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Mechanisms of Proliferative Vitreoretinopathy
Wiedemann P.,
Universität Leipzig, Klinik und Poliklinik für Augenheilkunde (Leipzig)
Proliferative vitreoretinopathy (PVR) is still the main cause for failure of retinal detachment surgery although essential efforts in the last 30 years have been undertaken in order to better understand and treat this clinical entity. Basic research showed that PVR is the final stage of a wound healing process. The risk of PVR is increased in the case of giant tears or macular relocation, after endoresection of tumors, in Wagner-Stickler-disease, in patients with atopic dermatitis, and possibly in Terson syndrom. PVR due to a trauma of the posterior segment is especially active. Clinical risk factors are preoperative eye diseases, the breakdown of the blood-retina-barrier, duration, size and kind of a retinal detachment, and intraoperative surgical decisions. Laser flare and biochemical laboratory parameters may indicate an increased risk of PVR. Future treatment strategies include atraumatic (first) surgery, and possibly adjunctive intraocular drugs and oxygen treatment.