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Proliferative Vitreoretinopathy

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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.


Presentation

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].

Severe Clinical Course
  • The early onset and the severe clinical course of proliferative vitreoretinopathy in these eyes showed parallels to traumatic proliferative vitreoretinopathy. The retina in all eyes could be reattached.[ncbi.nlm.nih.gov]
Ulcer
  • Langenbach R, Morham SG, Tiano HF et al (1995) Prostaglandin synthase 1 gene disruption in mice reduces arachidonic acid-induced inflammation and indomethacin-induced gastric ulceration. Cell 83:483–492 CrossRef PubMed Google Scholar 21.[doi.org]

Workup

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].

Foam Cell
  • A histological examination revealed that the epiretinal membrane consisted of collagen fibers, glial proliferation, foam cells and lymphocytes. The foam cell in the epiretinal membrane is a characteristic finding in an eye with Coats' disease.[ncbi.nlm.nih.gov]

Treatment

  • Both groups will receive the standard surgical treatment appropriate for their eye condition and routine peri-operative treatment and care, differing only in the addition of the supplementary adjunctive agent in the treatment group.[ncbi.nlm.nih.gov]
  • Both groups will receive the standard surgical treatment appropriate for their eye condition and routine perioperative treatment and care, differing only in the addition of supplementary adjunctive agents in the treatment group.[ncbi.nlm.nih.gov]
  • Further studies to clarify the efficacy of available and novel treatment options are warranted.[ncbi.nlm.nih.gov]
  • Early diagnosis, prompt systemic and ocular treatment, as well as close ophthalmic examination are essential in such cases.[ncbi.nlm.nih.gov]
  • Proliferative vitreoretinopathy (PVR) is a still incompletely defined term for a pathological process that occurs after retinal detachment and subsequent surgical treatment.[symptoma.com]

Prognosis

  • 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.[symptoma.com]
  • When the concentrations of IGFBP-6 or KNG1 were greater than 98.5 pg/ml or 88.5 ng/ml, respectively, they predicted the PVR prognosis with both a sensitivity and specificity of 80 per cent.[ncbi.nlm.nih.gov]
  • Thus, the identification of this type of intraretinal PVR is crucial for planning surgery and it is important information for the prognosis for each patient.[touchophthalmology.com]
  • Generally, these have a poorer long-term prognosis for vision and successful surgical outcome despite the fact that they may be easier to peel intraoperatively than less mature, fresh membranes.[healio.com]
  • Patients with PVR-associated RD should be informed preoperatively about the possibility of recurrence, poor visual prognosis, refractive changes, and potential longterm complications.[retinatoday.com]

Etiology

  • Dis. ... dokt. med. nauk [The role of vitrectomy in treatment of eye diseases of traumatic, degenerative and inflammatory etiology. DSc Thesis]. Moscow; 1987. 8. Zakharov V.D., Sharipova D.N., Shatskikh A.V.[cyberleninka.ru]
  • Keywords: Osteoporosis/complications; Vitreoretinopathy, proliferative; Retinopathy of prematurity; Eye diseases, hereditary/etiology; Fluorescein angiography; Fundus oculi; Visual acuity; Vitreous body/surgery; Retinal detachment; Human; Female; Child[scielo.br]

