Contemporary patterns and factors associated with registry-coded proliferative vitreoretinopathy after retinal detachment repair in the IRIS® Registry

Background Proliferative vitreoretinopathy (PVR) remains a major cause of failure after retinal detachment (RD) repair. We evaluated the incidence, timing, and factors associated with registry-coded PVR after primary RD repair. Methods This retrospective cohort study included eyes undergoing incident primary RD repair from January 2017 through December 2024 in the American Academy of Ophthalmology IRIS ® Registry, with more than 6 months of follow-up and postoperative data available through July 31, 2025. Registry-coded PVR was identified using H35.2x diagnoses recorded in the operated eye. Diagnoses recorded within ± 14 days of RD repair were classified as concurrent registry-coded PVR, whereas those recorded more than 14 days after repair were classified as delayed registry-coded PVR. We described the proportion of eyes with concurrent registry-coded PVR and the cumulative incidence and timing of delayed registry-coded PVR. Multivariable Cox proportional hazards models incorporating time-varying ocular covariates evaluated factors associated with delayed registry-coded PVR. Results Among 202,975 eyes, 1.37% had concurrent registry-coded PVR. The 1-year cumulative incidence of delayed registry-coded PVR was 2.20% (95% confidence interval [CI], 2.14–2.27). Younger (< 40 years) and older (≥ 70 years) age groups had higher hazards than those aged 60–69 years, with age-related associations varying over follow-up. Low ZIP code–level household income (<$35,000 vs. $35,000–$74,999; hazard ratio [HR], 1.48; 95% CI, 1.23–1.77) and rural residence (HR, 1.22; 95% CI, 1.13–1.33) were independently associated with increased hazard. Compared with pars plana vitrectomy, complex RD repair (HR, 1.65; 95% CI, 1.52–1.79) and pneumatic retinopexy (HR, 1.20; 95% CI, 1.09–1.32) were associated with higher hazard, whereas scleral buckling was associated with lower hazard (HR, 0.66; 95% CI, 0.55–0.78). Vitreous hemorrhage, macular puckering, and glaucoma first recorded after the landmark were associated with higher hazard. Preexisting pseudophakia or concurrent cataract extraction was associated with lower hazard (HR, 0.90; 95% CI, 0.84–0.96). Conclusions Delayed registry-coded PVR was recorded in approximately 1 in 45 eyes within 1 year after primary RD repair. Its occurrence was associated with age, socioeconomic characteristics, surgical approach, postoperative ocular conditions, and cataract surgery timing, with age-related associations varying over follow-up. Clinical trial number Not applicable.