Proliferative Retinal Detachment

Proliferative Retinal Detachment

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Proliferative vitreoretinopathy (PVR) is the most common cause of failure in retinal detachment surgery. [1, 2, 3, 4, 5, 6, 7, 8, 9] It can occur in untreated eyes or occur after pneumatic retinopexy, cryotherapy, laser retinopexy, scleral buckling, or vitrectomy. [4, 7, 8] Because excessive retinopexy and operating on inflamed eyes can cause proliferative vitreoretinopathy, some cases should be considered iatrogenic. Epimacular membranes occurring after retinal detachment surgery can be thought of as limited proliferative vitreoretinopathy. Proliferative vitreoretinopathy can occur from glial or retinal pigment epithelium (RPE) proliferation. [1, 2, 3, 10, 11, 12, 13] PVR can also occur in diabetic traction retinal detachment cases if there are associated retinal breaks. Penetrating or blunt trauma may also result in proliferative vitreoretinopathy.

Also see the clinical guideline summary from the American Academy of Ophthalmology, Posterior vitreous detachment, retinal breaks, and lattice degeneration.

Proliferative vitreoretinopathy is a reparative process, similar to a keloid, initiated by full- or partial-thickness retinal breaks, retinopexy, and other types of retinal damage. Loss of contact inhibition causes the surrounding glial or RPE cells to migrate to one or both surfaces of the retina. [1] Although the cells exhibit modest mitotic activity, it is largely a hypocellular process. Glial or RPE cells migrate further and cover the posterior surface of the detached posterior hyaloid face. [9, 10, 13, 14] Fibronectin-lined coated pits serve as attachments of RPE or glial cells to collagen fibers and other components of the extracellular matrix. The migration/contraction mechanism causes tangential force on the retina via multiple star folds and fixed folds. [13, 15, 14] The collagen fibers of anterior and posterior vitreous cortex contract because of a similar hypocellular contraction process.

United States

Of all retinal detachment surgery cases, 5-10% develop proliferative vitreoretinopathy. [8]

International

Worldwide incidence is the same as that in the United States.

Proliferative vitreoretinopathy has no associated mortality. Morbidity is limited to blindness in the affected eye if not treated successfully. If several operations are required to repair proliferative vitreoretinopathy, poor vision may result even with a successfully attached retina.

No known racial predilection exists for proliferative retinal detachment.

No known sexual predilection exists for proliferative retinal detachment.

Although proliferative vitreoretinopathy can occur at all ages, some observers believe that proliferative tissue may develop more rapidly in children.

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Steve Charles, MD Founder and CEO of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Russell P Jayne, MD Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists

Disclosure: Nothing to disclose.

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