We reviewed the records of all patients with rhegmatogenous
retinal detachments examined and treated by a single surgeon (B.P.C.) at the University of Virginia, Charlottesville, between 1978 and 1984. Of the 607 eyes that satisfied the selection criteria, a preliminary chart review of outcomes found that 65 (10.7%) had
proliferative vitreoretinopathy and 34 had
macular puckers. From the remaining 508 eyes, 325 controls were randomly selected to match each case from within a time window. Thirty-six (55.4%) of the 65 patients with
proliferative vitreoretinopathy had had unequivocal reattachment after a single procedure before the onset of
proliferative vitreoretinopathy, and the only clearly identified technical difficulty that was significantly more common in the patients with
proliferative vitreoretinopathy was the inability to identify a
retinal break. Several other features of the rhegmatogenous
retinal detachments that correlated with the development of postoperative
proliferative vitreoretinopathy were identified, and stepwise discriminant analysis was used to ascertain which of these were more important. The strongest predictor was use of
vitrectomy in management of the detachment. Following this in order of importance were the presence of preoperative
proliferative vitreoretinopathy, preoperative
choroidal detachment, and the amount of cryopexy required.
Vitrectomy remained a strong predictor even when considered after adjustment for all other characteristics. These data suggest that
proliferative vitreoretinopathy is not simply an
iatrogenic disease, but it is more likely to occur in association with certain detachment features that either by themselves or through their management require prolongation of the
retinal wound healing process.