Many drugs, such as colchicine, corticosteroids, retinoids, and heparin, might be useful for inhibiting PVR development at specific stages. More detailed understanding of the pathophysiology underlying PVR may lead to the development of effective prophylactic and/or adjunct therapies. Further work is necessary to identify optimal adjunct therapies for the management of RD and PVR.

SUMMARY AND KEY POINTS

Current methods of surgical management of RD and PVR are pneumatic retinopexy, scleral buckling, and PPV. The principles of surgical management consist of sealing all retinal breaks and relief of vitreoretinal traction. However, although surgical success rates for PVR have improved as vitrectomy techniques and instruments have evolved, more than 25% of initially successful cases result in retinal redetachment due to recurrent tractional proliferation. This of course, results in suboptimal visual results as well.

Recent efforts have therefore been directed toward pharmacologic inhibition of cellular proliferation and membrane contraction with drugs such as daunorubicin, 5-fluorouracil, and heparin. Pharmacologic inhibition of the pathologic response involved in cell adhesion, proliferation, and membrane contraction would most likely improve the surgical success rate for RD. Moreover, better understanding of the processes leading to retina damage after detachment, and knowledge of how to protect or rehabilitate such retinas, may ultimately result in better visual outcomes, even in relatively long-standing macular-off retinal detachments.

REFERENCES

1.Charteris DG, Sethi CS, Lewis GP, et al. Proliferative vitreoretinopathy

– developments in adjunctive treatment and retinal pathology. Eye 2002;16:369–374.

2.Ivanisevic M, Bojic L, Eterovic D. Epidemiological study of nontraumatic phakic rhegmatogenous retinal detachment. Ophthalmic Res 2000;32:237–239.

3.Subramanian ML, Topping TM. Controversies in the management of primary retinal detachments. Int Ophthalmol Clin 2004;44:103–114.

4.Ramos M, Kruger EF, Lashkari K. Biostatistical analysis of pseudophakic and aphakic retinal detachments. Semin Ophthalmol 2002;17:206–213.

5.Erie JC, Raecker ME, Baratz KH, et al. Risk of retinal detachment after cataract extraction, 1980–2004: a population-based study. Trans Am Ophthalmol Soc 2006;104:167–175.

6.Bhagwandien AC, Cheng YY, Wolfs RC, et al. Relationship between retinal detachment and biometry in 4262 cataractous eyes. Ophthalmology 2006;113:643–649.

7.Tuft SJ, Minassian D, Sullivan P. Risk factors for retinal detachment after cataract surgery: a case-control study. Ophthalmology 2006;113:650–656.

8.Colin J, Robinet A, Cochener B. Retinal detachment after clear lens extraction for high myopia: seven-year follow-up. Ophthalmology 1999;106:2281–2284; discussion 2285.

9.Alio JL, Ruiz-Moreno JM, Shabayek MH, et al. The risk of retinal detachment in high myopia after small incision coaxial phacoemulsification.

Am J Ophthalmol 2007;144:93–98.

10.Jahn CE, Richter J, Jahn AH, et al. Pseudophakic retinal detachment after uneventful phacoemulsification and subsequent neodymium: YAG capsulotomy for capsule opacification. J Cataract Refract Surg 2003;29:925–929.

11.Ranta P, Tommila P, Kivela T. Retinal breaks and detachment after neodymium: YAG laser posterior capsulotomy: five-year incidence in a prospective cohort. J Cataract Refract Surg 2004;30:58–66.

12.Weinberg DV, Lyon AT, Greenwald MJ, et al. Rhegmatogenous retinal detachments in children: risk factors and surgical outcomes. Ophthalmology 2003;110:1708–1713.

13.Wang NK, Tsai CH, Chen YP, et al. Pediatric rhegmatogenous retinal detachment in East Asians. Ophthalmology 2005;112:1890–1895.

14.Ryan SJ. Retina. 4th ed. Philadelphia: Elsevier/Mosby; 2006.

15.Girard P, Mimoun G, Karpouzas I, et al. Clinical risk factors for proliferative vitreoretinopathy after retinal detachment surgery. Retina 1994;14:417–424.

16.Duquesne N, Bonnet M, Adeleine P. Preoperative vitreous hemorrhage associated with rhegmatogenous retinal detachment: a risk factor for postoperative proliferative vitreoretinopathy? Graefes Arch Clin Exp Ophthalmol 1996;234:677–682.

17.Retina Society Terminology Committee Classification. The classification of retinal detachment with proliferative vitreoretinopathy. Ophthalmology 1983;90:121–125.

18.Bonnet M, Guenoun S. Surgical risk factors for severe postoperative proliferative vitreoretinopathy (PVR) in retinal detachment with grade B PVR. Graefes Arch Clin Exp Ophthalmol 1995;233:789–791.

19.Jaccoma EH, Conway BP, Campochiaro PA. Cryotherapy causes extensive breakdown of the blood–retinal barrier. A comparison with argon laser photocoagulation. Arch Ophthalmol 1985;103:1728–1730.

20.Wiedemann P, Weller M. The pathophysiology of proliferative vitreoretinopathy. Acta Ophthalmol Suppl 1988;189:3–15.

