Proliferative Vitreoretinopathy Detachment: Surgical Management

Proliferative vitreoretinopathy (PVR) involves the growth and contraction of membranes within the vitreous cavity and on the retinal surfaces following rhegmatogenous retinal detachment. PVR is a frequent cause of retinal detachment surgery failure, accounting for over 75% of cases with primary retinal detachment surgical failure. This chapter discusses the surgical management and prevention strategies for PVR in retinal detachments. Despite efforts to develop pre-operative and per-operative adjuncts to prevent PVR, the most effective prevention involves identifying high-risk patients and optimising surgical techniques. Surgical management of PVR entails the principles of relieving retinal traction, retinal break closure, and minimizing recurrence of traction. Techniques such as laser retinopexy, scleral buckling, membrane peeling, retinectomy, and the use of long-acting tamponades are employed to address these aspects. While the anatomical success of these procedures varies, the impact on visual acuity remains a challenge, with a limited proportion of patients achieving significant visual improvement. The choice between silicone oil and long-acting gas tamponade is determined by the degree of PVR activity and the risk of recurrence.