Use of perfluorocarbon liquids in proliferative vitreoretinopathy: results and complications.

BACKGROUND--The present study was set up to evaluate the influence of perfluorocarbon liquids on the postoperative anatomical and functional results as well as on the complication rates in eyes with proliferative vitreoretinopathy (PVR). METHODS--Sixty five consecutive eyes (64 patients) with PVR in different stages requiring surgical intervention where liquid perfluorocarbons were used were compared with 64 consecutive eyes (62 patients) operated without the help of perfluorocarbon immediately before this time. Both groups were similar with regard to severity of PVR, number of operations, and initial visual acuity. The observation period was shorter in the perfluorocarbon group because they were operated more recently (17.4 months as against 24.4 months). RESULTS--The anatomical as well as the functional success rates were not significantly higher in the perfluorocarbon group (69% v 61% and 65% v 53% respectively). However, in cases operated on without perfluorocarbons where reproliferation would occur it was of much greater severity than in cases where perfluorocarbons were used. The number of uncured cases with contraction of the retina at least in the inferior half was more than twice as high in the group operated on without perfluorocarbon. Combined with massive reproliferation secondary glaucoma and bullous or band keratopathy were more frequent in eyes treated before the use of perfluorocarbon. CONCLUSION--The intraoperative use of perfluorocarbon liquids in vitreoretinal surgery does not prevent postoperative reproliferation but does reduce its severity.     

Evaluation of radiation therapy for experimental proliferative vitreoretinopathy in rabbits

We evaluated effects of radiation therapy on experimental proliferative vitreoretinopathy (PVR) induced in rabbits by double gas compression of the vitreous followed by homologous dermal-skin fibroblast injection. Electrons were irradiated in two rabbit groups. Group A animals (20 eyes) received 1000 cGy of irradiation immediately after cell injection; group B rabbits (9 eyes), which showed pucker formation 7 days after cell injection, were irradiated on that day at the same dose as was given to group A rabbits. Control animals (14 eyes) were not irradiated. The incidences of traction retinal detachment on day 28 were: control, 86%; group A, 10%; and group B, 22%. There were statistically significant differences between control and group A values and between control and group B values. No significant difference was found between group A and group B. Irradiation of 1000 cGy did not alter the histological picture of experimental PVR. The results showed that radiation suppressed the development of PVR when applied not only immediately after cell injection but also during pucker stages.This study was partly supported by Grant-in-Aids for Scientific Research A-61440075 and 01010042 from the Ministry of Education, Science and Culture of the Japanese government     

The antiproliferative effect of fractionized radiation therapy: Optimization of dosage

Fractionized radiation therapy with high-energy electrons have proven to reduce retinal detachment rate from 85% to 5% in the fibroblast model using a dosage of 3000 rad, starting from the first postoperative day. The purpose of this study is to gain more information about the therapeutic range of fractionized radiation therapy in experimental PVR. We therefore investigated the efficacy of this therapy when the total dose is reduced to 2000 rad. Irradiation treatment started on the first postoperative day. Eight weeks after cell implantation 5 of 14 eyes (35%) in the irradiated group and 15 of 16 eyes of the control group (93%) showed traction detachment. The statistically significant result proves a broad therapeutic range of fractionized radiation therapy in experimental PVR. We believe that a combination with antiinflammatory drugs could lead to a dose reduction in both therapies in patients.     

The lack of an effect of intraocular steroids on irradiated fibroblasts in experimental proliferative vitreoretinopathy

Contraction of intraocular membranes is an important event in the development of proliferative vitreoretinopathy (PVR). When sufficient numbers of cells are present in the vitreous cavity, the retina usually detaches as a result of the contractive force generated by these cells. Steroids reduce the occurrence of retinal detachments in rabbit models of PVR by inhibiting the proliferation of injected fibroblasts. In this study, we used non-proliferative, irradiated cells to determine a possible effect of steroids on preretinal membrane contraction in PVR. We found no clinical difference between steroid treated eyes and sham-treated control eyes. Surgical reduction of the contractile tissue and medical therapy to prevent reproliferation are necessary in order to treat PVR effectively. Offprint requests to: R. MachemerThis study was supported by the National Eye Institute, Grant EYO 2903, Research to Prevent Blindness, Alcon Laboratories, and the Helena Rubinstein Foundation     

