gms | German Medical Science

Proliferative vitreoretinopathy (PVR) presents the gravest post-injury challenge for the surgeon. PVR can start developing after a few days following the trauma, and, especially in children, may have a vicious course. In the most severe cases, it not only causes loss of vision, but also loss of the eyeball, destroying the ciliary body via scar formation on its surface. The incidence of PVR in certain injury types exceeds 90%.

Ideally, a pharmaceutical solution would work best; however, none of the many drugs that have been tested achieved the desired effect. The only drug that does show inhibition of PVR, methotrexate, is not suited for trauma cases since its application should start before the injury would occur.

The trauma surgeon is left with a single option: prophylactic chorioretinectomy. By destroying the choroid and the retina around the wound, including a deep impact site caused by an intraocular foreign body, there is a very good chance that – at least at this location – PVR will not ensue. The procedure is also able to prevent – or treat if necessary – the presence of full-thickness retinal folds developing from the injury site. The procedure should be performed within 100 hours of the injury, before the PVR process starts.

Finally, it is mandatory during the vitrectomy/prophylactic chorioretinectomy surgery to completely clean the surface of the ciliary body (blood, fibrin, vitreous), and also remove both lens capsules in children.