RISK-FACTORS FOR SEVERE POSTOPERATIVE PVR IN GIANT TEARS

Background In eyes with giant retinal tears, the rate of severe postop erative PVR and failure to permanently reattach the retina remains esp ecially high in spite of technical advances in surgical management. th is study was conducted to elucidate the clinical and surgical risk fac tors for severe postoperative PVR in such eyes. Patients and methods W e reviewed the records of 68 consecutive patients (69 eyes) with giant retinal tears. Univariate and multivariate statistical analyses were used to evaluate the risk factors for severe PVR. Results The rate of severe postoperative and failure to permanently reattach the retina we re 43.5% (30/69 eyes). It was influenced at a statistically significan t level by two independent risk factors: 1) the presence and severity of preoperative PVR and 2) the use of cryotreatment as compared to the use of ALP treatment. Severe postoperative PVR occurred in 63.6% (14/ 22 eyes) of eyes managed with cryotreatment versus 31.1% (14/45 eyes) of eyes managed with ALP treatment (P < 0.02). The rate of severe post operative PVR was 64% (16/25 eyes) in eyes with grade C-D PVR preopera tively versus 31.8% (14/44 eyes) in eyes with no PVR or grade B PVR pr eoperatively (P < 0.01). In eyes managed with the use of ALP treatment the rate of severe postoperative PVR remained influenced at a statist ically significant level (P < 0.005) by the presence of grade C-D PVR preoperatively. Grade C-D PVR was significantly more frequent preopera tively in patients with visual symptoms of 3 week-duration or more at initial examination (23/24 patient, 95.8%), than in those with visual symptoms under 3 week-duration (8/41 patients, 19.5%) (P:0.0005). Conc lusion The results suggest that the high incidence of severe postopera tive PVR in giant retinal tears may be decreased by 1) early managemen t before the occurrence of PVR and 2) the use of argon laser photocoag ulation rather than cryotreatment as the method of creating a choriore tinal scar.