Irradiation pretreatment before fibroblast implantation in experimental PVR

Fibroblast injection into the vitreous body causes traction detachment in the rabbit's eye. Various working groups reported different results on the main causes of the development of experimental PVR. These contradictions encouraged us to investigate the main source of experimental PVR by irradiating the ocular tissues before fibroblast implantation thus suppressing cell proliferation originating from host tissue. Over a period of 3 weeks, 22 eyes received ten radiations in a total dosage of 3000 rad. After the last radiation, 250,000 fibroblasts were implanted into 22 eyes. In another 4 eyes, fibroblast implantation but no radiation was carried out. After 8 weeks, 59% of 22 eyes developed different stages of retinal detachment. Comparison with the group of unirradiated eyes, which developed retinal detachment in 85%, revealed no significant differences in the number of detachments.Abbreviation PVR proliferative vitreoretinopathy     

Perfluorocarbon liquids as postoperative short-term vitreous substitutes in complicated retinal detachment

To avoid postoperative compartmentalization of the vitreous cavity, which can potentially accelerate the recurrence of proliferative vitreoretinopathy (PVR), 32 eyes of 32 selected patients with complicated retinal detachment were managed with lensectomy, vitrectomy, 5-day internal tamponade with perfluorocarbon liquids (PFCL) and postoperative supine positioning until PFCL removal. Intraoperatively, 19 eyes had grade C3 or greater PVR; 10 eyes exhibited ocular trauma and 6 displayed giant tears. All but 5 patients (PFCL/fluid exchange) underwent PFCL/silicone oil exchange 5 days after surgery. Anatomic attachment of the retina was achieved with one operation in 25 (78%) of the 32 eyes with a median follow-up of 8 months (mean 8.4 months). Of the 20 eyes that underwent silicone oil removal, none redetached. Nineteen eyes (61 %) showed no or only mild reproliferation; a macular pucker developed in 50% of the 20 eyes successfully reattached after PFCL/silicone oil exchange and in none of the 5 eyes successfully reattached after PFCL/fluid exchange. Intraocular tolerance of PFCL for up to 5 days of internal tamponade appeared to be good as judged by static threshold perimetry in the two patients tested and by our functional outcomes, with 88% of the reattached eyes showing a final visual acuity of 5/200 or better.Presented as oral communication at the Association for Research in Vision and Ophthalmology (ARVO) Annual Meeting, Sarasota, 3–9 May 1992     

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features,surgical techniques,and long-term results

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.     

Does the presence of heparin and dexamethasone in the vitrectomy infusate reduce reproliferation in proliferative vitreoretinopathy?

Background: Reproliferation following vitrectomy for proliferative vitreoretinopathy (PVR) causes redetachment in up to 55% of cases. Heparin and corticosteroids have each been shown to inhibit the development of proliferative vitreoretinopathy (PVR) in experimental models. However, little information is available on the use of these agents in humans. Methods: In this pilot study, 62 eyes of 62 patients with severe PVR requiring vitrectomy were prospectively randomized to receive either BSS Plus (control) or BSS Plus with heparin and dexamethasone (HD) in the infusate. Results: After one operation, the retina was reattached 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 developed in 26.5% of the control group (9 of 34 eyes) and 16% of the HD group (4 of 25 eyes; P = 0.26). Postoperative hemorrhage was significantly more frequent in the HD group (P = 0.02) but did not influence final visual or anatomic outcome. Hypotony was less frequent in the HD group but the difference was not significant (P = 0.063). Conclusion: The trend from this randomized pilot study suggests that HD supplementation of the vitrectomy infusate may reduce the reproliferation rate in PVR and possibly reduce the rate of hypotony. Postoperative hemorrhage was more frequent with HD but did not cause redetachment or alter visual outcome. A multicenter trial involving more patients would be required to better evaluate the efficacy of HD as a pharmacologic adjunct to PVR surgery.Presented at the American Academy of Ophthalmology Meeting, Dallas, 12 November 1992     

