Surgery of retinal detachment with proliferative vitreoretinopathy

Surgical treatment of retinal detachment complicated by proliferative vitreoretinopathy (PVR) depends on understanding both the pathoanatomy of the structural changes and the biologic time course of the intraocular proliferative process. Successful surgery is dependent on treating both the traction and rhegmatogenous components. Vitreous surgery is used to relieve the transvitreal traction and to remove epiretinal membranes causing fixed folding of the posterior retina. A broad and high scleral buckle is used to close all retinal breaks and to relieve remaining anteroperipheral vitreous and epiretinal membrane traction that cannot be relieved by vitrectomy. Vitreous surgery is best done after the proliferative process has run its biologic time course to minimize recurrence of epiretinal membranes. Therefore, staged procedures may be used in selected cases by first modifying the scleral buckle to treat the rhegmatogenous component followed later by definitive vitreous surgery. The principles and techniques of managing retinal detachment with PVR are described.