Classifications for Proliferative Vitreoretinopathy (PVR): An Analysis of Their Use in Publications over the Last 15 Years

Abstract

Purpose. To evaluate the current and suitable use of current proliferative vitreoretinopathy (PVR) classifications in clinical publications related to treatment. Methods. A PubMed search was undertaken using the term “proliferative vitreoretinopathy therapy”. Outcome parameters were the reported PVR classification and PVR grades. The way the classifications were used in comparison to the original description was analyzed. Classification errors were also included. It was also noted whether classifications were used for comparison before and after pharmacological or surgical treatment. Results. 138 papers were included. 35 of them (25.4%) presented no classification reference or did not use any one. 103 publications (74.6%) used a standardized classification. The updated Retina Society Classification, the first Retina Society Classification, and the Silicone Study Classification were cited in 56.3%, 33.9%, and 3.8% papers, respectively. Furthermore, 3 authors (2.9%) used modified-customized classifications and 4 (3.8%) classification errors were identified. When the updated Retina Society Classification was used, only 10.4% of authors used a full C grade description. Finally, only 2 authors reported PVR grade before and after treatment. Conclusions. Our findings suggest that current classifications are of limited value in clinical practice due to the inconsistent and limited use and that it may be of benefit to produce a revised classification.

Inflammatory and Fibrogenic Factors in Proliferative Vitreoretinopathy Development

“…Retinal ischemia develops immediately after retinal detachment, followed by progressive photoreceptor apoptosis and contraction of fibrotic epiretinal membranes. 7 PVR retinal fibrosis is initiated by fibroblasts derived from RPE cells that undergo epithelial-mesenchymal transition (EMT) and begin collagen and ECM deposition, 8 orchestrated by a dysregulated panel of proinflammatory, chemotactic cytokines and mitogenic growth factors, 7 which induce an exaggerated inflammatory reaction at sites of retinal tears and detachment. 9 The early identification of inflammatory/fibrotic factors (IFF) that predict the subsequent development of PVR and direct treatments aimed at impeding/inhibiting PVR development after retinal reattachment surgery would constitute a significant clinical advance.…”

iOCT in PVR Surgical Management

“…These membranes may be epi-, intra-or sub-retinal. One of the crucial points is a correct and widely accepted classification which must include intraretinal status [4,25]. In fact, PVR is characterized by epiretinal, subretinal but also intraretinal proliferation [4,26,27].…”

Protein Kinase A Inhibitor H89 Attenuates Experimental Proliferative Vitreoretinopathy

“…The contraction of such membranes causes retinal distortion and tractional RD. 2 The pathogenesis of PVR includes cell migration, cell proliferation, and epiretinal membrane (ERM) formation and contraction, and the main cellular participants are retinal pigment epithelial (RPE) cells. 3,4 In RD, the blood-retinal barrier is disrupted, and the chemotactic and mitogenic activities are increased in the vitreous humor.…”