DOES THE PRESENCE OF HEPARIN AND DEXAMETHASONE IN THE VITRECTOMY INFUSATE REDUCE REPROLIFERATION IN PROLIFERATIVE VITREORETINOPATHY

Background: Reproliferation following vitrectomy for proliferative vit reoretinopathy (PVR) causes redetachment in up to 55% of cases. Hepari n and corticosteroids have each been shown to inhibit the development of proliferative vitreoretinopathy (PVR) in experimental models. Howev er, little information is available on the use of these agents in huma ns. Methods: In this pilot study, 62 eyes of 62 patients with severe P VR requiring vitrectomy were prospectively randomized to receive eithe r BSS Plus (control) or BSS Plus with heparin and dexamethasone (HD) i n the infusate. Results: After one operation, the retina was reattache d in 42 (71%) of 59 eyes: 22 (65%) of 34 eyes in the control group and 20 (80%) of 25 eyes in the HD group (P=0.16). Reproliferation develop ed in 26.5% of the control group (9 of 34 eyes) and 16% of the HD grou p (4 of 25 eyes; P=0.26). Postoperative hemorrhage was significantly m ore frequent in the HD group (P=0.02) but did not influence final visu al or anatomic outcome. Hypotony was less frequent in the HD group but the difference was not significant (P=0.063). Conclusion: The trend f rom this randomized pilot study suggests that HD supplementation of th e vitrectomy infusate may reduce the reproliferation rate in PVR and p ossibly reduce the rate of hypotony. Postoperative hemorrhage was more frequent with HD but did not cause redetachment or alter visual outco me. A multicenter trial involving more patients would be required to b etter evaluate the efficacy of HD as a pharmacologic adjunct to PVR su rgery.