Primary Retinal Detachment Repair in Eyes Deemed High Risk for Proliferative Vitreoretinopathy: Surgical Outcomes in 389 Eyes

Abstract

To evaluate surgical outcomes in eyes with primary rhegmatogenous retinal detachment (RRD) deemed at high risk for postoperative proliferative vitreoretinopathy (PVR). Retrospective, consecutive case cohort study. Eyes undergoing primary RRD repair with pars plana vitrectomy (PPV) or combined PPV with scleral buckling (PPV/SB) between January 1, 2016 and December 30, 2017 at Wills Eye Hospital. Eyes were defined as 'high risk' if at least one of the following risk factors for PVR was present on pre-operative exam: pre-operative PVR grade A or B, vitreous hemorrhage, RRD involving 50% or more of retinal area, presence of 3 or more retinal breaks, history of prior cryotherapy, presence of choroidal detachment, and/or duration of RRD greater than 2 weeks. Surgical failure was defined as an additional intervention required for the retinal reattachment. Single surgery attachment success (SSAS) rate 3 months after first surgical intervention for primary RRD. Of 2053 reviewed charts, a total of 389 eyes (18.9%) met the definition of high risk and were included in the analysis. Mean patient age was 63.5 years. PPV/SB was performed in 125 (32.1%) eyes and PPV alone in 264 (67.9%) eyes. The SSAS rate for the overall cohort was 71.5% at 3 months. SSAS rate was significantly higher in eyes treated with PPV/SBP compared to PPV (80.8% versus 67%, respectively, p=0.006). On multivariate analysis, use of PPV/SB was the only feature associated with SSAS (OR 2.04, 95% CI 1.12 - 3.69, p=0.019). In eyes with primary RRD and risk factors for PVR, overall SSAS was 71.5% after primary repair. In this cohort, use of PPV/SB was associated with a significantly higher SSAS compared to PPV alone.