Association Between Iris Manipulation during Phacovitrectomy for Retinal Detachment Repair and Proliferative Vitreoretinopathy

Purpose: To determine if iris manipulation during phacovitrectomy for retinal detachment (RD) repair is associated with the development of proliferative vitreoretinopathy (PVR). Methods: Single-center, comparative, retrospective cohort study of 536 eyes who underwent phacovitrectomy for cataract extraction and RD repair between 2013 and 2024. Eligible eyes had at least three months follow-up. Iris manipulation was defined as mechanical pupillary expansion or synechiolysis. Patients with a history of uveitis were excluded. The primary outcome was the development of PVR, and secondary outcomes included the development of other postoperative complications. Results: Of the included eyes, 66 were in the iris manipulation group and 470 were in the control group. The average follow-up time was 18.9 ± 16.0 weeks. Among the 34 eyes without baseline PVR in the iris manipulation group, 5 eyes (14.7%) developed PVR. Among the 282 eyes without baseline PVR in the control group, 12 (4.3%) developed PVR. After adjusting for patients who had prior retinal surgery in an additional regression analysis, iris manipulation remained a significant predictor for PVR development (odds ratio (OR) 3.64; p = 0.038). There were no significant differences in the OR for the development of the other postoperative complications between the groups. Conclusion: Iris manipulation during phacovitrectomy for RD repair and cataract extraction was significantly associated with development of PVR in the absence of active inflammation, despite a similar profile of other postoperative complications. These findings highlight the potential role of iris trauma in amplifying intraocular inflammation and contributing to PVR pathogenesis.