Strategies to influence PVR development.

Abstract

Proliferative vitreo-retinopathy (PVR) is a complication of rhegmatogenous retinal detachment or severe ocular trauma (intraocular foreign body, penetration, perforation, contusion, rupture). The risk of PVR varies from 10 to 40% depending on the original disease. Strategies to influence the risk of PVR include surgical techniques, pharmacological adjuncts, and preventive measurements. Surgical influences on the risk of PVR comprise: surgical skills (buckling, atraumatic procedure), primary vitrectomy, early vitrectomy, retinectomy, choice of vitreous tamponade agent. The influence of most such parameters is not confirmed by prospective randomized studies. Pharmaceutical adjuncts include daunomycin, 5-fluoruracil plus heparin and others. The influence of most such parameters has been studied by prospective randomized studies. The effect is statistically significant, its clinical relevance is subject of current discussion. Prevention of PVR, via prevention of injury, was successful in the past as shown by the reduction of wind screen injuries after the seatbelt legislation was installed, and reduction of work related injuries from protective eyewear. As for the treatment of existent PVR despite some progress in the past, there should be better ways of treatment ahead of us.