Update on Patrick....

Well today's visit wasn't as easygoing as we had originally hoped for!! Basically, its common for some to have scar tissue formation in the eye that causes further problems (aka. proliferative vitreoretinopathy). Pat has that now and over the weekend has to get his air bubble against the back of his eye as much as possible to smooth out the retina and then have it lasered on monday!!! I found a really good link with pictures and everything that I'm posting to better explain it!!! Pictures always help!!! If the laser isn't as affective or this type of thing reoccurs we have discussed using the oil (the article will explain)!!I'll keep everyone posted on how it goes!!!


Proliferative Vitreoretinopathy

Proliferative vitreoretinopathy (PVR) is the most common complication of a retinal detachment (RD), and occurs in approximately 8-10% of patients who develop an RD. Proliferative vitreoretinopathy, despite the long name, is simply scar tissue formation within the eye. This condition has been called by many names, including massive periretinal proliferation (MPP) and massive vitreous retraction (MVR), and was finally dubbed proliferative vitreoretinopathy (PVR) by the Retina Society Terminology Committee. "Proliferative" because cells proliferate and "Vitreoretinopathy" because the problems involve the vitreous and retina. Proliferative vitreoretinopathy can be divided into multiple categories based on the configuration of the retina and the location of the scar tissue, and this categorization is used by eye care specialists to describe to one another the severity and configuration of the retina in PVR.

At the time of a retinal detachment and the formation of a retinal tear, RPE cells that are normally under the retina come through the retinal tear and enter the vitreous cavity. After the retinal detachment is repaired or not repaired (if the patient does not seek help) these cells proliferate on the surface of the retina (and sometimes under the retina) in sheets, which contract and pull the retina back off.

Proliferative Vitreoretinopathy

In PVR scar tissue forms in sheets on the retina which contract. This marked contraction pulls the retina toward the center of the eye and detaches and distorts the retina severely. PVR can occur both posteriorly (as shown) and anteriorly with folding of the retina both anteriorly and circumferentially.



These sheets can occur in the posterior portion of the retina, or in any other location of the retina, including in the far anterior periphery of the retina, and causing redetachment. The surgery to repair an eye detached from PVR includes pars plana vitrectomy, membrane peeling where we use small instruments to peel the membranes from the surface of the retina, and scleral buckling.

PVR with total RD




The PVR scar tissue (yellow) proliferates on the surface of the retina then contracts and detaches the retina (gray). Vitrectomy is used to remove the scar tissue and re-attach the retina with special gases and fluids.


These techniques are combined with fluids placed in the eye to flatten the retina and reattach it to the outer wall of the retina followed by laser photocoagulation to connect the retina to the outer layers permanently. In recent years Perfluoron (PFO), perfluoro-n-octane, has revolutionized our surgery by allowing us to push the retina into its normal position with this heavier-than-water fluid. Perfluoron, when injected, settles to the back of he eye and pushes the subretinal fluid to the front, simplifying removal. RVT members were fortunate to participate in the Perfluoron studies.

Perfluoron and PVR

Perfluoron used to "push" retina back into position while PVR membranes are peeled from retina allowing the retina to be re-attached and vision to be rehabilitated.



A gas bubble may be placed in the eye to hold the retina in place while it is healing, or as an alternative silicone oil may be used to hold the retina in position. The advantage to the gas bubble is that is goes away on its own, and the patient does not require another operation. The advantage to the silicone oil bubble is that the patient does not have to have any head positioning for two to three weeks following surgery like they do with gas and can go back to normal activities in a few days. The disadvantage is that silicone oil requires removal in several months following the procedure. These were compared in theSilicone Oil Study and were found to be equivalent in outcome (long-acting gas vs. silicone oil).

Retinal Reattachment

The retina is now reattached with Perfluoron holding the retina in position while laser is applied to connect the retina permanently. PFO is then removed and replaced with gas or silicone.



Although PVR is a catastrophic complication of retinal detachment surgery and can cause profound visual loss, it has gone from being unsuccessful to be repaired in the late 1970s to having a very high success rate in repairing PVR detachments today. Repair of retinal detachments due to proliferative vitreoretinopathy is one of the specialties of Retina and Vitreous of Texas. We were fortunate to have participated in both the Perfluoron and Richard-James Silicone Oil studies associated with this condition.

The most recent possibility for treating PVR is VitrenAse (Vit 100), a new medication aimed at halting the growth of PVR membranes by actually stopping the formation of the proteins necessary to make new scar tissue. RVT was the study center for this medication in this region of the country. Vit 100 did not prove to be beneficial in short term use, but we are hoping a longer term version will be helpful.