In a large retrospective database study, patients with keloids who underwent retinal detachment (RD) repair were found to be more likely to subsequently develop proliferative vitreoretinopathy (PVR) than patients without keloids, though additional investigation into this possible relationship and the likely complex mechanisms behind it are recommended.
Study Design
This was a retrospective cohort study that accessed data from the TriNetX database to assess the association between keloid formation and PVR. Patients with uncomplicated RD repair were identified based on medical record codes for pneumatic retinopexy, primary scleral buckle, or vitrectomy with or without scleral buckle, and patients with keloids were identified using codes for hypertrophic scar or scar conditions and fibrosis of skin. In total, there were 33,943 patients with a history of RD repair, 1482 of whom had keloids. Patients in the keloid and non-keloid groups—matched for age, sex, and race (1061 per cohort)—were compared based on the development of PVR (identified using codes for PVR secondary surgery with complex RD repair) within 6 months of primary RD repair.
Outcomes
Within 6 months of primary RD repair, 9.0% of patients in the keloid group were diagnosed with PVR vs only 4.2% of patients in the non-keloid group. During the same time period, more patients in the keloid group underwent subsequent complex RD repair than in the non-keloid group (8.0% vs 6.4%, respectively), though this difference was not significant.
Limitations
There are inherent limitations with the use of large databases, including the inability to assess the impact of certain potential confounders (e.g., cigarette smoking) and the uncertain accuracy of coding. Additionally, it is possible that patients could receive eye and skin evaluation as well as treatments outside of the TriNetX institutions.
Clinical Significance
At this point, I will counsel patients with keloids that they may be at greater risk of PVR development after retinal detachment repair and could have higher likelihood of requiring further surgery.
Financial Disclosures: Dr. Ajay Kuriyan discloses financial relationships with 4DMT, Adverum, Annexon, National Eye Institute, Novartis, Alcon Pharmaceuticals (Grant Support); Alimera Sciences, Allergan, Bausch + Lomb, EyePoint Pharmaceuticals (Consultant/Advisor); Iveric Bio, Optos (Lecture Fees/Speakers Bureau); Lumata Health, Recens Medical (Consultant/Advisor, Private Equity/Stock Holder); Spark Therapeutics (Consultant/Advisor, Lecture Fees/Speakers Bureau); Genentech (Consultant/Advisor, Lecture Fees/Speakers Bureau, Grant Support).