Asaria, Riaz Hassan Yusuf; (2002) Proliferative vitreoretinopathy (PVR) - The use of adjuvant therapy in the preventative treatment of PVR and the study of clinical and biological risk factors. Doctoral thesis (M.D.), UCL (University College London).

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Abstract

Proliferative vitreoretinopathy (PVR) is a major cause of failure of retinal detachment surgery and is thought to complicate 5 to 10% of all detachments. This thesis has investigated the use of adjuvant therapy in the preventative treatment of PVR and the identification of clinical and biological risk factors involved in PVR. A prospective randomised control study was conducted comparing intravitreal infusion of either 5 Fluorouracil (5-FU) and heparin or placebo in high-risk patients undergoing primary vitrectomy for rhegmatogenous retinal detachment surgery. There were 87 patients in each group. The incidence of postoperative PVR was significantly lower (P=0.019) in the treatment group. Of the placebo group 26.4% (23/87) and 12.6% (11 /87) of the 5-FU/heparin group developed postoperative PVR. In the 5-FU/heparin group the number of patients undergoing more than one operation was 19.5% (17/87) and the number of reoperations due to PVR was 52.9% (9/17). In the placebo group the number of patients undergoing more than one operafion was 25.3% (22/87) and the number of reoperations due to PVR was 72.7% (16/22). Patients in the placebo treated group had a significantly worse visual acuity outcome (p=<0.05). This study also investigated the accuracy of a "predictive risk formula" for the development of PVR and to assess its use in a clinical setting. Complete data were available on 214 out of 220 patients. Nine point two percent of the low risk (12/130) and 27.4% (23/84) of the high risk patients developed postoperative PVR (p<0.0001). Further risk factor analysis was also performed on these patients. Multiple regression analysis revealed only the existence of preoperative PVR, higher levels of bFGF and protein to be significant independent risk factors (p<0.05) for the development of PVR. Combined multiple logistic regression on clinical and biological risk factors revealed only preoperative PVR to be a significantly independent risk factor (p=0.01) for the development of postoperative PVR.

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