Selective Removal of Exposed Retinal Pigment Epithelium in Eyes With Extensive Retinal Loss to Prevent Proliferative Vitreoretinopathy

Purpose: To describe a surgical technique consisting of selective removal of exposed retinal pigment epithelium (RPE) in eyes with extensive retinal loss, aimed at reducing postoperative proliferative vitreoretinopathy (PVR). Methods: This retrospective interventional case series included eyes undergoing complex retinal detachment surgery characterized by large areas of retinal absence with exposed RPE, including giant retinal tears, retinectomies, and large retinal breaks. Following standard pars plana vitrectomy and retinal stabilization, exposed RPE was selectively removed using a Charles flute needle under active aspiration with a protective silicone tip. Silicone oil tamponade was used in all cases. Results: Ten eyes were included. Mean best-corrected visual acuity (BCVA) improved significantly from approximately 0.72 ± 0.12 logMAR preoperatively to 0.42 ± 0.19 logMAR at 3 months (p = 0.027) and further to 0.38 ± 0.13 logMAR at final follow-up (p = 0.009). No patient developed clinical signs of PVR at 6 months. One recurrence occurred at 6 months; however, no associated signs of PVR were observed. No intraoperative or postoperative complications related to RPE removal were observed. Conclusions: Selective removal of exposed RPE in areas of retinal absence may reduce the exposure of the cellular substrate responsible for PVR formation and represents a potentially effective adjunctive technique in high-risk retinal detachment surgery.