Surgery as the Primary Management of Proliferative Vitreoretinopathy

Abstract

lthough attempts were made ot reattach retinas using proliferative vitreoretinopathy by various techniques before the 1970s, it was the development and subsequent refinement of closed-eye, mechanized pars plana vitrectomy that initiated the rapid rise in the surgical success rate. This article presents a personal history of the milestone accomplishments that facilitated the strong possibility of success that patients with proliferative vitreoretinopathy can now anticipate. Currently, various gasses, chemical compounds, and pharmaceutical agents serve adjunctively to advance surgical techniques with the expectation that they may be the primary curative procedure in the future. As in the past, what is unconventional today may be common tomorrow.

Surgical Technique: Viscodissection for Managing Funnel Retinal Detachments

“…If the macula remains attached, early surgery is recommended, whereas if detached, some studies suggest delaying intervention until the proliferative phase stabilizes. However, postponing surgery beyond 28 days may increase the risk of PVR progression and poor functional outcomes [ 4 , 5 ].…”

“…Advances in wide-field visualization, high-speed vitrectomy probes, and intraoperative staining have significantly improved PVR surgery outcomes [ 5 , 6 ]. Despite this, removing residual vitreous and epiretinal membranes remains challenging, especially in cases with strong vitreoretinal adhesions.…”

“…Funnel retinal detachments pose significant challenges due to circumferential and anteroposterior contraction, dense fibrotic membranes, and severe retinal stiffness [ 2 ]. Conventional approaches, including vitrectomy, membrane peeling, and PFCL-assisted reattachment, may be insufficient due to extreme membrane adherence [ 5 ]. In such cases, viscoelastic agents have been employed to push the funnel-shaped retinal detachment posteriorly out of the anterior chamber [ 11 ] allowing for easier and safer trocar placement.…”

Surgical Technique: Viscodissection for Managing Funnel Retinal Detachments

“…If the macula remains attached, early surgery is recommended, whereas if detached, some studies suggest delaying intervention until the proliferative phase stabilizes. However, postponing surgery beyond 28 days may increase the risk of PVR progression and poor functional outcomes [ 4 , 5 ].…”

“…Advances in wide-field visualization, high-speed vitrectomy probes, and intraoperative staining have significantly improved PVR surgery outcomes [ 5 , 6 ]. Despite this, removing residual vitreous and epiretinal membranes remains challenging, especially in cases with strong vitreoretinal adhesions.…”

“…Funnel retinal detachments pose significant challenges due to circumferential and anteroposterior contraction, dense fibrotic membranes, and severe retinal stiffness [ 2 ]. Conventional approaches, including vitrectomy, membrane peeling, and PFCL-assisted reattachment, may be insufficient due to extreme membrane adherence [ 5 ]. In such cases, viscoelastic agents have been employed to push the funnel-shaped retinal detachment posteriorly out of the anterior chamber [ 11 ] allowing for easier and safer trocar placement.…”

Managing PVR in the Era of Small Gauge Surgery

“…However, in cases with severe PVR, additional maneuvers are required to relieve traction in order to reattach the retina and prevent redetachment [ 6 , 7 , 35 ]. These goals can be better achieved with the help of a combined and meticulously done scleral buckle and vitrectomy with long-term silicon oil tamponade and also to prevent retinal redetachment and recurrence of PVR to as much extent as possible [ 36 , 37 ].…”

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

“…At present, PVR is considered one of the most important factors in primary surgical failure [ 1 , 6 , 7 , 8 ], being associated with a lower success rate, ranging between 45% and 85% [ 8 , 9 , 10 ]. Williamson et al found 22% lower success rates in the presence of PVR.…”

Surgical Technique: Viscodissection for Managing Funnel Retinal Detachments

“…If the macula remains attached, early surgery is recommended, whereas if detached, some studies suggest delaying intervention until the proliferative phase stabilizes. However, postponing surgery beyond 28 days may increase the risk of PVR progression and poor functional outcomes [ 4 , 5 ].…”

“…Advances in wide-field visualization, high-speed vitrectomy probes, and intraoperative staining have significantly improved PVR surgery outcomes [ 5 , 6 ]. Despite this, removing residual vitreous and epiretinal membranes remains challenging, especially in cases with strong vitreoretinal adhesions.…”

“…Funnel retinal detachments pose significant challenges due to circumferential and anteroposterior contraction, dense fibrotic membranes, and severe retinal stiffness [ 2 ]. Conventional approaches, including vitrectomy, membrane peeling, and PFCL-assisted reattachment, may be insufficient due to extreme membrane adherence [ 5 ]. In such cases, viscoelastic agents have been employed to push the funnel-shaped retinal detachment posteriorly out of the anterior chamber [ 11 ] allowing for easier and safer trocar placement.…”

Managing PVR in the Era of Small Gauge Surgery

“…However, in cases with severe PVR, additional maneuvers are required to relieve traction in order to reattach the retina and prevent redetachment [ 6 , 7 , 35 ]. These goals can be better achieved with the help of a combined and meticulously done scleral buckle and vitrectomy with long-term silicon oil tamponade and also to prevent retinal redetachment and recurrence of PVR to as much extent as possible [ 36 , 37 ].…”

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

“…At present, PVR is considered one of the most important factors in primary surgical failure [ 1 , 6 , 7 , 8 ], being associated with a lower success rate, ranging between 45% and 85% [ 8 , 9 , 10 ]. Williamson et al found 22% lower success rates in the presence of PVR.…”

Surgical Technique: Viscodissection for Managing Funnel Retinal Detachments

“…If the macula remains attached, early surgery is recommended, whereas if detached, some studies suggest delaying intervention until the proliferative phase stabilizes. However, postponing surgery beyond 28 days may increase the risk of PVR progression and poor functional outcomes [ 4 , 5 ].…”

“…Advances in wide-field visualization, high-speed vitrectomy probes, and intraoperative staining have significantly improved PVR surgery outcomes [ 5 , 6 ]. Despite this, removing residual vitreous and epiretinal membranes remains challenging, especially in cases with strong vitreoretinal adhesions.…”

“…Funnel retinal detachments pose significant challenges due to circumferential and anteroposterior contraction, dense fibrotic membranes, and severe retinal stiffness [ 2 ]. Conventional approaches, including vitrectomy, membrane peeling, and PFCL-assisted reattachment, may be insufficient due to extreme membrane adherence [ 5 ]. In such cases, viscoelastic agents have been employed to push the funnel-shaped retinal detachment posteriorly out of the anterior chamber [ 11 ] allowing for easier and safer trocar placement.…”

Managing PVR in the Era of Small Gauge Surgery

“…However, in cases with severe PVR, additional maneuvers are required to relieve traction in order to reattach the retina and prevent redetachment [ 6 , 7 , 35 ]. These goals can be better achieved with the help of a combined and meticulously done scleral buckle and vitrectomy with long-term silicon oil tamponade and also to prevent retinal redetachment and recurrence of PVR to as much extent as possible [ 36 , 37 ].…”

Incidence and Risk Factors Affecting the Recurrence of Primary Retinal Detachment in a Tertiary Hospital in Spain

“…At present, PVR is considered one of the most important factors in primary surgical failure [ 1 , 6 , 7 , 8 ], being associated with a lower success rate, ranging between 45% and 85% [ 8 , 9 , 10 ]. Williamson et al found 22% lower success rates in the presence of PVR.…”