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Proliferative Retinal Detachment Follow-up

  • Author: Steve Charles, MD; Chief Editor: Hampton Roy, Sr, MD  more...
Updated: Mar 15, 2016

Further Outpatient Care

All patients must be examined on the first postoperative day to determine if increased IOP, flat chamber, incorrect patient positioning, or endophthalmitis (a rare finding) is present. Most patients are then examined in 1-3 weeks.


Further Inpatient Care

Outpatient surgery for vitreoretinal surgery is the criterion standard. Concomitant medical conditions should determine the need for an inpatient approach.


Inpatient & Outpatient Medications

Topical fourth-generation fluoroquinolones (Vigamox) are used 4 times/day for approximately 1 week after surgery. All patients receive subconjunctival cefazolin (vancomycin if allergic to penicillins) and subconjunctival ceftriaxone at the end of surgery. Systemic antibiotics are not indicated.

Topical cycloplegics, such as Cyclogyl 1%, are used 2-3 times/day for 2-3 weeks after surgery.

Subconjunctival steroids, such as Kenalog (triamcinolone acetonide), are used in all patients except those who are steroid responders. The author never uses systemic steroids in these patients.

Topical steroids are used in all patients who are not steroid responders. The drops are administered 4 times/day. Prednisolone acetate 1% is the preferred agent.



General ophthalmologists should transfer patients with proliferative vitreoretinopathy (PVR) to vitreoretinal surgeons.



Excessive retinopexy (especially cryopexy), operating on inflamed eyes, bleeding, iris trauma, excessive operating times, retained lens material, viscoelastics, and excessive operative trauma contribute to recurrent proliferative vitreoretinopathy.



Recurrent proliferative vitreoretinopathy is the most common complication, occurring at a frequency of 25-50%.[8, 14, 23, 24]

Cataracts may occur from prolonged gas or silicone oil contact with the lens.

Uveitis may occur from excessive retinopexy, lengthy surgery, iris trauma, or retained lens material.

Intravitreal, anterior chamber, subretinal, or suprachoroidal hemorrhage may occur.

Glaucoma secondary to uveitis, excessive gas bubbles, pupillary block, silicone oil emulsification, surgical trauma to vortex veins or aqueous veins, or steroid glaucoma may occur.

Ocular or periocular manifestations are as follows:

  • Retina - Epiretinal membranes, fixed folds, star folds, and subretinal placoid or dendritic proliferation
  • Vitreous - Condensation, contraction, pigmentation, and posterior vitreous detachment[14, 23, 24]
  • Other - Visual loss


The anatomical success rate is dependent on the patient mix, the technique used, unknown patient factors, and the surgeon's skill. The success rate varies from 50-90%.[14, 23, 24]

The visual prognosis is dependent on duration and height of the detachment, media clarity, epimacular membranes, and other unknown factors.


Patient Education

Inform the patients about positioning, activity, visual prognosis, complications, medications, anesthesia risk factors, and anatomical and visual success rates.

Contributor Information and Disclosures

Steve Charles, MD Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine

Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Russell P Jayne, MD Consulting Vitreoretinal Surgeon, The Retina Center at Las Vegas

Russell P Jayne, MD is a member of the following medical societies: American Medical Association, American Society of Cataract and Refractive Surgery, American Society of Retina Specialists

Disclosure: Nothing to disclose.

  1. Sethi CS, Lewis GP, Fisher SK, et al. Glial remodeling and neural plasticity in human retinal detachment with proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci. 2005 Jan. 46(1):329-42. [Medline].

  2. Coral K, Angayarkanni N, Gomathy N, Bharathselvi M, Pukhraj R, Rupak R. Homocysteine levels in the vitreous of proliferative diabetic retinopathy and rhegmatogenous retinal detachment: its modulating role on lysyl oxidase. Invest Ophthalmol Vis Sci. 2009 Aug. 50(8):3607-12. [Medline].

  3. Praidou A, Klangas I, Papakonstantinou E, et al. Vitreous and serum levels of platelet-derived growth factor and their correlation in patients with proliferative diabetic retinopathy. Curr Eye Res. 2009 Feb. 34(2):152-61. [Medline].