Epidemiology

  • Laatikainen L, Tolppanen EM, Harju H: Epidemiology of rhegmatogenous retinal detachment in a Finnish population. Acta Ophthalmol 1985;63:59-64.[karger.com]
  • Nicholson BP, Zhou M, Rostamizadeh M et al (2014) Epidemiology of epiretinal membrane in a large cohort of patients with uveitis. Ophthalmology 121:2393–2398 CrossRef PubMed PubMedCentral Google Scholar 25.[doi.org]
  • Posttraumatic proliferative yitreoretinopathy: the epidemiologic profile, onset, risk factors, and visual outcome. Ophthalmology 1997; 104 : 1166–1173 15 Sobaci G, Mutlu FM, Bayer A, Karagui S, Yildirim E.[nature.com]
  • EPIDEMIOLOGY AND PATHOGENESIS PVR occurs following surgical repair of retinal detachment but can develop in untreated cases, particularly those that are long-standing or with large breaks.[medtextfree.wordpress.com]
  • Epidemiology Frequency United States Of all retinal detachment surgery cases, 5-10% develop proliferative vitreoretinopathy. [8] International Worldwide incidence is the same as that in the United States.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • This chapter will examine the pathophysiology, classification, and pharmacotherapy, and describe the strategy and rationale of how to deal with this recurrent condition and to limit and contain its sequelae. 2014 S. Karger AG, Basel[ncbi.nlm.nih.gov]
  • Further study is needed to understand the pathophysiologic mechanisms underlying this correlation.[ncbi.nlm.nih.gov]
  • Knowledge of the pathobiological and pathophysiological mechanisms involved in posttraumatic PVR is increasing the possibilities of management, and it is hoped that in the future our treatment strategies will evolve, in particular adopting a multidrug[ncbi.nlm.nih.gov]
  • More detailed understanding of the pathophysiology underlying PVR may lead to the development of effective prophylactic and/or adjunctive therapies.[ncbi.nlm.nih.gov]
  • This result will expand our knowledge of pathophysiologic characteristics of PVR, and might be helpful for further developing possible treatment on this disorder.[ncbi.nlm.nih.gov]

Prevention

  • The high viscosity of OVDs sealed the iatrogenic retinal breaks and thus prevented the PFCL from leaking into the subretinal space during the vitrectomy.[ncbi.nlm.nih.gov]
  • AUTHORS' CONCLUSIONS: Results from this review indicate that there is inconsistent evidence from two studies on patients at different risk of PVR on the effect of LMWH and 5-FU used during vitrectomy to prevent PVR.[ncbi.nlm.nih.gov]
  • Intravitreal injection of LY prevented tractional retinal detachment in 14 out of 15 animals.[ncbi.nlm.nih.gov]
  • Author information 1 Swiss Eye Institute and University of Bern, Bern, Switzerland. justus.garweg@swiss-eye-institute.com Abstract Because proliferative vitreoretinopathy cannot be effectively treated, its prevention is indispensable for the success of[ncbi.nlm.nih.gov]
  • Purpose: Proliferative vitreoretinopathy (PVR) is an inflammatory fibrotic disease resulting from the inflammatory milieu after retinal detachment, which can prevent retinal healing.[ncbi.nlm.nih.gov]

References

Article

  1. Sadaka A, Giuliari GP. Proliferative vitreoretinopathy: current and emerging treatments. Clin Ophthalmol. 2012;6:1325-1333.
  2. Di Lauro S, Kadhim MR, Charteris DG, Pastor JC. Classifications for Proliferative Vitreoretinopathy (PVR): An Analysis of Their Use in Publications over the Last 15 Years. J Ophthalmol. 2016;2016:7807596.
  3. Pastor JC. Proliferative vitreoretinopathy: an overview. Surv Ophthalmol. 1998;43(1):3–18.
  4. Vinores SA, Campochiaro PA, Conway BP. Ultrastructural and electron-immunocytochemical characterization of cells in epiretinal membranes. Invest Ophthalmol Vis Sci. 1990;31(1):14–28
  5. Garweg JG, Tappeiner C, Halberstadt M. Pathophysiology of proliferative vitreoretinopathy in retinal detachment. Surv Ophthalmol. 2013;58(4):321-329.
  6. Mietz H, Heimann K. Onset and recurrence of proliferative vitreoretinopathy in various vitreoretinal disease. Br J Ophthalmol. 1995;79(10):874-877.
  7. Sadeh AD, Dotan G, Bracha R, Lazar M, Loewenstein A. Characteristics and outcomes of paediatric rhegmatogenous retinal detachment treated by segmental scleral buckling plus an encircling element. Eye (Lond). 2001;15(Pt 1):31-33.
  8. Schwartz SG, Flynn HW, Lee W-H, Ssemanda E, Ervin A-M. Tamponade in surgery for retinal detachment associated with proliferative vitreoretinopathy. Cochrane Database Syst Rev. 2009;(4): CD006126.
  9. Tseng W, Cortez RT, Ramirez G, Stinnett S, Jaffe GJ. Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery. Am J Ophthalmol. 2004;137(6):1105-1115.
  10. Boscher C, Kuhn F. An endoscopic overview of the anterior vitreous base in retinal detachment and anterior proliferative vitreoretinopathy. Acta Ophthalmol. 2014;92(4):e298-304.

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Last updated: 2019-07-11 20:08