Quality Improvement in Vitreoretinal Surgery: Single-Center Report on Utility of Routine Intravenous Fluids in Pars Plana Vitrectomy

Abstract

Purpose: To assess the clinical outcomes in patients who did or did not receive intravenous fluids while undergoing pars plana vitrectomy (PPV) surgery. Methods: This single-center, retrospective observational study evaluated 361 patients who underwent PPV at the Cleveland Clinic Cole Eye Institute from August 1, 2024, to January 31, 2025. Medical records were reviewed to determine intraoperative administration of intravenous fluids and systemic comorbidities. Patients received either monitored anesthesia care or general anesthesia. Blood glucose levels in patients with diabetes and creatinine clearance rates in all patients were assessed pre- and postoperatively. Intraoperative vasopressor use and rates of perioperative clinical decompensation episodes were evaluated. Results: A total of 212 patients (59%) did not receive intravenous fluids, and 149 patients (41%) received intravenous fluids during the study period. Only 1 patient, who received general anesthesia with intravenous fluids, required intraoperative hypoglycemia treatment. Most patients (>95%) did not receive routine postoperative kidney function testing, but there were no recorded episodes of acute kidney injury at 1 month after PPV. Among patients who received intravenous fluids, 8 (2%) required intraoperative vasopressors, all of whom received general anesthesia. There were no acute decompensation episodes in the perioperative period. No patients required conversion from monitored anesthesia care to general anesthesia. Conclusions: Forgoing intraoperative administration of intravenous fluids was not associated with increased rates of systemic adverse events or perioperative clinical decompensation episodes in patients who underwent PPV. The findings suggest that in patients who are deemed appropriate for monitored anesthesia care, the addition of routine intravenous fluids is of unclear clinical benefit.