Patient-Reported Outcomes After Surgery for Proliferative Vitreoretinopathy: Post Hoc Analysis of a Randomized Controlled Trial

Introduction Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure in rhegmatogenous retinal detachment (RRD) and is associated with poor visual prognosis. We aimed to report changes in VFQ-25 and SF-36 tests following surgery for PVR-RRD and identify clinical and demographic factors associated with recovery. Methods This is a post-hoc analysis of a phase IIIb randomised, participant-masked clinical trial evaluating slow-release dexamethasone in PVR-RRD. Patients underwent pars plana vitrectomy with silicone oil tamponade. Vision-related QOL was assessed using VFQ-25, and SF-36 test, at baseline, 6 months, and 12 months postoperatively. VFQ-25 subscales and SF-36 domains were analysed descriptively and with non-parametric paired tests; associations with best-corrected visual acuity (BCVA, logMAR) and other variables were assessed using Spearman correlation and non-parametric tests. Results A total of 139 patients were included (mean age 61 years; 60% male). VFQ-25 total score improved from a median of 65.5 at baseline to 70 at 12 months (p=0.0004). SF-36 total score improved from 68 to 77.5 at 12 months (p=0.006). Worse 12-month BCVA correlated with lower VFQ-25 (p<0.001) and showed a borderline association with SF-36 (p=0.054). In univariable analyses, women reported lower 12-month QOL; however, gender associations were attenuated in multivariable models (VFQ-25: β=−4.39, p=0.073; SF-36: β=−4.71, p=0.199). Retinal anatomical status and number of surgeries were not associated with QOL outcomes. Subscale/domain analyses showed the largest improvements in psychosocial domains: VFQ-25 mental health increased from 50.0 to 68.8 (p=3.35×10⁻⁵), and SF-36 mental health increased from 68.0 to 80.0 (p=2.38×10⁻⁶), while most physical health domains were stable. Conclusions Despite the complexity of PVR-RRD, significant improvements in both visual function and general QOL were observed postoperatively driven largely by psychosocial recovery. Final BCVA and baseline QOL had a greater influence on perceived recovery than anatomical success or number of surgeries. These findings highlight the importance of personalised care and rehabilitation in managing PVR-RRD patients.