Extensive peripheral retinectomy combined with posterior 360 degrees retinotomy for retinal reattachment in advanced proliferative vitreoretinopathy cases

Posterior 360 degrees retinotomy in conjunction with extensive peripheral retinectomy was necessary for retinal reattachment in 18 eyes. A visual acuity of 20/400 or better was achieved in 22% of the patients; in patients with rubeosis, regression was found in 89%. Of the hypotonus eyes, preoperatively 78% were normotensive postoperatively after removal of anterior proliferative vitreoretinopathy (PVR) covering ciliary epithelium. The major intraoperative complication was hemorrhage, which could be readily controlled. Recurrent retinal detachment (RD) occurred in 39% and reproliferation in 50% of the patients.     

Long-term outcomes of heavy silicone oil tamponade for complicated retinal detachment

PURPOSE: To assess the long-term success rates and complications of heavy silicone oil tamponade (Oxane HD) in the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR). METHODS: Twenty-one eyes of 21 patients with complicated retinal detachment and PVR were included in this study. Vitreoretinal surgery with heavy silicone oil (Oxane HD) tamponade was performed in all patients. Heavy silicone oil was injected by perfluorocarbon liquid-air-silicone oil exchange, and was removed after 3 months. The main outcomes of the surgery including the success and complication rates were evaluated during the mean follow-up period of 11.4+/-0.88 months. Wilcoxon signed ranks test was used for statistical analysis of visual acuity changes. The outcomes of our study were compared with those of the previous studies. RESULTS: All eyes had complicated retinal detachment with PVR Grade C3 or worse. Retinal detachment was rhegmatogenous in 6 eyes, secondary to previous detachment surgery in 11 eyes, secondary to proliferative diabetic retinopathy in 3 eyes, and secondary to perforating eye injury in 1 eye. The overall anatomic success rate was 80.9% at the end of the follow-up period. The overall visual success rate was 42.8%, with no statistically significant difference from baseline (p>0.05). Postoperative complications included severe reproliferation (4 eyes), intraocular pressure rise (3 eyes), anterior dislocation of silicone oil (2 eyes), posterior subcapsular cataract formation (4 eyes), vitreous hemorrhage (1 eye), rubeosis iridis (3 eyes), optic atrophy (1 eye), and ocular pain and photophobia (21 eyes). CONCLUSIONS: According to the results of this study, vitreoretinal surgery with temporary heavy silicone oil tamponade appears to increase the anatomic success rates with minimal complication rate in cases with complicated retinal detachment and PVR.     

丝裂霉素C提高人工鼻泪管治疗慢性泪囊炎疗效的意义

目的探讨丝裂霉素C（MMC）对提高人工鼻泪管植入术治疗慢性泪囊炎疗效的意义。方法89例（98眼）慢性泪囊炎分为治疗组和对照组。对照组采用人工鼻泪管植入术,而治疗组在人工鼻泪管植入术中及术后7d使用0．02％MMC0．5mL注入泪道。结果术后随访10～12个月,治疗组36眼中有35IliON道冲洗通畅,对照组62眼中有53眼泪道冲洗通畅,差异有统计学意义（P=0．004）。结论在人工鼻泪管植入术中、术后应用MMC是一种能提高远期疗效的安全、有效的辅助措施。     

伴严重增殖性玻璃体视网膜病变视网膜脱离的玻璃体手术及失败原因探讨

本文报导采用现代玻璃体手术结合巩膜扣带、空气或硅油填塞治疗81例伴严重增殖性玻璃体视网膜病变(PVR)视网膜脱离的手术效果.经过6～28个月(平均14个月)的随访,视网膜完全平伏者54例,成功率66.7%,对极严重的PVR D(?)(闭斗状脱离)也取得50%的成功率.硅油填塞初步应用于极严重病例尤其是巨大裂孔的治疗,取得明显的效果.本文病例术后视力提高者50例,不变19例,下降12例,术后视力在0.05以上者共34例.认为玻璃体手术结合其它技术是伴严重PVR手术治疗的有效方法,提出进一步提高PVR治疗成功率的方法:彻底清除增殖膜及寻找一种有效抑制膜增殖而对眼内其它组织无毒性的药物。指出旧的PVR分级法存在的不足,推荐用于硅油研究的PVR新的分级法.     

