[Intraocular surgery for secondary retinal detachment in proliferative vitreoretinopathy]

Proliferative vitreoretinopathy (PVR) is defined as the growth and contraction of cellular membranes within the vitreous cavity and on both surfaces of the retina following rhegmatogenous retinal detachment. This process is extremely important as these membranes exert traction and may cause recurrent detachment by reopening otherwise successfully treated retinal breaks or create new retinal breaks. We present the results of a small retrospectively series of 63 cases operated in the University of Geneva Eye Clinic, between 1990 and 1993. Surgical procedure, anatomical results, visual acuity have been reviewed.

Surgical technique, number of surgical procedures, anatomical result and final visual acuity, have been reviewed in each case. Subjects have been divided into two groups depending on the degree of PVR (stage B or C). All patients have been operated combining extra- and intraocular microsurgical technique (scleral buckling, extended vitrectomy, perfluorodecaline, peroperative tamponade, endolaser photocoagulation, retinectomy and gaz or silicone oil tamponade).

In the group presenting a stage-B PVR, the retina was reattached in 79% of cases, but only in 47% of the stage-C cases after one surgical procedure. The functional results showed only 31% of cases with a visual acuity superior to 0.4 in the stage-B group and 28% in the stage-C one. In all the stage-B cases that needed further surgical procedure, the retina could be definitely reattached, but in 9% cases of the stage-C group the retina remained detached and in 18% of the same group permanent silicone oil tamponade was necessary to maintain the retina reattached.

Significant evolution has been observed in microsurgical endoocular surgery in the last ten years, allowing a significant improvement in the anatomical results. Stage-B PVR could be efficiently treated by one surgical procedure in more than 2/3 of cases strongly suggesting the use of endoocular microsurgery as a first intention procedure for retinal detachment complicated by stage-B PVR. An initial stage-C PVR is associated with a poorer anatomical and functional result because of an increased risk of recurrent PVR.