INCREASED INTRAOCULAR-PRESSURE ALTER MACULAR HOLE SURGERY

PURPOSE: To determine the incidence and timing of increased intraocula r pressure in eyes with an idiopathic macular hole treated with bovine transforming growth factor-beta(2) (TGF-beta(2)) with different intra ocular gas concentrations, recombinant TGF-beta(2), or placebo. METHOD S: Intraocular pressure was measured preoperatively and two days, two weeks, six weeks, and three months postoperatively in two prospective studies of the treatment of idiopathic macular hole with vitrectomy. G roup 1 consisted of 95 eyes treated with bovine TGF-beta(2). Eyes in t his group were treated with different concentrations of air and perflu oropropane (C3F8) intraocular gas bubbles. Fifteen eyes were treated w ith air, 15 eyes with 5% perfluoropropane, 15 eyes with 10% perfluorop ropane, and 50 eyes with 16% perfluoropropane. Group 2 consisted of 29 eyes treated with recombinant TGF-beta(2). Twenty-six eyes were treat ed with placebo in a double-masked, randomized, placebo controlled stu dy evaluating recombinant TGF-beta(2) with a 16% perfluoropropane intr aocular gas bubble, RESULTS: At the two week examination, the intraocu lar pressure in Group 1 eyes was >30 mm Hg in four (26.7%) of 15 eyes treated with air, two (13.3%) of 15 eyes treated with 5% perfluoroprop ane, one (8.3%) of 12 eyes treated with 10% perfluoropropane, and nine (19.1%) of 47 eyes treated with 16% perfluoropropane. There was no st atistically significant difference in the risk of increased intraocula r pressure in eyes treated with short-, intermediate-, or long-duratio n gas tamponade using bovine TGF-beta(2). The intraocular pressure in Group 2 was >30 mm Hg at the two-week examination in 11 (39.3%) of 28 eyes receiving recombinant TGF-beta(2) compared with one (4.3%) of 23 eyes receiving a placebo (P = .006). CONCLUSIONS: Some eyes develop in creased intraocular pressure after vitreous surgery for macular hole, and the increase occurs most frequently between two days and two weeks postoperatively. The risk of increased intraocular pressure is somewh at increased in eyes treated with bovine TGF-beta(2) but is markedly i ncreased in eyes in which recombinant TGF-beta(2) is used as an adjunc tive agent for macular hole surgery, Intraocular injection of growth f actors produced by similar recombinant DNA techniques may result in po tentially dangerous increased intraocular pressure several weeks after surgery. Impurities in the recombinant TGF-beta(2) may explain the re latively high risk of increased intraocular pressure.