Fibrovascular Proliferation and Tractional Retinal Detachment

Retinal neovascularization (NV) is the hallmark of proliferative diabetic retinopathy (PDR). The NV complex consists of vessels and fibrous tissue. In the early stage of PDR, when fibrovascular proliferation (FVP) is less prominent, medical treatment may prevent disease progression. Controversy exists as to the best strategy for medical treatment. Panretinal photocoagulation (PRP) was the treatment of choice before anti-vascular endothelial growth factor (VEGF) therapy became available (Group TDRSR, Int Ophthalmol Clin 27:239–253, 1987; Group ETDRSR, Ophthalmology 98:766–785, 1991; Group TDRSR, Am J Ophthalmol 81:383–396, 1976). Studies have shown that repeated intravitreal anti-VEGF injection alone may inhibit NV growth or even improve nonperfusion (Writing Committee for the Diabetic Retinopathy Clinical Research N et al., JAMA 314:2137–2146, 2015). Many investigators prefer the combination of anti-VEGF and PRP to obtain a long-term beneficial effect and to decrease the likelihood of the rebound of FVP when the use of anti-VEGF is stopped or when the follow-up visit becomes difficult for the patient (Gross et al., JAMA Ophthalmol 136:1138–1148, 2018). Nonetheless, a certain proportion of patients still experience progression of FVP, and surgical intervention is needed to restore visual function. The common features of FVP, the evolution of FVP, the surgical technique used to treat eyes with FVP, and the complications associated with FVP are discussed in this chapter.