21.Casaroli Marano RP, Vilaro S. The role of fibronectin, laminin, vitronectin and their receptors on cellular adhesion in proliferative vitreoretinopathy. Invest Ophthalmol Vis Sci 1994;35:2791–2803.

22.Baudouin C, Hofman P, Brignole F, et al. Immunocytology of cellular components in vitreous and subretinal fluid from patients with proliferative vitreoretinopathy. Ophthalmologica 1991;203:38–46.

23.Lee SC, Kwon OW, Seong GJ, et al. Epitheliomesenchymal transdifferentiation of cultured RPE cells. Ophthalmic Res 2001;33:80–86.

24.Glaser BM, Cardin A, Biscoe B. Proliferative vitreoretinopathy. The mechanism of development of vitreoretinal traction. Ophthalmology 1987;94:327–332.

25.Hiscott P, Sheridan C, Magee RM, et al. Matrix and the retinal pigment epithelium in proliferative retinal disease. Prog Retin Eye Res 1999;18:167–190.

26.Wiedemann P. Growth factors in retinal diseases: proliferative vitreoretinopathy, proliferative diabetic retinopathy, and retinal degeneration. Surv Ophthalmol 1992;36:373–384.

27.Jerdan JA, Pepose JS, Michels RG, et al. Proliferative vitreoretinopathy membranes. An immunohistochemical study. Ophthalmology 1989;96:801–810.

28.Fuller DG, Laqua H, Machemer R. Ultrasonographic diagnosis of massive periretinal proliferation in eyes with opaque media (triangular retinal detachment). Am J Ophthalmol 1977;83:460–464.

29.Schwartz SG, Flynn HW. Primary retinal detachment: scleral buckle or pars plana vitrectomy? Curr Opin Ophthalmol 2006;17:245–250.

30.Saw SM, Gazzard G, Wagle AM, et al. An evidence-based analysis of surgical interventions for uncomplicated rhegmatogenous retinal detachment. Acta Ophthalmol Scand 2006;84:606–612.

31.Pastor JC. Proliferative vitreoretinopathy: an overview. Surv Ophthalmol 1998;43:3–18.

32.Ryan SJ. Traction retinal detachment. XLIX Edward Jackson Memorial Lecture. Am J Ophthalmol 1993;115:1–20.

33.Iverson DA, Ward TG, Blumenkranz MS. Indications and results of relaxing retinotomy. Ophthalmology 1990;97:1298–1304.

34.Federman JL, Eagle Jr RC. Extensive peripheral retinectomy combined with posterior 360 degrees retinotomy for retinal reattachment in advanced proliferative vitreoretinopathy cases. Ophthalmology 1990;97:1305–1320.

35.Kirchhof B. Strategies to influence PVR development. Graefes Arch Clin Exp Ophthalmol 2004;242:699–703.

36.Tornambe PE, Hilton GF, Brinton DA, et al. Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling. Ophthalmology 1991;98:1115–1123.

37.Ahmadieh H, Moradian S, Faghihi H, et al. Anatomic and visual outcomes of scleral buckling versus primary vitrectomy in pseudophakic and aphakic retinal detachment: six-month follow-up results of a single operation – report no. 1. Ophthalmology 2005;112:1421–1429.

38.Brazitikos PD, Androudi S, Christen WG, et al. Primary pars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial. Retina 2005;25:957–964.

39.Wolfensberger TJ. Foveal reattachment after macula-off retinal detachment occurs faster after vitrectomy than after buckle surgery. Ophthalmology 2004;111:1340–1343.

40.Chang S, Coleman DJ, Lincoff H, et al. Perfluoropropane gas in the management of proliferative vitreoretinopathy. Am J Ophthalmol 1984;98:180–188.

41.Sell CH, McCuen 2nd BW, Landers 3rd MB, et al. Long-term results of successful vitrectomy with silicone oil for advanced proliferative vitreoretinopathy. Am J Ophthalmol 1987;103:24–28.

42.Sun JK, Arroyo JG. Adjunctive therapies for proliferative vitreoretinopathy. Int Ophthalmol Clin 2004;44:1–10.

43.Wiedemann P, Hilgers RD, Bauer P, et al. Adjunctive daunorubicin in the treatment of proliferative vitreoretinopathy: results of a multicenter clinical trial. Daunomycin Study Group. Am J Ophthalmol 1998;126:550–559.

44.Shinohara K, Tanaka M, Sakuma T, et al. Efficacy of daunorubicin encapsulated in liposome for the treatment of proliferative vitreoretinopathy. Ophthalmic Surg Lasers Imaging 2003;34:299–305.

45.Asaria RH, Kon CH, Bunce C, et al. Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy: Results from a randomized, double-blind, controlled clinical trial. Ophthalmology 2001;108: 1179–1183.

46.Wickham L, Bunce C, Wong D, et al. Randomized controlled trial of combined 5-fluorouracil and low-molecular-weight heparin in the

management of unselected rhegmatogenous retinal detachments undergoing primary vitrectomy. Ophthalmology 2007;114:698–704.

47.Garcia RA, Sanchez JG, Arevalo JF. Combined 5-fluorouracil, low-molecular- weight heparin, and silicone oil in the management of complicated retinal detachment with proliferative vitreoretinopathy grade C. Ophthalmic Surg Lasers Imaging 2007;38:276–282.

Pharmacotherapy to Amenable Diseases Retinal • 3 section