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Frank S Siringo, Jeffrey Olson, Scott Oliver, Marc Mathias, Naresh Mandava, Jesse M Smith; Tobacco Use as a Risk Factor For Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):1414.
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© ARVO (1962-2015); The Authors (2016-present)
Proliferative vitreoretinopathy (PVR) is “the most common cause of failure in retinal detachment surgery". Risk factors include aphakia, vitreous hemorrhage, number/size of breaks, quadrants involved, choroidal detachment, uveitis, trauma, and chronicity. Tobacco use has been associated with worse vision after retinal detachment, and abnormal wound healing in the general surgery literature, but an association with PVR per se has not been described. The primary aim of this study is to compare the rate of PVR development in eyes undergoing repair of primary rhegmatogenous retinal detachment between current daily tobacco users and non-users.
Retrospective study of consecutive primary rhegmatogenous retinal detachment surgeries performed at the University of Colorado between January 1, 2012 and April 7, 2014. Billing data was queried for CPT codes 67107, 67108, 67105, 67110, and 67113. Patients who underwent more than one retinal detachment surgery were counted once, unless the fellow eye was operated on. Cases where PVR developed were identified via review of the electronic health record (EHR). Tobacco use was ascertained from the EHR; patients self-identified as current daily users, former users, or having never used. Former tobacco users were counted as non-users, due to lack of quit dates. Exclusion criteria included traction or exudative retinal detachment, trauma, pre-operative PVR , <1 month follow-up, and missing tobacco use data in the EHR. Relative risk for developing PVR between current daily tobacco users and non-users was calculated.
A total of 768 surgeries were identified. After adjusting for exclusion criteria, 235 eyes were included: 25 current daily tobacco users (11%), and 210 non-users (89%). The overall rate of PVR development was 7.6% (18/235 eyes), in non-tobacco users 6.2% (13/210), and in tobacco users 20% (5/25). Relative risk for PVR in tobacco users was 2.43 (95% CI 1.26-8.31, p= 0.015).
In this study, current daily tobacco use was a statistically significant risk factor for PVR, with a relative risk of 2.43. It may be useful to counsel retinal detachment patients on tobacco cessation. Limitations of this study include its retrospective nature, and lower self-reported incidence of tobacco use (11%) compared to the CDC 2102 adult smoking rate in Colorado (17.7%).
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