[Has the incidence of postoperative PVR in rhegmatogenous retinal detachment decreased?].

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).