  4. Rodriguez de la Rua E, Pastor JC, Aragon J, et al. Interaction between surgical procedure for repairing retinal detachment and clinical risk factors for proliferative vitreoretinopathy. Curr Eye Res. 2005 Feb. 30(2):147-53. [Medline].

  5. Tsui I, Schubert HD. Retinotomy and silicone oil for detachments complicated by anterior inferior proliferative vitreoretinopathy. Br J Ophthalmol. 2009 Sep. 93(9):1228-33. [Medline].

  6. Li W, Zheng J, Zheng Q, Wu R, Wang X, Xu M. Clinical complications of Densiron 68 intraocular tamponade for complicated retinal detachment. Eye (Lond). 2010 Jan. 24(1):21-8. [Medline].

  7. Tinley CG, Gray RH. Routine, single session, indirect laser for proliferative diabetic retinopathy. Eye (Lond). 2009 Sep. 23(9):1819-23. [Medline].

  8. Abrams GW, Azen SP, McCuen BW 2nd, Flynn HW Jr, Lai MY, Ryan SJ. Vitrectomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy: results of additional and long-term follow-up. Silicone Study report 11. Arch Ophthalmol. 1997 Mar. 115(3):335-44. [Medline].

  9. Anderson DH, Stern WH, Fisher SK, Erickson PA, Borgula GA. The onset of pigment epithelial proliferation after retinal detachment. Invest Ophthalmol Vis Sci. 1981 Jul. 21(1 Pt 1):10-6. [Medline].

  10. Campochiaro PA. Pathogenic mechanisms in proliferative vitreoretinopathy. Arch Ophthalmol. 1997 Feb. 115(2):237-41. [Medline].

  11. Campochiaro PA, Glaser BM. Platelet-derived growth factor is chemotactic for human retinal pigment epithelial cells. Arch Ophthalmol. 1985 Apr. 103(4):576-9. [Medline].

  12. Campochiaro PA, Jerdan JA, Glaser BM. Serum contains chemoattractants for human retinal pigment epithelial cells. Arch Ophthalmol. 1984 Dec. 102(12):1830-3. [Medline].

  13. Campochiaro PA, Jerdan JA, Glaser BM, Cardin A, Michels RG. Vitreous aspirates from patients with proliferative vitreoretinopathy stimulate retinal pigment epithelial cell migration. Arch Ophthalmol. 1985 Sep. 103(9):1403-5. [Medline].

  14. Charles S. Methodology and research on proliferative vitreoretinopathy. Presented at: Retina Society Meeting: Cleveland, OH; Nov 1985.

  15. Chandler DB, Rozakis G, de Juan E Jr, Machemer R. The effect of triamcinolone acetonide on a refined experimental model of proliferative vitreoretinopathy. Am J Ophthalmol. 1985 Jun 15. 99(6):686-90. [Medline].

  16. Ando F, Kondo J. A plastic tack for the treatment of retinal detachment with giant tear. Am J Ophthalmol. 1983 Feb. 95(2):260-1. [Medline].

  17. Laqua H, Machemer R. Clinical-pathological correlation in massive periretinal proliferation. Am J Ophthalmol. 1975 Nov. 80(5):913-29. [Medline].

  18. Mandelcorn MS, Machemer R, Fineberg E, Hersch SB. Proliferation and metaplasia of intravitreal retinal pigment epithelium cell autotransplants. Am J Ophthalmol. 1975 Aug. 80(2):227-37. [Medline].

  19. Patel NN, Bunce C, Asaria RH, Charteris DG. Resources involved in managing retinal detachment complicated by proliferative vitreoretinopathy. Retina. 2004 Dec. 24(6):883-7. [Medline].

  20. Santana M, Wiedemann P, Kirmani M, et al. Daunomycin in the treatment of experimental proliferative vitreoretinopathy: retinal toxicity of intravitreal daunomycin in the rabbit. Graefes Arch Clin Exp Ophthalmol. 1984. 221(5):210-3. [Medline].

  21. Stern WH, Lewis GP, Erickson PA, et al. Fluorouracil therapy for proliferative vitreoretinopathy after vitrectomy. Am J Ophthalmol. 1983 Jul. 96(1):33-42. [Medline].

  22. Tano Y, Chandler D, Machemer R. Treatment of intraocular proliferation with intravitreal injection of triamcinolone acetonide. Am J Ophthalmol. 1980 Dec. 90(6):810-6. [Medline].

