This work evaluates the anatomic and functional outcomes of primary rhegmatogenous retinal detachments (RRDs) with preoperative grade B and C proliferative vitreoretinopathy (PVR) vs eyes without PVR.
Methods:
As a multi-institutional, interventional, retrospective study of all patients undergoing primary RRD surgical procedures from January 1, 2015, through December 31, 2015, this study evaluated the visual acuity (VA) outcomes and single-surgery anatomic success rates (SSAS) of patients with primary grade B and C PVR at the time of RRD repair.
Results:
A total of 2486 eyes underwent primary RD surgery during the study period, of which 153 eyes (6.2%) had documented preoperative PVR grade B or C. Eyes without PVR had better SSAS compared with eyes with grade B or C PVR (87% vs 83% vs 75%, respectively, P < .0001). Eyes without PVR also had better final mean (SD) logMAR VA (0.35 [0.47]; 20/45 Snellen equivalent) than eyes with PVR of grade B (0.50 [0.56]; 20/63 Snellen equivalent) or grade C (P < .0001). In only eyes with preoperative PVR, there were no significant differences in final VA or SSAS on multivariate analysis based on surgical approach or use of retinectomy or membrane peeling alone in the intraoperative management of PVR.
Conclusions:
Eyes with primary preoperative grade B and C PVR appear to have significantly worse VA outcomes and lower surgical success rates. Surgical approach and management of PVR membranes did not appear to affect VA or success rates, indicating that preoperative PVR severity may dictate these outcomes.
RachalWFBurtonTC. Changing concepts of failures after retinal detachment surgery. Arch Ophthalmol. 1979;97(3):480–483. doi:10.1001/archopht.1979.01020010230008
2.
MendesTSGomesAMVRochaBSPassos JuniorHVAbujamraS. Evaluation of retinectomy in the treatment of severe proliferative vitreoretinopathy. Int J Retina Vitreous. 2015;1:17. doi:10.1186/s40942-015-0018-3
3.
RyanSJ. The pathophysiology of proliferative vitreoretinopathy in its management. Am J Ophthalmol. 1985;100(1):188–193. doi:10.1016/s0002-9394(14)75004-4
4.
LewisHAabergTMAbramsGW. Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy. Am J Ophthalmol. 1991;111(1):8–14. doi:10.1016/s0002-9394(14)76889-8
5.
HiltonGMachemerRMichelsROkunESchepensCShwartzA. The classification of retinal detachment with proliferative vitreoretinopathy. Ophthalmology. 1983;90(2):121–125. doi:10.1016/s0161-6420(83)34588-7
6.
PastorJCRojasJPastor-IdoateSDi LauroSGonzalez-BuendiaLDelgado-TiradoS. Proliferative vitreoretinopathy: a new concept of disease pathogenesis and practical consequences. Prog Retin Eye Res. 2016;51:125–155. doi:10.1016/j.preteyeres.2015.07.005
7.
SebagJ. Shaken not stirred. Ophthalmology. 2001;108(7):1177–1178. doi:10.1016/s0161-6420(01)00621-2
8.
IdreesSSridharJKuriyanAE. Proliferative vitreoretinopathy: a review. Int Ophthalmol Clin. 2019;59(1):221–240. doi:10.1097/IIO.0000000000000258
9.
ChangSColemanDJLincoffHWilcoxLMBraunsteinRAMaiselJM. Perfluoropropane gas in the management of proliferative vitreoretinopathy. Am J Ophthalmol. 1984;98(2):180–188. doi:10.1016/0002-9394(87)90353-9
10.
StopaMKocieckiJ. Anatomy and function of the macula in patients after retinectomy for retinal detachment complicated by proliferative vitreoretinopathy. Eur J Ophthalmol. 2011;21(4):468–472. doi:10.5301/EJO.2010.6069
11.
BanerjeePJQuartilhoABunceC, et al.Slow-release dexamethasone in proliferative vitreoretinopathy: a prospective, randomized controlled clinical trial. Ophthalmology. 2017;124(6):757–767. doi:10.1016/j.ophtha.2017.01.021
12.
PastorJC. Proliferative vitreoretinopathy: an overview. Surv Ophthalmol. 1998;43(1):3–18. doi:10.1016/s0039-6257(98)00023-x
13.
LeanJSSternWHIrvineARAzenSP. Classification of proliferative vitreoretinopathy used in The Silicone Study. The Silicone Study Group. Ophthalmology. 1989;96(6):765–771. doi:10.1016/s0161-6420(89)32821-1
14.
