Adjuvant mitomycin C during vitrectomy in young adults with primary nontraumatic rhegmatogenous retinal detachment and grade C proliferative vitreoretinopathy

BACKGROUND: Proliferative vitreoretinopathy (PVR) complicates 5-10% of rhegmatogenous retinal detachments (RRD) and remains a major cause of surgical failure. Intraoperative mitomycin C (MMC), a potent antiproliferative agent, may suppress postoperative PVR formation. This study evaluated the anatomical, functional, and safety outcomes of intraoperative MMC in young adults with primary RRD complicated by grade C PVR. METHODS: This retrospective cohort study included 126 eyes of patients aged 18-45 years with primary nontraumatic RRD and grade C PVR. All eyes underwent 25-gauge pars plana vitrectomy with silicone oil tamponade. Intraoperative MMC was administered in 61 eyes, while 65 eyes served as controls. The primary outcome was single-surgery anatomical success at 6 months. Secondary outcomes included final retinal reattachment, PVR progression, best-corrected visual acuity (BCVA), intraocular pressure (IOP) changes, silicone oil removal, and MMC-related adverse events. RESULTS: MMC-treated eyes showed significantly lower rates of postoperative PVR progression and reoperation than controls (P < 0.05). Primary and final reattachment rates and BCVA improvement were higher in the MMC group, although differences did not reach statistical significance. No clinically detectable retinal or optic nerve toxicity attributable to MMC was observed. Rates of elevated IOP, hypotony, cystoid macular edema, and intraocular inflammation were comparable between groups. CONCLUSIONS: Intraoperative adjuvant MMC was associated with reduced postoperative PVR progression and reoperation rates in young adults with primary RRD and grade C PVR. A favorable trend was also observed in anatomical and visual outcomes, suggesting that MMC may represent a promising adjunctive treatment strategy in selected high-risk patients.