Systemic Immunomodulatory Therapy and the Rate of Reoperation for Retinal Redetachment in Adults: An IRIS Registry Study

Purpose: To determine whether systemically administered immunomodulatory therapeutic agents may be associated with a lower risk of reoperation following initially successful repair of rhegmatogenous retinal detachment (RRD). Methods: This was a retrospective cohort study conducted using the IRIS Registry to identify patients who had undergone surgical repair of RRD and had at least 6 months of postoperative follow-up. Patients receiving systemic immunomodulatory therapy for a non-ocular inflammatory disease at the time of repair (group 1) and control subjects not receiving immunomodulatory therapy at the time of repair (group 2) were identified. The main outcome measure was rate of reoperation within 90 days. Results: Group 1 was composed of 683 patients (705 eyes). Group 2 was composed of 36 298 patients (37 337 eyes). The proportion of eyes requiring reoperation was 78/705 (11.1%) in group 1 and 5119/37 337 (13.7%) in group 2. The risk of reoperation was higher for group 2, with an odds ratio (OR) of 1.30 (95% CI, 1.01-1.66) compared with group 1 ( P = .038). Other risk factors associated with additional surgical intervention in groups 1 and 2 were older age ( P = .014 and P = .011) and positive smoking history (each P < .001). Conclusions: The need for reoperation following primary RRD repair was lower in patients being treated with systemic immunomodulatory therapy at the time of surgery. Individuals not receiving immunomodulatory therapy were 1.3 times more likely to require reoperation. Additional studies are warranted to assess systemic immunomodulatory therapy as a treatment option for patients at high risk for redetachment due to proliferative vitreoretinopathy.