MachemerRAabergTMFreemanHMIrvineARLeanJSMichelsRM. An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol. 1991;112(2):159–165. doi:10.1016/s0002-9394(14)76695-4
15.
Di LauroSKadhimMRCharterisDGPastorJC. Classifications for proliferative vitreoretinopathy (PVR): an analysis of their use in publications over the last 15 years. J Ophthalmol. 2016;2016:7807596. doi:10.1155/2016/7807596
16.
AdelmanRAParnesAJMichalewskaZDucournauD; European Vitreo-Retinal Society Retinal Detachment Study Group. Clinical variables associated with failure of retinal detachment repair: the European Vitreo-Retinal Society Retinal Detachment Study report number 4. Ophthalmology. 2014;121(9):1715–1719. doi:10.1016/j.ophtha.2014.03.012
17.
RyanEHRyanCMForbesNJ, et al.Primary Retinal Detachment Outcomes Study report number 2: phakic retinal detachment outcomes. Ophthalmology. 2020;127(8):1077–1085. doi:10.1016/j.ophtha.2020.03.007
18.
WangJCRyanEHRyanC; et al.Primary Retinal Detachment Outcomes Study Group. Factors associated with the use of 360-degree laser retinopexy during primary vitrectomy with or without scleral buckle for rhegmatogenous retinal detachment and impact on surgical outcomes (PRO Study report number 4). Retina.
2019;40(11):2070–2076. doi:10.1097/IAE.0000000000002728
19.
RyanEHJosephDPRyanCM, et al.Primary Retinal Detachment Outcomes Study: methodology and overall outcomes—Primary Retinal Detachment Outcomes Study report number 1. Ophthalmol Retina. 2020;4(8):814–822. doi:10.1016/j.oret.2020.02.014
20.
HolladayJT. Proper method for calculating average visual acuity. J Refract Surg. 1997;13(4):388–391.
21.
JosephDPRyanEHRyanCM, et al.Primary Retinal Detachment Outcomes Study: pseudophakic retinal detachment outcomes: Primary Retinal Detachment Outcomes Study report number 3. Ophthalmology. 2020;127(11):1507–1514. doi:10.1016/j.ophtha.2020.05.005
22.
SatoTEmiKBandoHIkedaT. Retrospective comparison of 25-gauge vitrectomy for repair of proliferative vitreoretinopathy with or without anterior proliferation. Graefes Arch Clin Exp Ophthalmol. 2014;252(12):1895–1902. doi:10.1007/s00417-014-2846-5
23.
CoffeeREJiangLRahmanSA. Proliferative vitreoretinopathy: advances in surgical management. Int Ophthalmol Clin. 2014;54(2):91–109. doi:10.1097/IIO.0000000000000023
24.
StoreyPAlshareefRKhuthailaM; et al.Wills PVR Study Group. Pars plana vitrectomy and scleral buckle versus pars plana vitrectomy alone for patients with rhegmatogenous retinal detachment at high risk for proliferative vitreoretinopathy. Retina.
2014;34(10):1945–1951. doi:10.1097/IAE.0000000000000216
25.
StarrMObeidARyanE; et al.Primary Retinal Detachment Outcomes Study Group. Retinal detachment with inferior retinal breaks. Primary vitrectomy versus vitrectomy with scleral buckle (PRO Study Report No. 9). Retina.
2020;41(3):525–530. doi:10.1097/IAE.0000000000002917
26.
MachemerR. Retinotomy. Am J Ophthalmol. 1981;92(6):768–774. doi:10.1016/s0002-9394(14)75627-2
27.
TsengJJBarileGRSchiffWMAkarYVidne-HayOChangS. Influence of relaxing retinotomy on surgical outcomes in proliferative vitreoretinopathy. Am J Ophthalmol. 2005;140(4):628–636. doi:10.1016/j.ajo.2005.04.021
28.
BlumenkranzMSAzenSPAabergT, et al.Relaxing retinotomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy. Silicone Study Report 5. The Silicone Study Group. Am J Ophthalmol.
1993;116(5):557–564. doi:10.1016/s0002-9394(14)73196-4
29.
Pastor-IdoateSRodríguez-HernándezIRojasJ; et al.Genetics on PVR Study Group. The T309G MDM2 gene polymorphism is a novel risk factor for proliferative vitreoretinopathy. PLoS One.
2013;8(12):e82283. doi:10.1371/journal.pone.0082283
30.
RojasJFernandezIPastorJC; et al.Genetics on PVR Study Group. A genetic case-control study confirms the implication of SMAD7 and TNF locus in the development of proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci.
2013;54(3):1665–1678. doi:10.1167/iovs.12-10931
