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In this study, the late secondary changes of the eye in long-standing, untreated rhegmatogenous retinal detachment (RRD) were examined. The most common complications were cataract (61.1%), strabismus (45.5%), toxic uveitis (27.3%) and development of proliferative vitreoretinopathy (100.0%). Complete loss of vision was found in all cases. Maximal visual acuity was hand motion, but only in 9.1% of cases. In the late follow-up period of untreated RRD, anatomic changes of the eye, permanent loss of vision and esthetic defects will appear.

Unlabelled: Recently, good functional and anatomical results have been reported in treating full thickness macular holes. Only a few studies describe a removal of a membrane at the vitreoretinal interface after having removal of the vitreous and its cortex. To demonstrate the beneficial effects of removing this membrane at the vitreoretinal interface we present our functional and anatomical results in this retrospective study., Patients: Altogether, 42 patients (27 women, 15 men) with an average age of 66.7 years and full thickness idiopathic macular holes stage II and III/IV (21 patients respectively) were retrospectively analysed. The minimum follow-up was 6 months. To reattach the macular, an intraocular gas tamponade was used in 36 patients (15% C2F6) and 6 patients were treated with an 20% SF6 gas tamponade., Results: Six months after operation, patients in the main group (42 patients) showed visual improvement in 53% (22 patients): 26% (11 patients) showed no change in visual acuity before and after operation. A deterioration was present in 21% (9 patients). In the group of patients in which a membrane at the vitreoretinal interface had been removal 68% (22 patients) showed improved visual acuity. In all 26% (8 patients) showed no change and in one case a deterioration was noticed. After removal of a membrane at the vitreoretinal interface no further macular hole was seen in 80% (25 patients). In this group, 90% (28 patients) complained of metamorphosia before operation. In the group of patients in which were no membrane at the vitreoretinal interface had been removed (11 patients), 73% (8 patients) showed a deterioration in visual acuity, no patient showed improved visual acuity and 27% (3 patients) retained the same level of visual acuity. No macular hole was noticed 6 months postoperatively in 27% (3 patients) in this group. In all 36% (4 patients) in this group complained of metamorphopsia before operation., Conclusion: Removal of a membrane at the vitreoretinal interface in patients with idiopathic macular holes stage II in IV improves functional and anatomical results. Metamorphosia is reduced significantly after removal of that membrane. According to our studies, metamorphosia is an indicator for the presence of a membrane at the vitreoretinal interface. Our results suggest that there are different types of idiopathic macular holes with a different pathogenesis in those where a membrane at the vitreoretinal interface could not be removed and those where it is possible to remove it. Cases where removal of this structure should be attempted show better functional and anatomical results. Studies using adjuvants, e.g. autologous platelet concentrate or transforming growth factor beta 2, should take into account that two different types of idiopathic macular holes exist.

Purpose: To evaluate the role of cryopexy in the stimulation of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment., Materials and Methods: A series of 595 eyes of 554 patients with primary rhegmatogenous retinal detachment, referred before any failed surgery, were prospectively evaluated. Univariate and multivariate statistical analyses of the data were conducted., Results: The incidence of postoperative PVR in relation to the methods used for retinopexy was dependent on the types and anatomy of retinal breaks associated with retinal detachment. The incidence of postoperative PVR was nil in retinal detachments due to atrophic holes in lattice, oral dialyses, and macular holes, regardless of the retinopexy methods. Postoperative PVR occurred solely in retinal detachments due to horseshoe tears (incidence 4.42%), paravascular tears of the postequatorial region (18.18%), and giant tears (24.6%) (P < 0.00001). The incidence of postoperative PVR was 0.5% in eyes with horseshoe tears with mobile posterior edges vs 9.72% in eyes with horseshoe tears with curled posterior edges, regardless of the retinopexy methods (P < 0.00001). In retinal detachments due to horseshoe tears with mobile posterior edges the incidence of postoperative PVR (0.5%) was not influenced by the retinopexy methods. In contrast, in retinal detachments due to horseshoe tears with curled posterior edges the incidence of postoperative PVR was higher in eyes managed with cryopexy (14.77%) than in eyes managed with laser retinopexy (1.78%) (P < 0.02). In retinal detachments due to giant tears the incidence of postoperative PVR was not statistically significantly greater in eyes managed with cryopexy (33.3%) than in eyes managed with laser retinopexy (15.6%). In tears 180 degrees and over in size, however, the incidence of postoperative PVR was significantly higher in eyes managed with cryopexy (9/11 eyes) than in eyes managed with laser retinopexy (5/17 eyes) (P = 0.006)., Conclusions: Cryopexy is not a stimulating factor for postoperative PVR in primary rhegmatogenous retinal detachments due to atrophic holes in lattice, oral dialyses, macular holes, or horseshoe tears with mobile posterior edges. In contrast, cryopexy probably is a stimulating factor for postoperative PVR in retinal detachments due to horseshoe tears with curled posterior edges or to retinal tears 180 degrees and over.

