ASSOCIATION BETWEEN IRIS MANIPULATION DURING PHACOVITRECTOMY FOR RETINAL DETACHMENT REPAIR AND PROLIFERATIVE VITREORETINOPATHY.

Abstract

To determine if iris manipulation during phacovitrectomy for retinal detachment repair is associated with the development of proliferative vitreoretinopathy (PVR). Single-center, comparative, retrospective cohort study of 536 eyes who underwent phacovitrectomy for cataract extraction and retinal detachment repair between 2013 and 2024. Eligible eyes had at least 3-month follow-up. Iris manipulation was defined as mechanical pupillary expansion or synechiolysis. Patients with a history of uveitis were excluded. The primary outcome was the development of PVR, and secondary outcomes included the development of other postoperative complications. Of the included eyes, 66 were in the iris manipulation group and 470 were in the control group. The average follow-up time was 18.9 ± 16.0 weeks. Among the 34 eyes without baseline PVR in the iris manipulation group, 5 eyes (14.7%) developed PVR. Among the 282 eyes without baseline PVR in the control group, 12 (4.3%) developed PVR. After adjusting for patients who had previous retinal surgery in an additional regression analysis, iris manipulation remained a significant predictor for PVR development (odds ratio 3.64; P = 0.038). There were no significant differences in the odds ratio for the development of the other postoperative complications between the groups. Iris manipulation during phacovitrectomy for retinal detachment repair and cataract extraction was significantly associated with development of PVR in the absence of active inflammation, despite a similar profile of other postoperative complications. These findings highlight the potential role of iris trauma in amplifying intraocular inflammation and contributing to PVR pathogenesis.