Proliferative Retinal Detachment Follow-up

Updated: Sep 26, 2017
  • Author: Steve Charles, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Follow-up

Further Outpatient Care

All patients must be examined on the first postoperative day to determine if increased IOP, flat chamber, incorrect patient positioning, or endophthalmitis (a rare finding) is present. Most patients are then examined in 1-3 weeks.

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Further Inpatient Care

Outpatient surgery for vitreoretinal surgery is the criterion standard. Concomitant medical conditions should determine the need for an inpatient approach.

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Inpatient & Outpatient Medications

Topical fourth-generation fluoroquinolones (Vigamox) are used 4 times/day for approximately 1 week after surgery. All patients receive subconjunctival cefazolin (vancomycin if allergic to penicillins) and subconjunctival ceftriaxone at the end of surgery. Systemic antibiotics are not indicated.

Topical cycloplegics, such as Cyclogyl 1%, are used 2-3 times/day for 2-3 weeks after surgery.

Subconjunctival steroids, such as Kenalog (triamcinolone acetonide), are used in all patients except those who are steroid responders. The author never uses systemic steroids in these patients.

Topical steroids are used in all patients who are not steroid responders. The drops are administered 4 times/day. Prednisolone acetate 1% is the preferred agent.

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Transfer

General ophthalmologists should transfer patients with proliferative vitreoretinopathy (PVR) to vitreoretinal surgeons.

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Deterrence/Prevention

Excessive retinopexy (especially cryopexy), operating on inflamed eyes, bleeding, iris trauma, excessive operating times, retained lens material, viscoelastics, and excessive operative trauma contribute to recurrent proliferative vitreoretinopathy.

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Complications

Recurrent proliferative vitreoretinopathy is the most common complication, occurring at a frequency of 25-50%. [8, 14, 23, 24]

Cataracts may occur from prolonged gas or silicone oil contact with the lens.

Uveitis may occur from excessive retinopexy, lengthy surgery, iris trauma, or retained lens material.

Intravitreal, anterior chamber, subretinal, or suprachoroidal hemorrhage may occur.

Glaucoma secondary to uveitis, excessive gas bubbles, pupillary block, silicone oil emulsification and surgical trauma to vortex veins or aqueous veins may occur. Steroid-associated glaucoma due to injected or topical steroids may also occur.

Ocular or periocular manifestations are as follows:

  • Retina - Epiretinal membranes, fixed folds, star folds, and subretinal placoid or dendritic proliferation

  • Vitreous - Condensation, contraction, pigmentation, and posterior vitreous detachment [14, 23, 24]

  • Other - Visual loss

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Prognosis

The anatomical success rate is dependent on the patient mix, the technique used, unknown patient factors, and the surgeon's skill. The success rate of anatomical reattachment ranges from 50%-90%. [14, 23, 24] The success rate decreases with an increasing number of surgical procedures performed on the eye.

The visual prognosis is dependent on location, duration and height of the detachment, media clarity, epimacular membranes, and other unknown factors.

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Patient Education

Inform the patients about positioning, activity, visual prognosis, complications, medications, anesthesia risk factors, and anatomical and visual success rates.

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