Managing PVR in the Era of Small Gauge Surgery.

Manish Nagpal,Sham Talati,Rakesh Juneja,Alessandro Meduri

doi:10.1155/2021/8959153

Manish Nagpal, Sham Talati + Show 2 more

Open Access

https://doi.org/10.1155/2021/8959153

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Abstract

Proliferative vitreoretinopathy (PVR) is the leading cause of failed rhegmatogenous retinal detachment (RRD) surgery. Based upon the presence of clinical features and due to associated underlying risk factors, it is classified into various grades based upon its severity and extent of involvement. Despite excellent skills, flawless techniques, and high-end technology applied in the management of RRD, PVR still occurs in 5–10% of cases. Due to the advancements in wide angle viewing systems, advance vitrectomy machines and fluidics, early identification, use of long-term heavy silicon oil tamponades, high-speed cutters, small-gauge vitrectomies, use of perfluorocarbon liquid (PFCL), and small-gauge forceps and scissors, the success rate in the management of PVR has increased leading to improved anatomical outcomes. However, functional outcomes do not correlate well with improved anatomical outcomes. Various complications occur after RRD repair that are responsible for re-retinal detachment and recurrence of PVR. This article highlights causes, risk factors, classification, grading, diagnosis, and approach to management of PVR and post-PVR surgery complications.

Highlights

In 1983, on the basis of “massive vitreous traction” or “massive periretinal proliferation,” the Retina Society Terminology Committee put forward a classification and Proliferative Vitreoretinopathy (PVR) was identified as an independent clinical entity [1,2,3,4]
It leads to growth and contraction of cellular membranes within the vitreous cavity and on both sides of the retinal surface leading to intraretinal fibrosis and failed rhegmatogenous retinal detachment (RRD) repair surgery (Figure 1) [5, 6]
PVR can manifest in various ways like traction, wrinkling of retinal surfaces, rolled edges, starfolds, and retinal shortening

Summary

Introduction

In 1983, on the basis of “massive vitreous traction” or “massive periretinal proliferation,” the Retina Society Terminology Committee put forward a classification and Proliferative Vitreoretinopathy (PVR) was identified as an independent clinical entity [1,2,3,4]. In a case of RRD with PVR, the flaps of the retina may assume a “V” pattern at the optic disc with very limited retinal mobility as they approach the optic nerve (open funnel retinal detachment) (Figure 5).

Results

Conclusion