Subject(s)
Diabetes Mellitus, Type 1/diagnosis , Diabetic Retinopathy/diagnosis , Pregnancy Complications/diagnosis , Pregnancy in Diabetics/diagnosis , Vitreoretinopathy, Proliferative/diagnosis , Adult , Antibodies, Monoclonal/administration & dosage , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/therapy , Diabetic Retinopathy/pathology , Diabetic Retinopathy/therapy , Female , Fluorescein Angiography , Humans , Incidental Findings , Intravitreal Injections , Light Coagulation , Macular Edema/complications , Macular Edema/diagnosis , Macular Edema/therapy , Pregnancy , Pregnancy Complications/therapy , Pregnancy in Diabetics/pathology , Pregnancy in Diabetics/therapy , Tomography, Optical Coherence , Vascular Endothelial Growth Factor A/antagonists & inhibitors , Vascular Endothelial Growth Factor A/immunology , Vitreoretinopathy, Proliferative/pathology , Vitreoretinopathy, Proliferative/therapyABSTRACT
PURPOSE: To evaluate the role of cryopexy in the stimulation of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment. MATERIALS AND METHODS: A series of 595 eyes of 554 patients with primary rhegmatogenous retinal detachment, referred before any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted. RESULTS: The incidence of postoperative PVR in relation to the methods used for retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PVR was nil in retinal detachments due to atrophic holes in lattice, oral dialyses, and macular holes, regardless of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior edges, regardless of the retinopexy methods (P < 0.00001). In retinal detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retinopexy methods. In contrast, in retinal detachments due to horseshoe tears with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed with laser retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears the incidence of postoperative PVR was not statistically significantly greater in eyes managed with cryopexy (33.3%) than in eyes managed with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly higher in eyes managed with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17 eyes) (P = 0.006). CONCLUSIONS: Cryopexy is not a stimulating factor for postoperative PVR in primary rhegmatogenous retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In contrast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior edges or to retinal tears 180 degrees and over.
Subject(s)
Cryosurgery/adverse effects , Retinal Detachment/surgery , Vitreoretinopathy, Proliferative/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Incidence , Laser Coagulation , Male , Middle Aged , Postoperative Complications , Prospective Studies , Retinal Detachment/etiology , Retinal Perforations/complications , Risk Factors , Scleral Buckling , VitrectomyABSTRACT
PURPOSE: To determine whether the incidence of severe postoperative PVR in primary rhegmatogenous retinal detachment has decreased over the last twelve years. MATERIALS AND METHODS: We prospectively evaluated 595 eyes of 554 consecutive patients with primary rhegmatogenous retinal detachment, referred before any failed attempt to reattach the retina, managed by the same surgeon between March 1983 and December 1994. The eyes were divided into two consecutive series: 275 eyes operated on from March 1983 through February 1988 (series no. 1), and 320 eyes operated on from February 1988 through December 1994 (series no. 2). We conducted univariate and multivariate statistical analyses to compare the incidence of postoperative PVR in the two consecutive series. RESULTS: The overall incidence of postoperative PVR was 8.72% (24/275 eyes) in series no. 1, versus 2.81% (9/320 eyes) in series no. 2 (p < 0.01). The incidence of postoperative PVR in retinal detachments due to atrophic holes in lattice degeneration, oral dialyses, and macular holes in myopic eyes, was nil in both series. The incidence of postoperative PVR in retinal detachments due to horseshoe tears with mobile posterior edges was 1.16% (1/86 eyes) in series no. 1, and 0% (0/109 eyes) in series no. 2. The incidence of postoperative PVR in retinal detachments associated with horseshoe tears with curled posterior edges was 21.15% (11/52 eyes) in series no. 1 versus 3.2% (3/93 eyes) in series no. 2 (p < 0.001). The incidence of postoperative PVR in giant tears was 35.5% (11/31 eyes) in series no. 1. and 14.7% (5/34 eyes) in series no. 2 (chi square = 3.77; at the limit of significance). The incidence of postoperative PVR in retinal detachments du to paravascular tears of the post-equatorial region in myopic eyes was 25% (1/4 eyes) in series no. 1, and 14% (1/7 eyes) in series no. 2. CONCLUSION: In our own experience, the incidence of postoperative PVR in primary rhegmatogenous retinal detachment has decreased at a statistically significant level since 1988. We believe that the decreased incidence of postoperative PVR in our most recent series is mainly related to the use of laser photocoagulation retinopexy rather than cryopexy in the management of high risk eyes (retinal detachments associated with horseshoe tears with curled posterior edges, and giant tears).
Subject(s)
Postoperative Complications , Retinal Detachment/surgery , Vitreoretinopathy, Proliferative/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Child , Child, Preschool , Factor Analysis, Statistical , Female , Humans , Male , Microsurgery/methods , Microsurgery/statistics & numerical data , Middle Aged , Prospective Studies , Risk Factors , Time Factors , Vitreoretinopathy, Proliferative/etiologyABSTRACT
BACKGROUND: Previous studies have shown that grade B proliferate vitreoretinopathy (PVR) is a considerable risk factor for the development of severe postoperative PVR. We conducted a prospective study to elucidate which surgical procedures used in retinal detachment management may stimulate the PVR process in such eyes. MATERIALS AND METHODS: The study included 156 eyes of 152 consecutive patients with rhegmatogenous retinal detachment complicated by grade B PVR referred before any failed surgery and operated on between 1983 and 1993. The parameters evaluated by multivariate statistical analysis included the cumulative circumferential extent of the retinal tears, the extent of the scleral buckle, gas injection, vitrectomy, the method used for retinopexy, and the time of surgical management during the period of the study. RESULTS: The incidence of severe postoperative PVR was 25.8% in eyes managed with cryotreatment versus 2.2% in eyes managed with argon laser photocoagulation (P = 0.001). The rate of severe postoperative PVR was not influenced by the other surgical variables. CONCLUSION: We conclude that cryotherapy may be a risk factor for the development of severe postoperative PVR in retinal detachments associated with grade B PVR.