  23. Charles S. Vitrectomy for retinal detachment. Trans Ophthalmol Soc U K. 1980. 100(4):542-9. [Medline].

  24. Charles S. Vitreous surgery for proliferative vitreoretinopathy. Presented at: Vitreous Society Meeting: Orlando, FL; Oct 1985.

  25. Cibis PA. Vitreous transfer and silicone injections. Trans Am Acad Ophthalmol. 1964. 68:983.

  26. Cibis PA, Becker B, Okun E, et al. The use of liquid silicone in retinal detachment surgery. Arch Ophthalmol. 1962. 68:590.

  27. Meredith TA, Lindsey DT, Edelhauser HF, Goldman AI. Electroretinographic studies following vitrectomy and intraocular silicone oil injection. Br J Ophthalmol. 1985 Apr. 69(4):254-60. [Medline].

  28. Momirov D, van Lith GH, Zivojnovic R. Electroretinogram and electrooculogram of eyes with intravitreously injected silicone oil. Ophthalmologica. 1983. 186(4):183-8. [Medline].

  29. Ober RR, Blanks JC, Ogden TE, Pickford M, Minckler DS, Ryan SJ. Experimental retinal tolerance to liquid silicone. Retina. 1983. 3(2):77-85. [Medline].

  30. Ober RR, Ryan SJ, Minckler DS, et al. Ocular tolerance to liquid silicone. Invest Ophthalmol Vis Sci. 1988. 19 Suppl:47.

  31. Okun E. Intravitreal surgery utilizing liquid silicone. A long term followup. Trans Pac Coast Otoophthalmol Soc Annu Meet. 1968. 49:141-59. [Medline].

  32. Okun E, Arribas N, Johnston GP. Therapy of retinal detachment complicated by massive preretinal fibroplasia. Long-term follow-up of patients treated with intravitreal liquid silicone. Bibl Ophthalmol. 1969. 79:563-71. [Medline].

  33. Ando F. Intraocular hypertension resulting from pupillary block by silicone oil. Am J Ophthalmol. 1985 Jan 15. 99(1):87-8. [Medline].

  34. Blumenkranz MS, Ophir A, Claflin AJ, Hajek A. Fluorouracil for the treatment of massive periretinal proliferation. Am J Ophthalmol. 1982 Oct. 94(4):458-67. [Medline].

  35. de Juan E Jr, Hickingbotham D, Machemer R. Retinal tacks. Am J Ophthalmol. 1985 Mar 15. 99(3):272-4. [Medline].

  36. Diddie KR, Azen SP, Freeman HM, et al. Anterior proliferative vitreoretinopathy in the silicone study. Silicone Study Report Number 10. Ophthalmology. 1996 Jul. 103(7):1092-9. [Medline].

  37. Dieudonne SC, La Heij EC, Diederen R, et al. High TGF-beta2 levels during primary retinal detachment may protect against proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci. 2004 Nov. 45(11):4113-8. [Medline].

  38. Foerster MH, Esser J, Laqua H. Silicone oil and its influence on electrophysiologic findings. Am J Ophthalmol. 1985 Feb 15. 99(2):201-6. [Medline].

  39. Freeman KD, Gregor ZJ. Electrophysiological responses after vitrectomy and intraocular tamponade. Trans Ophthalmol Soc UK. 1985. 104:129.

  40. Glaser BM. A new method of treating giant tears without patient rotation with the use of intraocular gas and silicone oil. Presented at: Annual Meeting of American Academy of Ophthalmology: Atlanta, GA; Oct 2 1985.

  41. Glaser BM, Vidaurri-Leal J, Michels RG, Campochiaro PA. Cryotherapy during surgery for giant retinal tears and intravitreal dispersion of viable retinal pigment epithelial cells. Ophthalmology. 1993 Apr. 100(4):466-70. [Medline].

  42. Han DP, Lewis MT, Kuhn EM, et al. Relaxing retinotomies and retinectomies. Surgical results and predictors of visual outcome. Arch Ophthalmol. 1990 May. 108(5):694-7. [Medline].

  43. Kohno T, Sorgente N, Patterson R, Ryan SJ. Fibronectin and laminin distribution in bovine eye. Jpn J Ophthalmol. 1983. 27(3):496-505. [Medline].

