Minimizing Proliferative Vitreoretinopathy Reaction in Rhegmatogenous Retinal Detachment: Is There a Role of Preoperative Anti-Inflammatory?

Abstract

Rhegmatogenous retinal detachment (RRD) is characterized by the detachment of the neurosensory retina from the retinal pigment epithelium (RPE). Delaying retinal surgery may trigger the formation of abnormal proliferative tissue from retinal cells and RPE tissue in the vitreous, known as proliferative vitreoretinopathy (PVR). 1,2 These complications have the potential to induce contraction, tractional force, and eventual retinal detachment. The progression of PVR involves intricate mechanisms influenced by inflammatory processes or mediators, angiogenesis, and fibrotic changes, contributing to the formation of new blood vessels and the deposition of connective tissue. 2,3,4,5,6 The inflammatory response associated with PVR is characterized by elevated levels of arachidonic acid metabolites (PGE2 and COX-2), TGF-ß, and monocytes or macrophages in the vitreous. Djatikusumo et al study scrutinized the preoperative administration of nepafenac 0.1%, a non-steroidal anti-inflammatory drug, aimed at averting the emergence of PVR in patients diagnosed with RRD, thereby enhancing the anatomical success of postoperative vitrectomy. 6,7,8 The research constituted a randomized clinical trial involving 61 subjects, partitioned into two distinct groups: 31 participants in the nepafenac 0.1% group and 30 in the control arm. Inclusion criteria entailed patients diagnosed with RRD concomitant with PVR grade A or B, scheduled for pars plana vitrectomy (PPV) interventions. Vitreous samples were collected during vitrectomy, and the vitreous biomarker levels (PGE2, COX-2, TGF-ß, and monocytes) from each group were subjected to analysis. 7 The administration of 0.1% nepafenac eye drops were administered three times daily for five days prior to PPV in patients with RRD and PVR. Evaluation was conducted to assess anatomical outcomes based on parameters including retinal reattachment rates, central subfield thickness (CST), and macular volume (MV). Overall, the study findings did not reveal a notable increase in anatomical success. Nonetheless, discernibly lower levels of TGF-ß, PGE2, and monocytes were observed in the 0.1% nepafenac group. Despite this observation, statistically insignificant differences were observed in biomarker levels between the two study groups. 7 In physiological conditions, RPE cells exhibit a state of dormancy concerning mitotic activity. Conversely, in retinal conditions characterized by compromised blood barriers such as ischemic conditions, the pathophysiological state of photoreceptor cells in RRD within the vitreous cavity prompts an increase in chemotactic and mitogenic activity. This condition initiates a cascade of inflammatory reactions, yielding various growth factors, cytokines, and chemokines, thereby fostering the proliferation and transformation of EPR cells. In PVR, as a pathological response, EPR cells transform into fibroblast-like cells, inducing functional and EDITORIAL