Vitreous Cortex Remnants After Retinal Detachment Surgery Do Not Trigger PVR, ERM

Vitreous cortex remnants (VCR) that persist after pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment (RRD) are not likely to result in proliferative vitreoretinopathy (PVR) or epiretinal membrane (ERM), according to a report published in Clinical Ophthalmology.

The prospective investigation included 103 eyes of 103 participants with acute, primary RRD undergoing PPV — without perfluorocarbon liquid or internal limiting membrane (ILM) peel, and no vitreous cortex remnant removal. Patients were treated and followed for 6 months or more from January 2019 to December 2020. Researchers used triamcinolone acetonide injection to uncover the patterns, extent, locations of vitreous cortex remnants.

Vitreous cortex remnants were detected in 61 eyes (59.2%); 54 of which displayed VCR over the macula (mVCR). Of those with peripheral vitreous cortex remnants (pVCR), 40 eyes exhibited VCR in 2 to 4 retinal quadrants, 31 eyes in all 4 quadrants, and 40 eyes had VCR in 1 to 2 inferior quadrants. At 6 months, proliferative vitreoretinopathy grade C developed in 6 eyes (5.8%), repeated RRD in 9 (8.7%), and ERM in 11 (10.7%).

Multivariate regression analysis revealed no correlation between proliferative vitreoretinopathy and the presence of peripheral vitreous cortex remnants — instead, the disorder appears significantly correlated with female sex (P =.016) and slightly with macula-off RRD (P =.056). In addition, mVCR had no correlation with subsequent ERM formation.

Two large analyses with conservative approaches showed 84.4% to 95.0% single-operation success using small-gauge PPV. Alternately, a set of 2 successive trials examining eyes with pVCR found differences at 3 months: 7.6% re-detachment from PVR after leaving remnants vs 2.1% PVR rate with removal.

There has also been substantial data to indicate taking away vitreous cortex remnants when RRD coincides with high myopia as a way to inhibit retinal stiffness.

“We believe that these preliminary findings indicating VCR and PVR are unrelated will be helpful to surgeons doing PPV, allowing for a quicker, safer, and less challenging surgery,” according to the researchers.

Limitations of this study comprised a short follow-up period, possible selection bias of those with new, simple RRD, no control group of patients with vitreous cortex remnant removal, and a relatively small sample size. Considering proliferative vitreoretinopathy is a more uncommon occurrence, it necessitates a greater number of eyes for definitive trend analysis.