  44. Kohno T, Sorgente N, Ryan SJ. Fibronectin distribution at the vitreoretinal interface. Invest Ophthamol Vis Sci. 1983. 24:240.

  45. Labelle P, Okun E. Ocular tolerance to liquid silicone. An experimental study. Can J Ophthalmol. 1972 Apr. 7(2):199-204. [Medline].

  46. Laqua H, Machemer R. Glial cell proliferation in retinal detachment (massive periretinal proliferation). Am J Ophthalmol. 1975 Oct. 80(4):602-18. [Medline].

  47. Lewis H, Aaberg TM. Causes of failure after repeat vitreoretinal surgery for recurrent proliferative vitreoretinopathy. Am J Ophthalmol. 1991 Jan 15. 111(1):15-9. [Medline].

  48. Machemer R. Massive periretinal proliferation (MPP) I. Pigment epithelium proliferation. Mod Probl Ophthalmol. 1975. 15:227. [Medline].

  49. Machemer R. Massive periretinal proliferation: a logical approach to therapy. Trans Am Ophthalmol Soc. 1977. 75:556-86. [Medline].

  50. Machemer R. Pathogenesis and classification of massive periretinal proliferation. Br J Ophthalmol. 1978 Nov. 62(11):737-47. [Medline].

  51. Machemer R. Role of the pigment epithelium in vitreous pathology. Trans Ophthalmol Soc U K. 1975. 95(3):402. [Medline].

  52. Machemer R, Aaberg TM, Freeman HM, Irvine AR, Lean JS, Michels RM. An updated classification of retinal detachment with proliferative vitreoretinopathy. Am J Ophthalmol. 1991 Aug 15. 112(2):159-65. [Medline].

  53. Machemer R, Laqua H. A logical approach to the treatment of massive periretinal proliferation. Ophthalmology. 1978 Jun. 85(6):584-93. [Medline].

  54. Machemer R, Laqua H. Pigment epithelium proliferation in retinal detachment (massive periretinal proliferation). Am J Ophthalmol. 1975 Jul. 80(1):1-23. [Medline].

  55. Machemer R, Sugita G, Tano Y. Treatment of intraocular proliferations with intravitreal steroids. Trans Am Ophthalmol Soc. 1979. 77:171-80. [Medline].

  56. Machemer R, van Horn D, Aaberg TM. Pigment epithelial proliferation in human retinal detachment with massive periretinal proliferation. Am J Ophthalmol. 1978 Feb. 85(2):181-91. [Medline].

  57. Pastor JC. Proliferative vitreoretinopathy: an overview. Surv Ophthalmol. 1998 Jul-Aug. 43(1):3-18. [Medline].

  58. Scott JD. A rationale for the use of liquid silicone. Trans Ophthalmol Soc U K. 1977 Jul. 97(2):235-7. [Medline].

  59. Scott JD. The treatment of massive vitreous retraction by the separation of preretinal membranes using liquid silicone. Mod Probl Ophthalmol. 1975. 15:285.

  60. Silicone Study Report 2. Vitrectomy with silicone oil or perfluoropropane gas in eyes with severe proliferative vitreoretinopathy: results of a randomized clinical trial. Arch Ophthalmol. 1992 Jun. 110(6):780-92. [Medline].

  61. Sternberg P Jr, Machemer R. Results of conventional vitreous surgery for proliferative vitreoretinopathy. Am J Ophthalmol. 1985 Jul 15. 100(1):141-6. [Medline].

  62. 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 Jun. 137(6):1105-15. [Medline].

  63. Van Horn DL, Aaberg TM, Machemer R, Fenzl R. Glial cell proliferation in human retinal detachment with massive periretinal proliferation. Am J Ophthalmol. 1977 Sep. 84(3):383-93. [Medline].

  64. Wiedemann P, Sorgente N, Bekhor C, Patterson R, Tran T, Ryan SJ. Daunomycin in the treatment of experimental proliferative vitreoretinopathy. Effective doses in vitro and in vivo. Invest Ophthalmol Vis Sci. 1985 May. 26(5):719-25. [Medline].

  65. Wiedemann P, Sorgente N, Kirmani M. Daunorubicin of experimental MPP-effective doses in vitro and in vivo. Invest Ophthalmol Vis Sci. 1983. 24 (Suppl):241.

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