Apoptotic cell death is a central mechanism underlying growth regulation in normal and pathologic neoplastic and nonneoplastic tissue formation. Apoptosis has also been detected in traction membranes of patients with proliferative vitreoretinopathy (PVR). Herein we report that CD 95 (Fas/APO-1), the cell-surface receptor for a potent proapoptotic cytokine, the CD 95 ligand, is expressed in traction membranes of patients with traumatic PVR. Retinal pigment epithelial (RPE) cells, which are thought to contribute to traction membrane formation, express CD 95 in vitro. However, these cells are resistant to CD 95 antibody-induced apoptosis, presumably because they synthesize cytoprotective proteins, which interfere with the CD 95-dependent killing cascade. Coexposure to inhibitors of RNA or protein synthesis sensitizes human RPE cells for CD 95-mediated apoptosis. In contrast, these agents have little effect on the resistance of these cells to tumor necrosis factor-alpha(TNF-alpha). Pre-exposure to TNF-alpha augments CD 95-mediated killing but not its own toxicity in the presence of inhibitors of RNA and protein synthesis. Preexposure to cycloheximide does not abrogate CD 95-mediated apoptosis, suggesting that labile, short-lived proteins do not mediate the cytotoxic effects of CD 95 antibodies. Taken together, our data indicate that immune-mediated CD 95-dependent killing of proliferating cells in vitreoretinal traction membranes might occur in vivo and could possibly be enhanced using novel approaches of immunopharmacotherapy.

Background: We conducted a prospective clinical study to elucidate the role of preoperative vitreous hemorrhage in the development of postoperative proliferative vitreoretinopathy (PVR) in primary rhegmatogenous retinal detachment., Materials and Methods: We prospectively evaluated 409 eyes of 390 patients affected by primary rhegmatogenous retinal detachment referred before any failed attempt to reattach the retina. Single and multiple logistic regression analysis were used to test 14 categories of variables., Results: Postoperative PVR occurred in 48 (11.7% of 409 eyes). Postoperative PVR developed in 41 (11.8%) of the 347 eyes with no preoperative vitreous hemorrhage, and 7 (11.3%) of the 62 eyes with preoperative vitreous hemorrhage (P = 0.90). The results of multiple logistic regression analysis showed that only four variables were significant factors which had independently and jointly an effect on the risk of postoperative PVR: (1) 90 degrees or greater circumferential extent of the retinal tears; (2) preoperative PVR grade B; (3) preoperative PVR grade C-D; and (4) the use of cyrotreatment as the method of retinopexy., Conclusion: With the surgical techniques currently used, mild preoperative vitreous hemorrhage is not an independent risk factor for postoperative PVR in primary rhegmatogenous retinal detachment. The role of moderate and severe vitreous hemorrhage remains to be fully evaluated in a larger series of eyes.

To find the prevalence of diabetes and diabetic eye complications, all inhabitants of the municipality of Eigersund were contacted. Those with known diabetes were encouraged to participate in our study. Among 12,447 people we found 223 diabetics (1.8%). Two hundred and ten of them (94.2%) participated in the study. Ophthalmological history was taken and careful ophthalmological examination carried out by one ophthalmologist. Twenty-nine patients (13.8%) had diabetic retinopathy -24 (11.4%) nonproliferative and 5 (2.4%) proliferative retinopathy. Retinopathy was found in 11 (34.4%) of 32 type I diabetics and in 18 (10.1%) of 178 type II diabetics. Forty-three patients (20.5%) had significant cataract, and 15 patients (7.3%) had one or both eyes operated for cataract. Forty-two patients (20.0%) had their therapy adjusted as a result of our investigation. The prevalence of retinopathy was lower than expected, especially among the type II diabetics. The ophthalmological care of diabetics can, however, still be much improved.

Complexes of endogenous immunopeptides produced by autologous peripheral blood lymphocytes were injected to the vitreous body of 17 chinchilla rabbits (34 eyes). The agents injected were autosupernatant. L fraction containing molecular substances with mol. weight of 40,000 to 60,000 D, and M fraction containing substances with mol. weight of 15,000 to 30,000 D. Clinical and morphologic studies demonstrated that injection of endogenous immunopeptides led to active lymphoid inflammatory infiltration associated with proliferation and formation of new vessels. In contrast to the M fraction, the exudative processes triggered by the L fraction were more definitely localized and associated with the appearance of fibroplastic cords (the proliferative component). The models created may be used for the development of methods for prevention and treatment of vitreoretinal proliferation.

