Proliferative Vitreoretinopathy
Scar tissue on the retina that can pull it out of place
Quick Facts
- Type: Eye (retinal) condition
- Main cause: Complication of retinal detachment
- Effect: Scarring that distorts or detaches the retina
- Treatment: Specialized retinal surgery
Overview
Proliferative vitreoretinopathy (PVR) is a condition in which scar tissue forms on the surface of the retina and within the vitreous gel of the eye. As this scar tissue grows and contracts, it can wrinkle the retina and pull it out of its normal position, leading to or worsening a retinal detachment.
PVR is most often a complication of a retinal detachment, particularly after it has been present for a while or after surgery to repair one. It is the most common reason that retinal detachment repair fails. PVR is a serious condition that requires care from a retinal specialist, because the scarring can threaten vision if not treated.
Symptoms
PVR often develops in an eye that has already had a retinal problem, so symptoms may overlap with those of retinal detachment. They include:
- Worsening or returning blurred vision
- New or increasing floaters
- Flashes of light
- A shadow or curtain spreading across part of the vision
- Distorted vision, where straight lines look bent
- Loss of vision if the retina detaches
Any sudden change in vision after a retinal detachment or its repair should be reported promptly, as it may signal PVR or re-detachment.
Causes
PVR develops when cells from the retina and surrounding tissue migrate and multiply on the retina's surface and in the vitreous, forming membranes of scar tissue. As these membranes contract, they exert traction on the retina.
Key factors include:
- Retinal detachment: Especially detachments that have been present for some time.
- Retinal tears or breaks: Particularly large or multiple breaks.
- Eye trauma: Injury that disrupts the retina.
- Previous retinal surgery: PVR can develop after detachment repair.
Risk Factors
- A retinal detachment, especially one that has been present a long time before repair
- Large, multiple, or giant retinal tears
- Previous eye surgery for retinal detachment
- Eye injury or trauma
- Bleeding inside the eye
Diagnosis
A retinal specialist diagnoses PVR through a thorough eye examination:
- Dilated eye exam: Examining the retina to detect scar tissue, wrinkling, and detachment.
- Imaging: Tests such as optical coherence tomography to view the layers of the retina in detail.
- Ultrasound: Used when the view of the retina is blocked, such as by bleeding, to assess the retina and scar tissue.
The severity of PVR is graded to help plan treatment.
Treatment
Treatment of PVR involves specialized retinal surgery to remove scar tissue and reattach the retina. It is performed by a retinal surgeon.
- Vitrectomy: Surgery to remove the vitreous gel and peel away the scar membranes pulling on the retina.
- Retinal reattachment: Techniques to flatten and secure the retina back in place.
- Tamponade: A gas bubble or silicone oil placed in the eye to hold the retina in position while it heals.
- Additional procedures: Laser or freezing treatment to seal retinal breaks.
Recovery requires close follow-up, and more than one surgery is sometimes needed. The goal is to save and stabilize vision.
When to See a Doctor
Contact an eye specialist promptly if you notice changes in vision, especially after a retinal detachment or its repair. Seek urgent eye care if you have:
- A sudden increase in floaters
- Flashes of light
- A shadow or curtain moving across your vision
- A sudden loss of vision
These can signal a retinal detachment or PVR that needs rapid evaluation to protect sight.
Frequently Asked Questions
What is proliferative vitreoretinopathy?
PVR is the growth of scar tissue on the retina and in the vitreous gel of the eye. As the scar tissue contracts, it can pull the retina out of place, causing or worsening a retinal detachment. It usually develops as a complication of retinal detachment.
Why does PVR happen after retinal detachment?
When the retina detaches, cells can migrate and multiply on its surface, forming membranes of scar tissue. These membranes contract and pull on the retina. PVR is the most common reason that retinal detachment repair fails.
What are the symptoms of PVR?
Symptoms often resemble those of retinal detachment, including worsening blurred vision, new floaters, flashes of light, a shadow across the vision, or distortion. Any new vision changes after retinal detachment or its repair should be reported promptly.
How is PVR treated?
Treatment involves specialized retinal surgery, usually a vitrectomy, to remove scar tissue and reattach the retina. A gas bubble or silicone oil may be placed in the eye to hold the retina in position while it heals. More than one surgery is sometimes needed.
When should I seek urgent care?
Seek urgent eye care for a sudden increase in floaters, flashes of light, a shadow or curtain across your vision, or sudden vision loss, especially after a retinal detachment. Rapid evaluation can help protect your sight.
References
- National Eye Institute (NEI). Retinal Detachment.
- American Academy of Ophthalmology. Retinal Detachment.
- MedlinePlus, U.S. National Library of Medicine. Retinal detachment.
- American Society of Retina Specialists. Proliferative Vitreoretinopathy.