82333/y9x9-1z35
Authors: Mr Gabriele Gallo Afflitto* 1 , Dr Lorenzo Fabozzi 2 , Dr Filomena Palmieri 1 , Dr Marco Anastasi 3 , Dr Pier Luigi Surico 4 , Mr Vincenzo Maurino 1 , A/Prof. Francesco Aiello 5 , Prof. Carlo Nucci 5
1Moorfields Eye Hospital NHS Foundation Trust,London,United Kingdom, 2Guy's and St Thomas' NHS Foundation Trust,London,United Kingdom, 3Department of Surgery, Dentistry, Pediatrics and Gynecology,University of Verona,Verona,Italy, 4Department of Ophthalmology,University of Udine,Udine,Italy, 5Department of Experimental Medicine,University of Rome “Tor Vergata”,Roma,Italy
Purpose
Although pars plana vitrectomy (PPV) is widely performed for vitreoretinal disease, concerns remain regarding long-term intraocular pressure (IOP) elevation and glaucoma development. Moreover, no comprehensive quantitative synthesis has provided clinically interpretable risk estimates stratified by lens status. We aimed to quantify the absolute and relative risks of ocular hypertension (OHT) and glaucoma after PPV and to determine whether lens status (phakic vs pseudophakic) modifies postoperative risk.
Setting
Systematic review and meta-analysis of comparative observational studies identified through MEDLINE, EMBASE, and Web of Science. Studies were predominantly conducted in tertiary vitreoretinal centers across Europe, Asia, and North America.
Methods
The protocol was prospectively registered in PROSPERO (CRD42024541683), and reporting followed PRISMA guidelines. Eligible studies included randomized and nonrandomized comparative studies reporting OHT or glaucoma after PPV in adults. Random-effects generalized linear mixed models were used to pool absolute risks (AR) and odds ratios (OR). Heterogeneity, influence diagnostics, and publication bias were assessed. Relative risks and numbers needed to treat for harm (NNTH) were derived for clinical interpretability. Risk of bias was assessed using ROBINS-I, and certainty of evidence was graded using GRADE.
Results
Forty-one observational studies (54,006 patients; 54,021 eyes) were included. The pooled AR was 5.6% (95% CI: 3.1–9.9; I² = 94.6%; low certainty) for post-PPV OHT and 3.9% (95% CI: 2.0–7.2; I² = 94.4%; low certainty) for glaucoma. Pseudophakic eyes demonstrated significantly higher risk than phakic eyes: OHT (OR 3.2; 95% CI: 1.4–9.9; I² = 75.1%; NNTH 8; very low certainty) and glaucoma (OR 11.8; 95% CI: 4.2–33.6; I² = 0%; NNTH 10; moderate certainty).
Conclusions
PPV is associated with a clinically meaningful risk of OHT and glaucoma. Lens status is a key risk modifier, with pseudophakia conferring substantially increased susceptibility. Approximately one additional case of glaucoma occurs for every 10 pseudophakic eyes undergoing PPV compared with phakic eyes. These findings support tailored surgical planning, informed patient counseling, and structured postoperative IOP surveillance, particularly in pseudophakic patients.