Proliferative vitreoretinopathy is described as a complication of retinal detachment and attempted surgical repair in which abnormal proliferation of cells involved in the process of retinal healing secrete very high amounts of proinflammatory cytokines, resulting in the formation of scars on the retina. Up to several months may pass before the initial signs and symptoms appear, mostly in the form of reduced visual acuity. A complete ophthalmologic exam is necessary to make the diagnosis.
Proliferative vitreoretinopathy (PVR) is a still incompletely defined term for a pathological process that occurs after retinal detachment and subsequent surgical treatment [1] [2]. Namely, PVR is predominantly described as the most common cause of surgical failure for rhegmatogenous retinal detachment (RRD) [1] [3], in which the detached retina creates a space for fluid to accumulate between the retinal pigment epithelium and the neurosensory component of this structure. The complete pathogenesis model is still not understood, but it is assumed that after retinal detachment (predominantly caused by trauma) and penetration of the blood-retina-barrier (RBB), local cells promote an inflammatory reaction by secreting various cytokines that aid in the process of healing [1] [4] [5]. More importantly, migration of various cell lineages is induced, including fibroblasts, polymorphonuclear leukocytes, lymphocytes, but also glial cells [1] [4]. These cells accumulate in the previous location of the retina, and in the attempt to repair retinal detachment, abnormal healing leads to the formation of scar tissue [1] [5]. Because no viable retinal tissue is formed, even after successful surgical treatment, patients suffer from reduced visual acuity that develops approximately a few months after the initial retinal detachment [1] [6] [7] [8]. Various intrinsic factors (severity of detachment, delay in diagnosis, the presence of vitreous hemorrhage, macular involvement, etc.) determine the extent of visual symptoms and the prognosis [1] [7] [9]. Furthermore, various studies have confirmed the recurrent nature of proliferative vitreoretinopathy, even after multiple surgeries [1] [9].
Despite the fact that the pathophysiological mechanisms that determine the course of recovery after retinal detachment, many studies have identified that some of the risk factors that facilitate a poorer prognosis (eg. delayed recognition and initiation of treatment) are highly preventable [9], primarily by conducting a proper ophthalmological examination and follow-up after retinal detachment. Physicians must consider proliferative vitreoretinopathy in the differential diagnosis of progressive visual acuity disturbances and loss of vision in patients who underwent surgical treatment for retinal detachment, meaning that a meticulously obtained patient history is vital in the diagnostic workup. Visual acuity testing is mandatory in all patients, and after clinical suspicion is raised, a dilated fundus examination is often sufficient to detect proliferative vitreoretinopathy [8]. Slit-lamp biomicroscopy can provide an insight into the retinal pathology [1], but ocular endoscopy has become a valuable tool (among many diagnostic and therapeutic approaches, including ultrasonography, optical coherence tomography, angiography, etc.) in the assessment of the retina, the ciliary body, and the vitreous body [10].