CRYOPEXY IN PRIMARY RHEGMATOGENOUS RETINAL-DETACHMENT - A RISK FACTORFOR POSTOPERATIVE PROLIFERATIVE VITREORETINOPATHY

Purpose: To evaluate the role of cryopexy in the stimulation of postop erative proliferative vitreoretinopathy (PVR) in primary rhegmatogenou s retinal detachment. Materials and methods: A series of 595 eyes of 5 54 patients with primary rhegmatogenous retinal detachment, referred b efore any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted. Results : The incidence of postoperative PVR in relation to the methods used f or retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PV R was nil in retinal detachments due to atrophic holes in lattice, ora l dialyses, and macular holes, regard less of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horses hoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P<0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile p osterior edges vs 9.72% in eyes with horseshoe tears with curled poste rior edges, regardless of the retinopexy methods (P<0.00001). In retin al detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retino pexy methods. In contrast, in retinal detachments due to horseshoe tea rs with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed wit h laser retinopexy (1.78%) (P<0.02). In retinal detachments due to gia nt tears the incidence of postoperative PVR was not statistically sign ificantly greater in eyes managed with cryopexy (33.3%) than in eyes m anaged with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly h igher in eyes managed with cryopexy (9/11 eyes) than in eyes managed w ith laser retinopexy (5/17 eyes) (P=0.006). Conclusions: Cryopexy is n ot a stimulating factor for postoperative PVR in primary rhegmatogenou s retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In con trast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior e dges or to retinal tears 180 degrees and over.