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Pharmacologic Interventions for the Prevention and Treatment of Proliferative Vitreoretinopathy: A Systematic Review
Salem Abu Al-Burak1, Ameen Alizada2, Kareem Sadek2
1Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Topic:
To evaluate the efficacy and safety of pharmacologic interventions (including 5-fluorouracil, low-molecular-weight heparin, methotrexate, corticosteroids, anti-VEGF agents, and retinoids) compared with control treatments for preventing or treating proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment repair.
Clinical Relevance:
PVR is the leading cause of anatomic failure after retinal detachment surgery. Despite advances in vitreoretinal techniques, no pharmacologic adjuvant has been established, and management remains primarily surgical.
Methods:
We registered our protocol with PROSPERO (CRD420261435402). We systematically searched 4 databases from inception to June 2026 for studies evaluating pharmacologic therapies for PVR prevention or treatment. Risk of bias was assessed using validated tools, and random-effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).
Results:
In total, 69 studies were included, with 31 contributing to the meta-analysis. No significant improvement in anatomic outcomes was observed with 5-fluorouracil plus low-molecular-weight heparin for prevention (RR, 0.94; 95% CI, 0.59-1.51), methotrexate for established PVR (RR, 0.96; 95% CI, 0.86-1.07), corticosteroids (RR, 1.11; 95% CI, 0.93-1.33), or anti-VEGF therapy (RR, 0.72; 95% CI, 0.32-1.64). Overall, pharmacologic therapy was associated with reduced redetachment risk (RR, 0.52; 95% CI, 0.28-0.94), mainly driven by methotrexate and anti-VEGF subgroups. Retinoids showed a potential benefit for reattachment. Certainty of evidence was low to very low.
Conclusion:
Current evidence does not support routine pharmacologic adjuvant therapy for PVR. Methotrexate, anti-VEGF agents, and retinoids show promising signals but require confirmation in adequately powered randomized controlled trials.
Financial Disclosure(S):
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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