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Review
. 2019 Winter;59(1):221-240.
doi: 10.1097/IIO.0000000000000258.

Proliferative Vitreoretinopathy: A Review

Sana Idrees, Jayanth Sridhar, Ajay E Kuriyan
Review

Proliferative Vitreoretinopathy: A Review

Sana Idrees et al. Int Ophthalmol Clin. 2019 Winter.

Abstract

Proliferative vitreoretinopathy (PVR) is the most common cause for failure of rhegmatogenous retinal detachment repair and is characterized by the growth and contraction of cellular membranes within the vitreous cavity and on both sides of the retinal surface as well as intraretinal fibrosis. Currently, PVR is thought to be an abnormal wound healing response that is primarily driven by inflammatory, retinal, and RPE cells. At this time, surgery is the only management option for PVR as there is no proven pharmacologic agent for the treatment or prevention of PVR. Laboratory research to better understand PVR pathophysiology and clinical trials of various agents to prevent PVR formation are ongoing.

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Figures

Figure 1.
Figure 1.. Fundus photo of left eye with retinal detachment and proliferative vitreoretinopathy (PVR)
Fundus wide-field photograph of contracted cellular membranes associated with proliferative vitreoretinopathy leading to retinal redetachment in the setting of proliferative diabetic retinopathy. The patient was successfully reattached after membrane peel, relaxing retinectomy, and laser with silicone oil tamponade.
Figure 2.
Figure 2.. Pathophysiology of proliferative vitreoretinopathy
A retinal detachment sets off a cascade of events that can lead to proliferative vitreoretinopathy and subsequent redetachment of the retina. These events include breakdown of the blood-retinal barrier, inflammation, activation of glial and retinal pigment epithelium (RPE) cells, and retinal hypoxia. Subsequently, there is a release of cytokines, growth factors, and chemokines, which facilitate RPE cell migration, proliferation, and epithelial-mesenchymal transition. The RPE-derived fibrotic cells migrate into the vitreous and begin to lay down a membrane on the surface of the retina. The fibrotic membrane contracts and leads to recurrent detachment of the retina. Additionally, the outer retina becomes ischemic and retinal photoreceptors undergo cell death and intraretinal fibrosis occurs, leading to stiffening of the retina.
See this image and copyright information in PMC

Comment in

  • Vitreoretinal surgery: Issues unresolved.
    Chawla R. Chawla R. Indian J Ophthalmol. 2023 Nov;71(11):3434-3435. doi: 10.4103/IJO.IJO_2725_23. Indian J Ophthalmol. 2023. PMID: 37870000 Free PMC article. No abstract available.

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