Proliferative Vitreoretinopathy (PVR) is a serious complication arising from retinal detachment. This condition can lead to significant vision loss, highlighting the importance of timely treatment from experienced eye specialists. If you’re facing this challenge, connect with skilled doctors listed with Specialty Vision for guidance on your options.
Proliferative vitreoretinopathy is a serious complication of rhegmatogenous retinal detachment (RRD). It occurs when scar-like membranes form on or around the retina and in the vitreous. These membranes can contract and pull on the retina, creating stiff folds or even shrinking it. PVR makes retinal detachment more difficult to treat and can reduce the chances of fully restoring vision.
PVR is essentially a faulty healing response. When a retinal detachment occurs, it sets off a chain of cellular changes. Cells that normally help maintain the retina start to migrate, multiply, and transform into different cell types. Instead of aiding in repair, they form fibrous membranes that tighten and tug at the retina.
This process is driven by:
Yes, Proliferative Vitreoretinopathy (PVR) can lead to blindness if not treated effectively.
Here’s how:
While PVR is challenging, early detection and advanced surgical care can often preserve some level of vision. Many patients retain functional or ambulatory vision, especially if treated before the macula is permanently affected.
The best way to reduce the risk of PVR is prompt and effective repair of a retinal detachment. However, even with optimal care, certain factors, both patient-related and surgical, can still contribute to its development.
Patients with a previous episode of PVR or those with large, chronic, or complex retinal detachments have a higher risk of recurrence.
Complications during or after retinal surgery may increase risk, including:
Certain ocular conditions create an environment that favors membrane formation:
Any process that disrupts the blood-retinal barrier promotes the release of growth factors and cytokines that stimulate cell migration and proliferation, key drivers of PVR.
Long intervals between retinal detachment and surgery increase the risk of PVR due to prolonged exposure to inflammatory processes and cellular activation.
These specific types of detachments carry a higher risk of developing PVR due to extensive retinal damage and increased traction.
While often used as a tamponade, silicone oil has been associated with increased PVR rates in some cases, especially when left in the eye long-term.
PVR often develops after a retinal detachment and may not cause new symptoms at first. However, it can interfere with the healing process and lead to further complications. Recognizing the signs early is important, especially after retinal surgery.
Vision may improve after surgery, then suddenly worsen again, this is a key warning sign of PVR recurrence.
Scar tissue can pull and wrinkle the retina, causing straight lines to appear wavy or creating blurry spots in vision.
Patients may notice dark spots, strands, or cobweb-like shapes drifting across their vision. These floaters may return or increase if membranes form inside the eye.
Shadows, missing patches, or a curtain-like effect in the side or central vision can occur if the retina detaches again.
If you're experiencing symptoms of Proliferative Vitreoretinopathy or have been diagnosed with a retinal detachment, it's crucial to seek expert care. Contact Dr. Smith at Specialty Vision to schedule a consultation and learn about your treatment options.
Some patients experience brief flashes, often in their peripheral vision, due to continued traction on the retina.
Scarring and retinal distortion may affect the ability to see clearly in low light or distinguish between similar shades.
Involvement of the central retina (macula) can interfere with reading, recognizing faces, or other detailed tasks.
Distortion or traction in one eye may cause imbalance or problems with judging distance.
Surgery is the primary treatment for PVR, with the goal of relieving retinal traction and reattaching the retina. Due to the complexity of the condition, procedures are often challenging and may need to be repeated. Visual recovery varies depending on the extent and duration of the detachment.
Illumination during peeling is critical and is provided using:
PFCL, a heavy fluid, is used to flatten and stabilize the retina during membrane dissection, especially in areas where traction pulls the retina anteriorly.
If traction cannot be fully relieved, a relaxing retinectomy may be needed:
Following surgery, close and regular follow-up is critical to ensure the best possible anatomical and visual outcomes. Postoperative complications can arise, and our retina specialists emphasize the importance of early detection and intervention. In the early weeks after surgery, monitoring for increased intraocular pressure, pupillary block glaucoma, and inflammation is essential, as these can compromise the success of the reattachment.
The early postoperative period is also marked by risks such as subretinal hemorrhage and inadvertent trauma to the choroid. If not addressed promptly, these complications can result in permanent vision loss, even in cases where the retina remains attached. Subretinal PFCL retention or silicone oil migration into the anterior chamber are further challenges that underscore the delicacy of the postoperative phase.
Long-term complications such as recurrent retinal detachment, persistent macular edema, glaucoma, or even hypotony can occur in some cases. Hypotony, in particular, has been noted in up to 15-24% of cases following surgery and can be extremely challenging to treat. It is essential to investigate any treatable causes, such as cyclodialysis clefts or cyclitic membranes, using techniques like ultrasound biomicroscopy. Our retina specialists remain diligent in monitoring these patients and addressing any evolving complications through additional treatments or surgical interventions if necessary.
If you're experiencing symptoms of Proliferative Vitreoretinopathy or have been diagnosed with a retinal detachment, it's crucial to seek expert care. Contact Dr. Smith at Specialty Vision to schedule a consultation and learn about your treatment options.
Proliferative Vitreoretinopathy (PVR) is a serious eye condition that can lead to vision loss. Find treatment options and expert care near you.