非常复杂型视网膜脱离的治疗探讨

目的:探讨治疗非常复杂型视网膜脱离的方法。方法:31例(31眼)非常复杂型视网膜脱离,包括原发性裂孔性视网膜脱离伴PVR-D3级及前段玻璃体严重增殖者14只眼;巨大裂孔性视网膜脱离伴严重PVR 8只眼;严重眼外伤伴眼内容物脱出及严重PVR 9只眼。采用巩膜冷凝、环扎、硅胶填压、玻璃体切割、视网膜前膜剥离/切除,视网膜松解性切开,过氟化碳液体注入,眼内/眼外排液以及硅油眼内填充等方法治疗。结果:随访3～16个月,31眼中,21只眼视网膜完全复位,占67.7％;5只眼大部分复位,占16.1％;5只眼未能复位,占16.1％。术后视力,除了失败的5只眼外,在其余的26只眼中,有一眼视力较术前下降,其余25只眼的视力均有不同程度的提高。结论:PVR及巨大裂孔性视网膜脱离的效果较好,分别有71.4％及87.5％完全复位,严重外伤的治疗效果较差。眼科学报1998;14:90—93。     

Steamroller versus basic technique in pneumatic retinopexy for primary rhegmatogenous retinal detachment

PURPOSE: To compare the effectiveness and safety of the "basic" technique with those of the "steamroller" technique in pneumatic retinopexy (PR) for primary rhegmatogenous retinal detachment. METHODS: In this prospective study, 40 eyes of 40 patients with primary rhegmatogenous retinal detachment were treated with PR by argon laser photocoagulation. PR with the steamroller technique (steamroller group) was performed randomly on 21 eyes of 21 patients, and 19 eyes of 19 patients were treated with PR with the basic technique (basic group). Main outcome measures were visual acuity, anatomical outcome, rate of proliferative vitreoretinopathy (PVR) development, and postoperative complications. RESULTS: Mean follow-up +/- SD was 14.7 +/- 9.9 months (range, 6-48 months). Single-operation success rate for all patients was 70% (28/40 eyes). Single-operation success rate was 74% (14/19 eyes) for the basic group and 67% (14/21 eyes) for the steamroller group (P = 0.629). PVR grade C-1 developed in one eye (5%) in each group. Overall success rate, after reoperations, was 100% for each group. Preoperative logMAR (logarithm of the minimum angle of resolution) visual acuity +/- SD was 2.01 +/- 0.43 in the basic group and 1.89 +/- 0.45 in the steamroller group (P = 0.434). Postoperative logMAR visual acuity +/- SD was 0.64 +/- 0.42 in the basic group and 0.46 +/- 0.35 in the steamroller group (P = 0.152). There was no statistically significant difference between basic and steamroller groups in terms of postoperative complications (P > 0.05). CONCLUSION: Basic and steamroller techniques appear to be equally effective and safe in PR for primary rhegmatogenous retinal detachment. The risk for PVR development seems to be similar with either technique. Further studies with a large number of patients are required for a more reliable conclusion.     

Results of silicone oil injections in various stages of proliferative vitreoretinopathy

One hundred patients suffering from proliferative vitreous retinopathy (PVR) at various stages underwent vitrectomy in combination with silicone oil injection. Retinal reattachment and navigating visual acuity were be achieved in the medium term in 75% of the patients with early PVR. In the cases where the condition was more advanced, with extended shortening of the retina there was a high rate of reproliferation, with the result that medium-term navigating visual acuity could only be achieved in a few cases. At the moment the major problem of PVR is postoperative epiretinal reproliferation.     

