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Disease

Proliferative Vitreoretinopathy (PVR)

Proliferative Vitreoretinopathy (PVR)
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Proliferative Vitreoretinopathy (PVR)

Vitrectomy in PVR
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Vitrectomy in PVR

Vitrectomy in PVR
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Vitrectomy in PVR

Proliferative vitreoretinopathy (PVR) is the most common complication following a retinal detachment associated with a retinal hole or break.  PVR refers to the growth of cellular membranes within the vitreous cavity and on the front and back surfaces of the retina. These membranes, which are essentially scar tissues, exert traction on the retina and may result in recurrences of retinal detachment, even after an initially successful retinal detachment procedure. PVR may be associated with spontaneous reopening of otherwise successfully treated retinal breaks and may even cause the development of new retinal breaks. Finally, PVR may be associated with severe distortion and "stiffness" of the retina, as a result of the contracting membranes. This aspect of the condition not infrequently results in disappointing visual results, despite the very best of management.

Removing the vitreous, and especially the scar tissue from the surface of the retina, is a delicate process that requires the surgeon to lift and peel strands of scar tissue away from the retina. If a scleral buckle had not been previously placed around the eye, one is placed during this surgery. The eye is then filled with air so that the retina is pushed against the back wall of the eye and against the scleral buckle. Once the retina is in place, laser is used to seal the retinal tears, and to form a strong attachment between the retina and the back wall of the eye. At this point, the surgeon will replace the air with a long-acting gas. The gas remains in the eye for many weeks before it is naturally absorbed. The vision is always very poor when air or gas is in the eye. The gas keeps the retina pushed up against the eye wall long enough for the laser burns to heal and take hold. In some cases, the same effect is achieved with clear silicone oil that is placed into the eye. If oil is placed into the eye, it is usually removed at a later time. Following surgery, it may sometimes be necessary for the patient’s head to be positioned in such a way as to help the gas seal the retinal tears. In some cases, extra injections of gas may be required after the surgery.

It is important to realize that recovery of vision after surgery for PVR may take many months. The chance of successful retinal reattachment with vitrectomy for PVR is about 80%. The chance of regaining vision that is good enough just to get around is about 60%. Reading vision only rarely returns. It should be clearly understood that the purpose of PVR surgery is to give the patient an eye that would have some vision, and could serve usefully if the other eye ever loses vision entirely.

It takes the vision a long time to completely recover after a vitrectomy. It is important to know that in some cases the scar tissue may re-form after the surgery and cause re-detachment of the retina.