By Purnima S. Patel, MD
This literature review found that currently available evidence from randomized trials is not sufficient to guide clinical care of patients with proliferative vitreoretinopathy (PVR), despite a recent increase in our understanding of its pathogenesis and advances in surgical technique.
The authors reviewed the literature from 2000 to 2014 for surgical and medical management of PVR.
The pathogenesis of PVR is not completely understood; however, retinal pigment epithelial (RPE) cells have been identified as central to the process. RPE cells are thought to differentiate and migrate through retinal breaks and proliferate on the retinal surface in a process thought to be driven by platelet-derived growth factor, vascular endothelial growth factor, transforming growth factor beta, epidermal growth factor and fibroblast growth factor.
They found that studies related to the surgical management of PVR are predominantly retrospective with significant heterogeneity in surgical technique and study populations, precluding subgroup analysis and meta-analysis.
They write that evidence supporting the use of scleral buckling procedures remains conflicting, whereas the use of retinectomy, especially in cases of anterior PVR, has yielded favorable outcomes. Heavy silicone oils, although found effective, have not been shown to be superior to typical silicone oil in terms of anatomical success rates.
Many anti-inflammatory options have been studied, including intravitreal triamcinolone and oral prednisone, without definitive success. Available evidence for low molecular weight heparin and 5-fluorouracil has been conflicting. Their use in patients at high risk for developing PVR may be of benefit but larger studies would be needed to elucidate efficacy.
Two randomized controlled trials found that isotretinoin may be of benefit, and a prospective, randomized, placebo-controlled trial at Wills Eye Institute is further studying this.