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Clinical Risk Factors for Proliferative Vitreoretinopathy

Clinical Risk Factors for Proliferative Vitreoretinopathy Abstract • We reviewed the records of all patients with rhegmatogenous retinal detachments examined and treated by a single surgeon (B.P.C.) at the University of Virginia, Charlottesville, between 1978 and 1984. Of the 607 eyes that satisfied the selection criteria, a preliminary chart review of outcomes found that 65 (10.7%) had proliferative vitreoretinopathy and 34 had macular puckers. From the remaining 508 eyes, 325 controls were randomly selected to match each case from within a time window. Thirty-six (55.4%) of the 65 patients with proliferative vitreoretinopathy had had unequivocal reattachment after a single procedure before the onset of proliferative vitreoretinopathy, and the only clearly identified technical difficulty that was significantly more common in the patients with proliferative vitreoretinopathy was the inability to identify a retinal break. Several other features of the rhegmatogenous retinal detachments that correlated with the development of postoperative proliferative vitreoretinopathy were identified, and stepwise discriminant analysis was used to ascertain which of these were more important. The strongest predictor was use of vitrectomy in management of the detachment. Following this in order of importance were the presence of preoperative proliferative vitreoretinopathy, preoperative choroidal detachment, and the amount of cryopexy required. Vitrectomy remained a strong predictor even when considered after adjustment for all other characteristics. These data suggest that proliferative vitreoretinopathy is not simply an iatrogenic disease, but it is more likely to occur in association with certain detachment features that either by themselves or through their management require prolongation of the retinal wound healing process. References 1. Okamura ID, Schepens CL, Brockhurst RJ, Regan CDJ, McMeel JW. The scleral buckling procedures, VII: silicone implants in reoperations . Arch Ophthalmol . 1964;72:297-308.Crossref 2. Rachal WF, Burton TC. Changing concepts of failures after retinal reattachment surgery . Arch Ophthalmol . 1979;97:480-483.Crossref 3. Bonnet M. Clinical factors predisposing to massive proliferative vitreoretinopathy in rhegmatogenous retinal detachment . Ophthalmologica . 1984;188:148-152.Crossref 4. Machemer R, Laqua H. Pigment epithelial proliferation in retinal detachment: massive periretinal proliferation . Am J Ophthalmol . 1975;80:1-23. 5. Machemer R, van Horn D, Aaberg TM. Pigment-epithelial proliferation in human retinal detachment with massive periretinal proliferation . Am J Ophthalmol . 1978;85:181-191. 6. Kampik A, Kenyon KR, Michels RG, Green WR, de la Cruz ZC. Epiretinal and vitreous membranes: comparative study of 56 cases . Arch Ophthalmol . 1981;99:1445-1454.Crossref 7. Campochiaro PA, Jerdan JA, Glaser BM. Serum contains chemoattractants for human retinal pigment epithelial cells . Arch Ophthalmol . 1984;102:1830-1833.Crossref 8. Campochiaro PA, Gaskin HC, Vinores SA. Retinal cryopexy stimulates traction retinal detachment formation in the presence of an ocular wound . Arch Ophthalmol . 1987;105:1567-1570.Crossref 9. Sen HA, Robertson TJ, Conway BP, Campochiaro PA. The role of breakdown of the blood-retinal barrier in cell-injection models of proliferative vitreoretinopathy . Arch Ophthalmol . 1988;106:1291-1294.Crossref 10. Schepens CL. Ophthalmoscopic observations related to the vitreous body . In: Schepens CL, ed. Importance of the Vitreous Body in Retina Surgery With Special Emphasis on Reoperations . St Louis, Mo: CV Mosby Co; 1960:94-123. 11. Tolentino FI, Schepens CL, Freeman HM. Massive preretinal retraction: a biomicroscopic study . Arch Ophthalmol . 1967;78:16-22.Crossref 12. Machemer R, Allen AW. Retinal tears 180 degrees and greater: management with vitrectomy and intravitreal gas . Arch Ophthalmol . 1976;94:1340-1346.Crossref 13. Freeman HM, Castillejos ME. Current management of giant retinal tears: results with vitrectomy and total air-fluid exchange in 95 cases . Trans Am Ophthalmol Soc . 1981;179:89-100. 14. Bonnet M. The development of severe proliferative vitreoretinopathy after retinal detachment surgery: grade B: a determining risk factor . Graefes Arch Clin Exp Ophthalmol . 1988;226:201-205.Crossref 15. Seelenfreund MH, Kraushar MF, Schepens CL, Freilich DB. Choroidal detachment associated with primary retinal detachment . Arch Ophthalmol . 1974;91:254-258.Crossref 16. SAS Institute Inc. SAS/STAT Guide for Personal Computers . 6th ed. Cary, NC: SAS Institute Inc; 1987:1028. 17. Brubaker RF, Pederson JE. Ciliochoroidal detachment . Surv Ophthalmol . 1983;27:281-289.Crossref 18. Jaccoma EH, Conway BP, Campochiaro PA. Cryotherapy causes extensive breakdown of the blood-retinal barrier: a comparison with argon laser photocoagulation . Arch Ophthalmol . 1985;103:1728-1730.Crossref 19. Campochiaro PA, Bryan JA III, Conway BP, Jaccoma EH. Intravitreal chemotactic and mitogenic activity: implication of blood-retinal barrier breakdown . Arch Ophthalmol . 1986;104:1685-1687.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Clinical Risk Factors for Proliferative Vitreoretinopathy