Radiotherapy for choroidal neovascularization (CNV) in age-related macular degeneration (AMD)

AIM OF THE STUDY: Several pilot studies have indicated, that radiation therapy might have a beneficial effect on the course of CNV in AMD. This controlled study was aimed at the question, whether such treatment might halt progression of neovascular AMD and whether a low or a high radiation dose should be applied. METHODS AND PATIENTS: Enclosed were patients aged > or = 60 and < or = 85 and eyes with a VA of > or = 0.1 and < or = 0.6, revealing a juxta/subfoveal CNV either of the occult or the classic type. Treatment was performed with a linear accelerator at fractions of 2 Gy up to a total dose of 10 Gy or 36 Gy. 95 eyes had completed follow-up of > or = 12 < or = 24 months. RESULTS: Among eyes with occult CNV 8 received 36 Gy, 16 were treated with 10 Gy and 21 were in the control group. Mean visual loss was 3.5 lines after 12 months and 5 lines after 24 months with no difference between irradiated eyes and those in the control group. In the groups with classic CNV 8 eyes were treated with 36 Gy, 27 eyes received 10 Gy and 15 eyes were in the control group. Mean visual loss after 6 months was 2.2 lines in eyes of both groups treated with radiation and 5.7 lines in the control group. This was statistically significant (p < 0.05). VA was < 0.1 after 12 (24) months of follow-up in 50 (75)% of the cases with 36 Gy, in 48 (83)% with 10 Gy and in 60 (83)% of the controls. These results were statistically significant after 12 months only. DISCUSSION AND CONCLUSIONS: The natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In eyes with classic CNV a VA of > or = 0.1 was maintained significantly more often in irradiated eyes than in those of the control group. Treatment with 36 Gy however was associated with an unacceptable incidence of radiation retinopathy.     

Outcome of temporary silicone oil tamponade in complex rhegmatogenous retinal detachment

PURPOSE: To evaluate the anatomic and visual outcomes and complications of temporary silicone oil (SO) retinal tamponade in patients with complex rhegmatogenous retinal detachments (RD). METHODS: The retrospective study included 100 eyes of 93 consecutive patients. Indications for the use of SO were proliferative vitreoretinopathy (PVR) (30 eyes), difficult RD (30 eyes), giant retinal tears (17 eyes), RD after penetrating trauma (14 eyes), and macular holes in highly myopic eyes (9 eyes). Vitrectomy surgery was performed with 5000-centistoke SO as the retinal tamponade. All eyes underwent prophylactic 360 degree retinopexy at the time of the retinal reattachment operation. The mean duration of SO tamponade was 26.4 weeks, with a mean follow-up of 67.5 weeks after removal of SO. RESULTS:. In 6 of 100 eyes (6%), the retina redetached after removal of SO. Including the successfully reoperated eyes, the final anatomic success rate was 96%. Other complications were cataract (61%), increased intraocular pressure (13%), hypotony (4%), keratopathy (4%), intravitreal hemorrhage (1%), and suprachoroidal hemorrhage (1%). Correspondence analysis demonstrated that redetachment and hypotony were associated with PVR and trauma. Overall, good visual outcome (20/200 or better) was achieved in 51% of the whole study group, and in 70.6% of eyes with giant tears, 62.1% of eyes with difficult RD, 44.8% of eyes with PVR, 33.3% of eyes with macular holes, and 28.6% of eyes with trauma (p=0.0382). Logistic regression analysis identified initial visual acuity of 20/200 or better as a factor associated with good visual outcome and occurrence of retinal redetachment/hypotony and old age ( > or = 50 years) as factors negatively associated with good visual outcome. CONCLUSIONS: The low redetachment rate might be due to prophylactic 360 degree retinopexy. Giant tears had the best visual outcome. Redetachment/hypotony had a negative impact on achievement of good visual outcome and were associated with PVR and trauma.     

