PhD defence K.W.A. (Koen) van Overdam

Brief summary:

Rhegmatogenous retinal detachment (RRD) is a serious, sight-threatening condition with a steadily increasing incidence, likely related to ageing and the rising prevalence of myopia. The primary cause of RRD is age-related posterior vitreous detachment (PVD), where the gel-like vitreous separates from the retina. This can lead to retinal tears, which may result in retinal detachment. Even with early surgical intervention, RRD can lead to severe visual impairment.

Despite advancements in surgical techniques, the recurrence rate remains around 10%, mainly due to proliferative vitreoretinopathy (PVR), where scar tissue forms on the surface of the retina. RRD complicated by PVR has significantly lower success rates, often necessitating additional surgeries and prolonged follow-up care, ultimately leading to more frequent unsatisfactory visual outcomes. This adversely affects patients’ quality of life and places a burden on the healthcare system. Furthermore, PVR formation is not only a complication of RRD but also a complicating factor in other retinal conditions.

In this thesis, a previously unrecognised factor contributing to PVR is highlighted: remnants of the vitreous cortex (VCR). These thin layers of vitreous can remain on the retina during a PVD and provide a foundation for scar tissue formation. Detecting and removing VCR during surgery is challenging, but it is crucial for improving outcomes. The need for new surgical techniques and tools to reduce the risk of PVR is emphasised, based on novel insights and preventive strategies, to improve outcomes for patients with retinal detachment and related retinal conditions.