Management of Retinal Detachment Accompanied by PVR: Controversy Continues

Even with the new advances in vitreous-retinal surgery achieved in recent years, vitreous surgeons still have to weigh the likelihood of needing more than one surgery to treat rhegmatogenous retinal detachment (RRD). This situation becomes more likely if the detachment is accompanied or there is a risk of proliferative vitreoretinopathy (PVR). PVR has been described as a process analogous to the healing and remodeling of the retina and its adjacent structures. This condition is found in approximately 10% of RRD cases. The migration of pigment epithelial cells through the breaks present in the RRD is well known [1-3]. Glial proliferation can be observed from micro-ruptures in the internal limiting membrane secondary to the vitreous traction or even to the peeling of membranes in previous interventions, in the case of recurrent RRD. These phenomena lead to migration and proliferation of cells above and below the retina with the formation of membranes [4-6]. Finally, the contraction of these cells is added due to the presence of intracellular microtubules similar to those existing in muscle cells. The traction on the retina exerted by these membranes plays an important role in the loss of the normal transretinal pressure gradient. Aggravating this phenomenon already present due to passage of fluid to the sub-retinal space through the retinal breaks. Therefore, when the surgeon is faced with RRD + PVR cases, he must take into account not only the main objective of stopping the fluid flow through the breaks, but also face and eliminate all traction on the retina. With this article, we attempt to offer elements found in the consulted bibliography, accompanied by our personal assessment of this condition, based on our experiences obtained from daily practice with our patients.