Frank Becquet Nantes, France

Purpose:

Increases in aqueous flare intensity indicate the breakdown of the ocular blood-aqueous barrier. This condition could partly influence proliferative vitreoretinopathy (PVR) development in rhegmatogenous retinal detachment (RD) because increased proteinaceous flare in the intraocular fluids is probably a stimulus to further cellular proliferation. Thus, changes in aqueous protein concentration in RD at different PVR grades were investigated.

Methods:

A prospective study of 241 patients presenting unilateral RD (PVR stage 0 to C) was performed. Laser cell-flare meter (LFM) analysis have been realised for each patient the day before, 2 days after and then 30 days after surgical treatment. Surgical treatment consisted in scleral buckling with cryotherapy with/without gas tamponade or vitrectomy. Statistical analyses were made to characterize flare status of each PVR stage. Uni-and multidimensional analyses were used to calculate the one month prognosis (recurrence or not) value of 10 clinical and LFM variables.

Results:

The aqueous flare increases significantly with the PVR stages (stage 0: 5 photons/msec to stage C3: 91 photons/msec preoperatively). Multidimensional analyses demonstrated that the following variables to have an independent unfavourable prognosis value were: RD extension, number of cryoapplication, break’ size, important aqueous flare. Statistical analyses also allow giving a specific discriminant value to RD extension and to preoperative important aqueous flare. This enables to enhance the PVR classification.

Conclusion:

LFM exam of the anterior chamber has a better predictive value than PVR classification. This clinical classification would be ameliorated, in term of prognosis, with the regular use of the LFM exam. This would lead to a more personalised preoperative medical care and surgical strategy.