Program list

SYMPOSIUM: FUNDAMENTALS
Moderators: Khaled El-Rakhawy, Cesare Forlini
Sunday, September 14th, 2003 ; 8:15 - 12:35

UPDATE ON PROPHYLAXIS, SURGICAL AND MEDICAL TREATMENT AND RESEARCH
J. Carlos Pastor
University of Valladolid, Valladolid, Spain

Proliferative vitreoretinopathy (PVR) is considered an anomalous scarring process affecting some rhegmatogenous retinal detachments (RD), with an incidence of 10%.
Althoug PVR was recognized as an entity in 1983 its management still remains a challenge. It is accepted as the commonest cause of RD surgery failure.
Its pathogenesis has similarities with the wound healing process and a crucial role for retinal pigment epithelial cells, retinal glial cells and macrophages have been identified. Recently, the attention has been focused on intraretinal changes (gliosis and/or fibrosis) that compromise the surgical and functional prognosis.
It has been establish that PVR is an acute event and some efforts have been made in the characterization of its chronology that may improve the present classifications providing important data for a more accurate treatment.
Several risk factors have been identified and some authors have developed formulas to determine the probability of developing PVR for each particular patient, but the sensitivity and specificity are still very low and improvements are necessary to spread their use. Genetic approach seems also an interesting pathway.
Despite the clear improvement on anatomic success with more refined surgical techniques developed during the last 25 years, the rate of anatomic reattachment is still no higher than 60% in the most severe cases of PVR, and functional results are very poor.
The use of heavy tamponades is now under investigation, and more efforts are being done in medical treatment and prophylaxis. The intraoperative use of 5-fluorouracil and heparin, or intraocular the injection of triamcinolone are the most accepted medical tools, but some others approaches are under investigation including gene therapy, growth factor regulation, combined therapies and anti-patelet derived growth factor (PDGF) drugs.