Proliferative Retinal Detachment

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

Background

Proliferative vitreoretinopathy (PVR) is the most common cause of failure in retinal detachment surgery. [1, 2, 3, 4, 5, 6, 7, 8, 9] It can occur in untreated eyes or occur after pneumatic retinopexy, cryotherapy, laser retinopexy, scleral buckling, or vitrectomy. [4, 7, 8] Because excessive retinopexy and operating on inflamed eyes can cause proliferative vitreoretinopathy, some cases should be considered iatrogenic. Epimacular membranes occurring after retinal detachment surgery can be thought of as limited proliferative vitreoretinopathy. Proliferative vitreoretinopathy can occur from glial or retinal pigment epithelium (RPE) proliferation. [1, 2, 3, 10, 11, 12, 13] PVR can also occur in diabetic traction retinal detachment cases if there are associated retinal breaks. Penetrating or blunt trauma may also result in proliferative vitreoretinopathy.

Also see the clinical guideline summary from the American Academy of Ophthalmology, Posterior vitreous detachment, retinal breaks, and lattice degeneration.

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Pathophysiology

Proliferative vitreoretinopathy is a reparative process, similar to a keloid, initiated by full- or partial-thickness retinal breaks, retinopexy, and other types of retinal damage. Loss of contact inhibition causes the surrounding glial or RPE cells to migrate to one or both surfaces of the retina. [1] Although the cells exhibit modest mitotic activity, it is largely a hypocellular process. Glial or RPE cells migrate further and cover the posterior surface of the detached posterior hyaloid face. [9, 10, 13, 14] Fibronectin-lined coated pits serve as attachments of RPE or glial cells to collagen fibers and other components of the extracellular matrix. The migration/contraction mechanism causes tangential force on the retina via multiple star folds and fixed folds. [13, 15, 14] The collagen fibers of anterior and posterior vitreous cortex contract because of a similar hypocellular contraction process.

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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.

Mortality/Morbidity

Proliferative vitreoretinopathy has no associated mortality. Morbidity is limited to blindness in the affected eye if not treated successfully. If several operations are required to repair proliferative vitreoretinopathy, poor vision may result even with a successfully attached retina.

Race

No known racial predilection exists for proliferative retinal detachment.

Sex

No known sexual predilection exists for proliferative retinal detachment.

Age

Although proliferative vitreoretinopathy can occur at all ages, some observers believe that proliferative tissue may develop more rapidly in children.

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