Causes of failure after initial vitreoretinal surgery for severe proliferative vitreoretinopathy.

We performed initial vitreoretinal surgery on 81 eyes with rhegmatogenous retinal detachments complicated by severe proliferative vitreoretinopathy. Of 81 eyes, 68 (84%) had undergone previous scleral buckling. We performed vitreous base dissection on all 18 eyes (22%) that had anterior proliferative vitreoretinopathy. With one vitreoretinal operation, 66 of 81 eyes (81%) remained totally reattached. The main cause of initial anatomic failure and reoperation was either new or recurrent proliferation at the vitreous base. With additional vitreoretinal surgery and after a mean follow-up period of 19 months, 73 of 81 retinas (90%) were totally reattached. The final causes of anatomic failure were anterior proliferative vitreoretinopathy and proliferation from relaxing retinotomies. Of the 73 successfully reattached eyes, 62 (85%) had postoperative visual acuity of 5/200 or better.