ConditionEyes & vision
Proliferative Vitreoretinopathy (PVR)
Proliferative vitreoretinopathy (PVR) is the growth of scar-like membranes on and under the retina, usually after a retinal detachment, retinal detachment surgery or a serious eye injury. The membranes contract and pull on the retina, causing it to detach again, and they are the most common reason retinal detachment surgery fails. PVR develops in about 5 to 10 percent of people after detachment repair, usually within the first 3 months. Treatment is further surgery, often vitrectomy with membrane removal and silicone oil.
Also called: PVR, massive periretinal proliferation (older term), retinal scar tissue after detachment
At a glance
- What it is
- Scar membranes forming on the retina that contract and cause repeat detachment.
- When it happens
- Usually 4 to 12 weeks after retinal detachment or its repair.
- How common
- About 5 to 10 percent of repaired retinal detachments.
- Risk factors
- Large or multiple tears, long-standing detachment, bleeding, inflammation, eye injury, multiple surgeries.
- Symptoms
- Gradually worsening vision, a returning shadow or distortion after initially successful surgery.
- Treatment
- Vitrectomy with membrane peeling, retinal release, laser and silicone oil or gas.
When to get help
Call 911 or go to the ER
- A new or spreading dark shadow or curtain in vision after retinal surgery
- Sudden loss of vision in an eye that had retinal surgery
See a doctor within a day or two
- Gradually worsening, distorted or blurry vision in the weeks after retinal detachment repair
- New floaters or flashes after surgery
- Severe eye pain, redness or nausea after surgery (possible high eye pressure)
Book a routine appointment
- Scheduled follow-up visits after retinal detachment repair, which are important for detecting PVR early
- Planning removal of silicone oil
What happens in PVR
When the retina tears or detaches, cells from the retina's pigment layer and other cells are released into the vitreous and onto the retinal surface. In some people, these cells multiply and change into scar-forming cells that lay down membranes, a wound-healing response gone wrong.
The membranes can form:
- on the surface of the retina (epiretinal)
- under the retina (subretinal)
- within the vitreous
As the membranes contract, they wrinkle, stiffen and pull the retina, creating fixed folds and causing it to detach again or preventing it from staying attached.
Risk factors
- large retinal tears (giant tears) or multiple tears
- retinal detachment that has been present for a long time before repair
- detachment involving a large area of the retina
- bleeding inside the eye (vitreous hemorrhage)
- inflammation (uveitis) or choroidal detachment
- penetrating eye injuries
- multiple previous retinal surgeries or extensive freezing treatment
- aphakia (no lens) and some other surgical factors
Symptoms
PVR usually appears several weeks after detachment surgery that initially seemed successful:
- gradual worsening of vision (vision loss)
- a shadow or curtain returning in part of the visual field
- distortion of straight lines
- blurred central vision if the macula is affected
Regular follow-up exams can detect PVR before symptoms appear.
Grading
Ophthalmologists grade PVR by severity:
| Grade | Findings |
|---|---|
| A | Vitreous haze and pigment clumps |
| B | Wrinkling of the inner retinal surface, rolled edges of tears |
| C | Full-thickness fixed folds in the retina, at the front (anterior) or back (posterior) |
Diagnosis
A retina specialist examines the eye with dilated pupils and may use:
- OCT (optical coherence tomography) to see membranes and retinal folds
- ultrasound when the view is cloudy
- wide-field retinal photography
Treatment
There is no proven medicine to prevent or reverse PVR, so treatment is surgical:
- pars plana vitrectomy: removing the vitreous gel
- membrane peeling: carefully removing scar membranes from the retinal surface
- retinectomy: cutting stiff retina to release traction, when needed
- scleral buckle: a band around the eye to support the retina in some cases
- laser to seal tears
- tamponade: filling the eye with silicone oil (often preferred in PVR) or long-acting gas to hold the retina in place. Silicone oil is usually removed in a later operation after several months
Medicines such as methotrexate injected into the eye are being studied to reduce PVR recurrence and are used by some surgeons off-label.
Outlook
Surgery reattaches the retina in most people with PVR, often needing more than one operation. Visual outcomes are often limited compared with uncomplicated detachments, especially if the macula was detached, but useful vision is often preserved. Early detection and treatment give the best results.
Frequently asked questions
What is proliferative vitreoretinopathy?
It is the growth of scar tissue membranes on or under the retina after a retinal detachment, retinal surgery or eye injury. The scar tissue contracts and pulls the retina off again, making it the most common cause of failed detachment repair.
What are the symptoms of PVR?
Gradually worsening vision, a returning shadow or curtain in part of the visual field, or distorted vision, usually 1 to 3 months after retinal detachment surgery that had initially gone well.
How is PVR treated?
PVR is treated with further surgery, usually a vitrectomy to remove the gel and peel scar membranes, sometimes with a scleral buckle or retinectomy, and filling the eye with silicone oil or gas to keep the retina attached.
Can PVR be prevented?
There is no proven preventive treatment yet. Prompt repair of retinal detachments, careful surgical technique and close follow-up reduce the risk and catch PVR early. Medicines to prevent it are being studied.
Sources
This guide was written from current patient and clinical guidance, including:
- American Academy of Ophthalmology: EyeWiki: Proliferative Vitreoretinopathy
- American Society of Retina Specialists: Retinal Detachment
- National Eye Institute: Retinal Detachment
- American Academy of Ophthalmology: Retinal Detachment Preferred Practice Pattern
- Retina Society Terminology Committee: The classification of retinal detachment with proliferative vitreoretinopathy