Risk factors for proliferative vitreoretinopathy in small gauge vitreoretinal surgery

摘要

Purpose : To identify risk factors for development of PVR in small gauge vitrectomy repair of primary rhegmatogenous retinal detachment Methods : This retrospective, case-control series including patients with rhegmatogenous retinal detachments from September 2005 to March 2015. 198 eyes that underwent primary repair of RRD with 23- or 25- gauge PPV. A database search was performed for the diagnosis code and patients were included if they had not had prior vitrectomy repair of the retinal detachment. 74 PVR eyes required secondary repair due to subsequent retinal detachment. 124 control eyes did not develop PVR. Eyes were excluded if there was associated trauma, ruptured globe, retinoschisis or current/past episodes of uveitis. Follow up ranged from 52 days to 8 yrs with a mean follow up of 9 months.Main outcome data included relative risk of PVR with regards to duration of symptoms, number of retinal breaks, inferior breaks, presence of vitreous hemorrhage, use of cryotherapy on initial surgery, application of 360 degree endolaser on initial surgical repair, failed prior intervention (laser/cryo/pneumatic retinopexy), and lens status at presentation. Univariate and multivariate logistic regression analysis was applied to determine the risk factors for PVR. Patients were excluded if follow up was less than 50 days following primary repair. Results : Statistically significant variables for developing PVR in the setting of small gauge vitrectomy repair of RRD included: cryoretinopexy at the time of primary repair (p-value 0.0002), 360 endolaser (p-value 0.0247), and increased duration of symptoms to time of repair (p-value 0.039). Non-statistically significant variables included inferior retinal breaks (p-value 0.0775), lens status (0.3879), scleral buckle during primary repair (0.786), vitreous hemorrhage on presentation(0.7175), macula status (0.3913), or association with multiple tears (0.4345) Conclusions : Increased duration of symptoms prior to presentation and intraoperative cryotherapy and 360 degree endolaser are statistically significant risk factors for development of PVR in small gauge vitrectomy repair of rhegmatogenous retinal detachments. A prospective study would be required to assess rate of PVR in small gauge study and further support these risk factors findings. This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.