In the JournalsPerspective

Interval of injury, vitrectomy a risk factor for proliferative vitreoretinopathy

Ocular trauma is associated with a high risk of proliferative vitreoretinopathy and poor postoperative visual outcomes, according to a study.

The study included 179 eyes with trauma and proliferative vitreoretinopathy (PVR). A control group comprised 221 eyes with trauma and no PVR.

Average follow-up was 11 months in the PVR group and 11.3 months in the control group, except for patients who had primary enucleation or evisceration. The average interval between injury and vitrectomy was 62.6 days in the PVR group and 16.8 days in the control group.

Interval of injury and vitrectomy longer than 28 days, severe vitreous hemorrhage and total retinal detachment were risk factors for PVR.

Presence of PVR, poor baseline visual acuity, relative afferent pupillary defect, total retinal detachment, and retinal tear or defect most strongly predicted poor anatomic and visual outcomes.

Forty-nine eyes (27.4%) in the PVR group and 115 eyes (52%) in the control group had anatomic restoration with ambulant visual acuity of 4/200 or greater.

Disclosure: The study authors have no relevant financial disclosures.

Ocular trauma is associated with a high risk of proliferative vitreoretinopathy and poor postoperative visual outcomes, according to a study.

The study included 179 eyes with trauma and proliferative vitreoretinopathy (PVR). A control group comprised 221 eyes with trauma and no PVR.

Average follow-up was 11 months in the PVR group and 11.3 months in the control group, except for patients who had primary enucleation or evisceration. The average interval between injury and vitrectomy was 62.6 days in the PVR group and 16.8 days in the control group.

Interval of injury and vitrectomy longer than 28 days, severe vitreous hemorrhage and total retinal detachment were risk factors for PVR.

Presence of PVR, poor baseline visual acuity, relative afferent pupillary defect, total retinal detachment, and retinal tear or defect most strongly predicted poor anatomic and visual outcomes.

Forty-nine eyes (27.4%) in the PVR group and 115 eyes (52%) in the control group had anatomic restoration with ambulant visual acuity of 4/200 or greater.

Disclosure: The study authors have no relevant financial disclosures.

    Perspective

    Due to the inherent variation of traumatic injuries, statistical analysis of large cohorts is valuable only to a point. It is difficult to extrapolate relevant data from such studies when evaluating an individual case in the clinical setting. That being said, this is a well-organized and well-written paper. The majority of the findings reinforce what we already know about PVR in the setting of trauma. First, it is bad and leads to poor visual outcomes. Second, it tends to occur in more severe injuries such as those with corneal-scleral rupture, those with vitreous hemorrhage and those with significant retinal detachment. Lastly, it tends to form more frequently and aggressively in younger patients. The most interesting finding in the study is the drastic increase in rates of PVR development with an increasing “interval of injury and vitrectomy.” This finding reinforces that attention to the timing of vitrectomy following primary repair is essential. Most interestingly, patients who were taken for vitrectomy less than 14 days from the time of their injury were 18.19 times less likely to develop PVR. Retinal surgeons often feel that it is best to wait at least 2 weeks for a posterior vitreous detachment to occur before performing a vitrectomy in the setting of trauma. This study forces us to question that practice.

    • James A. Eadie, MD
    • Senior Vitreoretinal Surgery Fellow, University of Wisconsin

    Disclosures: Eadie has no relevant financial disclosures.