The Classification of Retinal Detachment with Proliferative Vitreoretinopathy

doi:10.1016/S0161-6420(83)34588-7

Ophthalmology

Volume 90, Issue 2, February 1983, Pages 121-125

https://doi.org/10.1016/S0161-6420(83)34588-7 Get rights and content

Abstract

The term proliferative vitreoretinopathy (PVR) is proposed as a designation for the clinical condition previously known variously as massive vitreous retraction, massive preretinal retraction, or massive periretinal proliferation. This is an abnormality in which rhegmatogenous retinal detachment is complicated by proliferation of membranes on both surfaces of the detached retina and on the posterior surface of the detached vitreous gel. The new classification subdivides PVR into four stages: A, minimal; B, moderate; C, marked; and D, massive. The extent of the fixed retinal folds is subdivided to indicate the number of involved quadrants. The degree of retinal shrinkage into a funnel-like configuration is subdivided into three grades.

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Proliferative vitreoretinopathy (PVR) is an abnormal and prolonged healing response to retinal injury (retinal detachment, post retinal detachment surgery) characterised by: pre/subretinal membrane formation; retinal gliosis and retinal shortening, retinal pigment epithelium cell proliferation; and increased glial (mainly Mu¨ller cells), fibroblast and inflammatory cell (macrophage, lymphocyte) activity, leading to tractional retinal holes/breaks and multiple costly eye operations suffered by patients. PVR can cause retinal re-detachment following primary surgical intervention for rhegmatogenous retinal detachment. Vitrectomy and scleral buckling surgery are the main approaches for treating PVR complications of retinal detachment. Patients require many operations to remove the scar tissue but vision results are suboptimal, and do not meet patient expectations. Over the past 40 years, this has been one of the greatest challenges for vitreoretinal surgeons and patients. Despite previous large clinical trials of multiple candidate drug therapeutics, no proven adjunctive treatment currently exists to either prevent, reduce, or treat PVR formation in retinal detachment. Both cellular proliferation and the intraocular inflammatory response are realistic targets for adjunctive treatments in PVR. The cellular components of PVR periretinal membranes (retinal pigment epithelial, glial, inflammatory and fibroblastic cells) proliferate and are thus targets for antiproliferative agents. In recent years, several new therapeutics have been tested, and we present an updated review of the clinical therapeutics for PVR in retinal detachment.
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The term proliferative vitreoretinopathy (PVR) describes an exuberant fibrovascular response to injury in which mechanisms designed for healing result in loss of retinal visual function. Although uncontrolled fibrovascular proliferation was recognized in the 19th century, a fuller appreciation of its pathogenesis didn't emerge until the latter part of the next century. The clinical picture of PVR was typically associated with retinal detachment, penetrating ocular trauma, and proliferative diabetic retinopathy complicated by vitreous hemorrhage. Major insights into modifiable risk factors of PVR came from Davi Kasner who stressed the importance of removing vitreous at the site of accidental injury. But it was Robert Machemer and the development of surgical vitrectomy that accelerated investigation into PVR. This chapter traces major advances in understanding the pathogenesis of proliferative retinopathy and PVR with an emphasis on morphologic studies. The photograph gallery includes the pathology of rhegmatogenous retinal detachment, vitreous syneresis, proliferative diabetic retinopathy, and anterior proliferative vitreoretinopathy.
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: Presented at the Eighty-seventh Annual Meeting of the American Academy of Ophthalmology, San Francisco, California, October 30–November 5, 1982.

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The Classification of Retinal Detachment with Proliferative Vitreoretinopathy

Abstract

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Vitreoretinal Pathology and Surgery in Retinal Detachment

Massive vitreous retraction

Ophthalmic Surg