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References (20)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1989.01070020213027
Publisher site
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Abstract

Abstract • We reviewed the records of all patients with rhegmatogenous retinal detachments examined and treated by a single surgeon (B.P.C.) at the University of Virginia, Charlottesville, between 1978 and 1984. Of the 607 eyes that satisfied the selection criteria, a preliminary chart review of outcomes found that 65 (10.7%) had proliferative vitreoretinopathy and 34 had macular puckers. From the remaining 508 eyes, 325 controls were randomly selected to match each case from within a time window. Thirty-six (55.4%) of the 65 patients with proliferative vitreoretinopathy had had unequivocal reattachment after a single procedure before the onset of proliferative vitreoretinopathy, and the only clearly identified technical difficulty that was significantly more common in the patients with proliferative vitreoretinopathy was the inability to identify a retinal break. Several other features of the rhegmatogenous retinal detachments that correlated with the development of postoperative proliferative vitreoretinopathy were identified, and stepwise discriminant analysis was used to ascertain which of these were more important. The strongest predictor was use of vitrectomy in management of the detachment. Following this in order of importance were the presence of preoperative proliferative vitreoretinopathy, preoperative choroidal detachment, and the amount of cryopexy required. Vitrectomy remained a strong predictor even when considered after adjustment for all other characteristics. These data suggest that proliferative vitreoretinopathy is not simply an iatrogenic disease, but it is more likely to occur in association with certain detachment features that either by themselves or through their management require prolongation of the retinal wound healing process. References 1. Okamura ID, Schepens CL, Brockhurst RJ, Regan CDJ, McMeel JW. The scleral buckling procedures, VII: silicone implants in reoperations . Arch Ophthalmol . 1964;72:297-308.Crossref 2. Rachal WF, Burton TC. Changing concepts of failures after retinal reattachment surgery . Arch Ophthalmol . 1979;97:480-483.Crossref 3. Bonnet M. Clinical factors predisposing to massive proliferative vitreoretinopathy in rhegmatogenous retinal detachment . Ophthalmologica . 1984;188:148-152.Crossref 4. Machemer R, Laqua H. Pigment epithelial proliferation in retinal detachment: massive periretinal proliferation . Am J Ophthalmol . 1975;80:1-23. 5. Machemer R, van Horn D, Aaberg TM. Pigment-epithelial proliferation in human retinal detachment with massive periretinal proliferation . Am J Ophthalmol . 1978;85:181-191. 6. Kampik A, Kenyon KR, Michels RG, Green WR, de la Cruz ZC. Epiretinal and vitreous membranes: comparative study of 56 cases . Arch Ophthalmol . 1981;99:1445-1454.Crossref 7. Campochiaro PA, Jerdan JA, Glaser BM. Serum contains chemoattractants for human retinal pigment epithelial cells . Arch Ophthalmol . 1984;102:1830-1833.Crossref 8. Campochiaro PA, Gaskin HC, Vinores SA. Retinal cryopexy stimulates traction retinal detachment formation in the presence of an ocular wound . Arch Ophthalmol . 1987;105:1567-1570.Crossref 9. Sen HA, Robertson TJ, Conway BP, Campochiaro PA. The role of breakdown of the blood-retinal barrier in cell-injection models of proliferative vitreoretinopathy . Arch Ophthalmol . 1988;106:1291-1294.Crossref 10. Schepens CL. Ophthalmoscopic observations related to the vitreous body . In: Schepens CL, ed. Importance of the Vitreous Body in Retina Surgery With Special Emphasis on Reoperations . St Louis, Mo: CV Mosby Co; 1960:94-123. 11. Tolentino FI, Schepens CL, Freeman HM. Massive preretinal retraction: a biomicroscopic study . Arch Ophthalmol . 1967;78:16-22.Crossref 12. Machemer R, Allen AW. Retinal tears 180 degrees and greater: management with vitrectomy and intravitreal gas . Arch Ophthalmol . 1976;94:1340-1346.Crossref 13. Freeman HM, Castillejos ME. Current management of giant retinal tears: results with vitrectomy and total air-fluid exchange in 95 cases . Trans Am Ophthalmol Soc . 1981;179:89-100. 14. Bonnet M. The development of severe proliferative vitreoretinopathy after retinal detachment surgery: grade B: a determining risk factor . Graefes Arch Clin Exp Ophthalmol . 1988;226:201-205.Crossref 15. Seelenfreund MH, Kraushar MF, Schepens CL, Freilich DB. Choroidal detachment associated with primary retinal detachment . Arch Ophthalmol . 1974;91:254-258.Crossref 16. SAS Institute Inc. SAS/STAT Guide for Personal Computers . 6th ed. Cary, NC: SAS Institute Inc; 1987:1028. 17. Brubaker RF, Pederson JE. Ciliochoroidal detachment . Surv Ophthalmol . 1983;27:281-289.Crossref 18. Jaccoma EH, Conway BP, Campochiaro PA. Cryotherapy causes extensive breakdown of the blood-retinal barrier: a comparison with argon laser photocoagulation . Arch Ophthalmol . 1985;103:1728-1730.Crossref 19. Campochiaro PA, Bryan JA III, Conway BP, Jaccoma EH. Intravitreal chemotactic and mitogenic activity: implication of blood-retinal barrier breakdown . Arch Ophthalmol . 1986;104:1685-1687.Crossref

Journal

Archives of Ophthalmology – American Medical Association

Published: Aug 1, 1989

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