From the Research
Currently, there are no universally accepted or FDA-approved treatments specifically for preventing proliferative vitreoretinopathy (PVR) after retinal detachment repair. Management primarily focuses on identifying high-risk patients and optimizing surgical techniques. Some surgeons use off-label pharmacological agents during surgery, including intravitreal corticosteroids (such as triamcinolone acetonide 4mg/0.1mL or dexamethasone 0.4mg/0.1mL) to reduce inflammation, which is believed to contribute to PVR development, as discussed in 1. Low-dose 5-fluorouracil (5-FU, 10-25μg/mL) and low-molecular-weight heparin (LMWH, 5-10 IU/mL) have been used in irrigation solutions during vitrectomy to inhibit cellular proliferation and membrane formation. For high-risk cases, some surgeons employ silicone oil tamponade rather than gas, as it may provide longer-term support and reduce PVR risk. Meticulous surgical technique is crucial, including thorough removal of vitreous gel, careful management of any retinal breaks, and minimizing intraoperative bleeding and inflammation.
The pathophysiology of PVR involves inflammatory processes, cellular migration, proliferation, and contraction of membranes on the retinal surface, which is why anti-inflammatory and anti-proliferative approaches are being investigated, as noted in 2. Despite numerous clinical trials, no pharmacological intervention has demonstrated consistent efficacy in preventing PVR, highlighting the need for continued research in this area. Some studies, such as 3, have explored the use of bevacizumab injected into silicone oil at the end of retinal reattachment surgery for severe PVR, but found that it does not eliminate the risk of postoperative PVR.
Key considerations in preventing PVR include:
- Identifying high-risk patients
- Optimizing surgical techniques
- Using off-label pharmacological agents during surgery to reduce inflammation
- Employing silicone oil tamponade for high-risk cases
- Meticulous surgical technique to minimize intraoperative bleeding and inflammation. As stated in 1, the cellular components of PVR periretinal membranes proliferate and are thus targets for antiproliferative agents, which is an area of ongoing research.