Vitrectomy and scleral buckling methods for proliferative vitreoretinopathy

The authors operated on 95 eyes with retinal detachment (RD) complicated by proliferative vitreoretinopathy (PVR) using vitrectomy combined with scleral buckling. The retina was successfully reattached in 10 (91%) of 11 eyes with mild PVR (B, C1), 14 (93%) of 15 eyes with moderate PVR (C2-C3), and 52 (75%) of 69 eyes with severe PVR (D1-D3). Thirteen (88%) of 15 eyes in which silicone oil was injected were successfully reattached. Eighty-eight percent of the 76 successfully reattached cases had a postoperative visual acuity of 5/200 or better; the median postoperative visual acuity was 20/200. Severe PVR was the cause of failure in 17 (89%) of 19 eyes in which the retina was not reattached.     

Combined 5-fluorouracil, low-molecular-weight heparin, and silicone oil in the management of complicated retinal detachment with proliferative vitreoretinopathy grade C.

BACKGROUND AND OBJECTIVE: To determine whether combined 5-fluorouracil (5-FU) and low-molecular-weight heparin (LMWH) could improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with proliferative vitreoretinopathy (PVR) grade C. PATIENTS AND METHODS: In an interventional, controlled, nonrandomized clinical trial, 33 eyes with complicated retinal detachment and PVR underwent vitrectomy with silicone oil and perioperative infusion of 5-FU and LMWH (study group) and 31 eyes underwent vitrectomy with silicone oil without adjunctive medication (control group). RESULTS: In the study group, 24 eyes (72.7%) had the retina attached and 9 had a retinal redetachment (27.3%) at 6 months. In the control group, 25 eyes (80.6%) had the retina attached and 6 eyes (19.4%) had a retinal redetachment at 6 months (chi-square: 0.53, P > .05). One-year postoperative data were available for 17 eyes in the study group and 19 eyes in the control group. Four eyes in each group (23.5% and 21%, respectively) developed retinal redetachment (chi-square: 0.03, P > .05). CONCLUSIONS: Combined 5-FU and LMWH does not seem to improve the outcome of vitreoretinal surgery with silicone oil for the management of complicated retinal detachment with PVR grade C.     

Functional outcome and prognostic factors in 304 eyes managed by retinectomy

BACKGROUND: This study was undertaken to relate the anatomic and functional results of patients who underwent retinectomy for complex retinal detachment (RD) to preoperative prognostic variables. METHODS: Three hundred and four eyes of 302 patients whose surgery involved retinectomy were included in the analysis. All eyes had established proliferative vitreoretinopathy (PVR grade C). The main outcome measures were (1) postoperative visual acuity of 6/24 or better, (2) status of the retina at the end of follow-up, and (3) incidence of hypotony whilst under review. RESULTS: PVR was secondary to rhegmatogenous RD in 237 eyes (78%), posterior trauma in 51 eyes (16.8%), tractional RD in vasoproliferative vasculitides in 12 eyes (4%), acute retinal necrosis in 2 eyes and endophthalmitis in 2 eyes. Complete reattachment rate after one operation was 51%, with final complete reattachment success rate of 72%. The visual acuity improved in 138 eyes (45%), remained the same in 73 eyes (24%) and became worse in 89 cases (29%). Postoperative visual acuity of 6/24 or better was significantly associated with preoperative vision, the duration of silicone oil tamponade, silicone oil removal and retinectomy size. There was also some evidence of association between visual outcome and the number of clock hours of retinal detachment. Final retinal attachment was significantly associated with silicone oil removal and preoperative vision, and final hypotony was significantly associated with silicone oil removal. The incidence of sympathetic ophthalmia in our study was 0.09% (one case). CONCLUSIONS: Good functional outcome is possible following retinectomy surgery despite advanced pathology and often multiple surgical procedures. Retinal redetachment as a result of reproliferation and hypotony appear to be the main reasons for anatomical and functional failure. The clinical features we have identified as good indicators for improved final visual acuity such as shorter tamponade duration, removal of silicone oil, smaller retinectomy size, fewer previous operations and better preoperative vision are surrogate markers of less advanced PVR and should prompt retinal surgeons to consider retinectomy at an earlier stage in the process of PVR development. Clinicians should be aware of the small risk of sympathetic ophthalmia from complex retinal surgery.