We thank Drs Takkar and Azad for their comments regarding our recent publication.

The authors cite a recent study by Mi and Thompson evaluating long-term intraocular pressure (IOP, mm Hg) outcomes following 20, 23, or 25 gauge vitrectomy for epiretinal membrane and macular hole indications. Compared to the fellow eye, Mi and Thompson note a statistically lower IOP in the surgical eye in the first 6 months following vitrectomy ( P < .05), with a return to statistically similar values at 1 year, at 2 years, and at mean final follow-up of 4.4 years post surgery. Drs Takkar and Azad inquire if such a trend was observed with 27 gauge vitrectomy, postulating that smaller sclerotomies may result in a earlier return to IOP baseline, and more specifically, if wound construction (angled vs straight incisions) had any effect on IOP trends at the 90-day time point.

Across all 95 eyes, we observed a trend toward decreased IOP following 27 gauge vitrectomy, with mean IOP decreasing from 16.8 ± 6.7 mm Hg preoperatively to 15.2 ± 3.4 mm Hg at mean final follow-up of 144 ± 54 days ( P = .02). IOP data for angled and straight wound construction techniques at postoperative day 90 and final follow-up are reported here. Compared to a mean baseline IOP of 16.4 ± 7.7, IOP was decreased to 14.9 ± 4.4 at 90 days ( P = .12) and 14.9 ± 3.6 at final follow-up ( P = .11) in the angled incision group. Compared to a mean baseline IOP of 17.8 ± 2.7, IOP was decreased to 16.1 ± 2.7 at 90 days ( P < .01) and 15.9 ± 2.6 at final follow-up ( P < .01) in the straight incision group, reaching statistical significance. However, there was no significant difference in mean IOP between groups (angled vs straight) at any time point, including 90 days ( P = .16) and final follow-up ( P = .19).

It is important to note that the trends in IOP reported by Mi and Thompson are relative to a fellow eye; include eyes undergoing 20, 23, or 25 gauge vitrectomy; and are only in eyes undergoing surgery for epiretinal membrane or macular hole indications. The surgical indications in our series are more varied, with trends in IOP followed only for the surgical eye.

The effect of vitrectomy on IOP remains a topic of interest. While a trend toward decreased IOP was noted overall, it is also important to note that the rates of IOP-related postoperative complications, such as hypotony and serous choroidal detachment, were similar with use of 27 gauge technology compared to rates reported with larger-gauge instrumentation, and, moreover, were similar with use of angled or straight wound construction strategies in our study. Longer-term follow-up will be necessary to better describe IOP trends following 27 gauge vitrectomy and how such trends may differ from larger-gauge equivalents.