Proliferative Vitreo-Retinopathy

Proliferative vitreo-retinopathy (PVR) is the most common cause of failed repair of a retinal detachment and occurs when scar tissue creates traction on the retina.

PVR is characterized by proliferation of retinal pigment epithelial cells, glial cells, and inflammatory cells on the surface of the retina and within the vitreous gel. Traction is the key feature in the pathogenesis of PVR. The location, extent and severity of traction vary substantially. PVR most frequently develops in the inferior retina or is at least most severe in the inferior retina.

The patients most at risk for PVR are those who had recent retinal detachment repairs, traumas, inflammation, retinal breaks, giant retinal tears, vitreous hemorrhage with retinal tears, and viral infection patients.

The Silicone Study Classification System for PVR delineates the progressive severity of stages based on location and extent of membranes, retinal breaks, and extent of retinal detachment.

Treatment is done when the proliferation matures within 6 to 12 weeks and has a white fibrotic appearance. Vitrectomy, membrane peeling, injection of gas or silicone oil, placement or reversion of a scleral buckle and endophotocoagulation as well as possible use of retinotomies are all considered and used when appropriate.

Oral 13-nic retinaic acid treatment orally postoperatively in patients undergoing PVR surgery improves the clinical outcome.

Complications following surgery include inflammation, low intraocular pressure, hemorrhage and phthisical eye.