Surgical Management of Proliferative Vitreoretinopathy: An Indian Perspective

Abstract

Proliferative vitreoretinopathy (PVR) remains the major complication associated with RRD surgery and the main reason for unsatisfactory anatomical and functional outcomes.

Proliferative vitreoretinopathy (PVR) is the clinical syndrome associated with retinal traction and detachment in which cells with proliferative potential multiply and contract on retinal surfaces and in the vitreous compartment.

Patients at our centre present with a spectrum of severity in PVR ranging from subtle retinal wrinkling, fixed folds and tears with rolled edges and to total rigid retinal detachment, retinal shortening and advanced peri-retinal proliferation.

PVR is the most common cause of failure in retinal detachment surgery. It can occur in untreated eyes with retinal detachment, especially with vitreous haemorrhage, or after cryotherapy or even laser retinopexy, pneumatic retinopexy, scleral buckling or vitrectomy and after a variety of surgical complications.

If PVR is progressive and macula reattachment delayed, then despite complex surgery, low vision is the result in the majority of the eyes.

This chapter discusses PVR and surgical management techniques at our centre.

At our institution, we treat lots of total cases of RD treated annually and recurrent RD. In my 31 years of experience in vitreoretinal surgery, I have treated thousands of complicated retinal detachments. PVR managements aim at surgical reattachment of the retina although the final vision outcomes over a long term are variable.

Conclusion:

Post PVR surgery recovery of vision is a long-term outcome which remains variable in spite of advanced surgical techniques. The success rate of successful operation is approximately 80%. The chance of regaining vision that is good enough just to get around is about 60%. Reading vision rarely returns; however, reasonable adaptable vision is attained using low vision aids.