The purpose of this study is to report retinal manifestations of lues in human immunodeficiency virus (HIV)-positive patients and to suggest a method for treatment of rhegmatogenous retinal detachments in these patients. Two HIV-positive patients with bilateral retinitis were examined and treated at the authors' institution for a period of 14 months. Ocular syphilis was diagnosed clinically, confirmed by cerebrospinal fluid serologic testing, and treated with intravenous penicillin. Both patients experienced bilateral rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy after resolution of the active retinitis. All four eyes underwent surgical repair with trans pars plana vitrectomy, epiretinal membrane delamination, gas-fluid exchange, endolaser, scleral buckle, and silicone oil instillation. The recognition of ocular syphilis as a cause of retinal detachment in HIV-positive patients is important. Prompt intervention with the appropriate medical and surgical treatments may result in the preservation of vision in these patients.

Background: Reproliferation following vitrectomy for proliferative vitreoretinopathy (PVR) causes redetachment in up to 55% of cases. Heparin and corticosteroids have each been shown to inhibit the development of proliferative vitreoretinopathy (PVR) in experimental models. However, little information is available on the use of these agents in humans., Methods: In this pilot study, 62 eyes of 62 patients with severe PVR requiring vitrectomy were prospectively randomized to receive either BSS Plus (control) or BSS Plus with heparin and dexamethasone (HD) in the infusate., Results: After one operation, the retina was reattached in 42 (71%) of 59 eyes: 22 (65%) of 34 eyes in the control group and 20 (80%) of 25 eyes in the HD group (P = 0.16). Reproliferation developed in 26.5% of the control group (9 of 34 eyes) and 16% of the HD group (4 of 25 eyes; P = 0.26). Postoperative hemorrhage was significantly more frequent in the HD group (P = 0.02) but did not influence final visual or anatomic outcome. Hypotony was less frequent in the HD group but the difference was not significant (P = 0.063)., Conclusion: The trend from this randomized pilot study suggests that HD supplementation of the vitrectomy infusate may reduce the reproliferation rate in PVR and possibly reduce the rate of hypotony. Postoperative hemorrhage was more frequent with HD but did not cause redetachment or alter visual outcome. A multicenter trial involving more patients would be required to better evaluate the efficacy of HD as a pharmacologic adjunct to PVR surgery.

Background: Although peripapillary subretinal neovascular membranes (PSRNs) are less common and often larger than neovascular complexes arising near the fovea, they may lead to severe visual loss. Very large (massive) PSRNs (MPSRNs) are 3.5 disc areas or greater in overall size, are even less common, and may contain a significant occult component, leading to slow and unpredictable growth. Such massive lesions may begin at the nasal margin of the disc and do not become symptomatic until they have extended around the disc toward the macula, threatening central vision. Although complete laser ablation has been used for symptomatic PSRNs with variable success, the optimal treatment of MPSRNs remains controversial., Methods: The authors reviewed the clinical course of 12 eyes of seven patients with MPSRNs. Ten eyes received laser treatment, which was limited to the temporal portion of the subretinal neovascular complexes only and two received no treatment., Results: Of the ten eyes receiving laser treatment, six showed stabilization of visual acuity, whereas in four the neovascular membrane progressed beneath the fovea with severe visual loss. In the two untreated eyes, the subretinal neovascular membrane progressed beneath the macula with the loss of central vision., Conclusions: In contrast to the small symptomatic PSRNs, which are usually treated by complete laser ablation, MPSRNs may stabilize with only partial laser treatment. However, both types of lesions may remain stable for long periods of time without any treatment and require treatment only if progression toward the fovea occurs.

Objective: To find the histopathologic findings about 10 eyes of 10 patients with silicone oil injection., Methods: The operative procedures included retinal detachment surgery, pars plana vitrectomy and silicone oil injection. The globes were enucleated 4 to 27 months after silicone oil injection. Paraffin sections were made for light microscopic examination., Results: The retina showed severe degeneration, pre- and sub-retinal membranous fibrous tissue proliferation. The round empty vacuoles formed by silicone oil could be seen in the proliferative membrane., Conclusions: It is demonstrated that silicone oil has great toxic effect to the detached retina and it may stimulate the development of proliferative vitreoretinopathy.

Purpose: Integrin-mediated extracellular matrix (ECM) attachment plays an important role in vitreous contraction of retinal pigment epithelial (RPE) cells. Disintegrins, a group of Arg-Gly-Asp (RGD)-containing peptides from viper venom, are potential anti-adhesion agents that interfere with integrin-ECM binding. This study was performed to determine whether disintegrins were effective in inhibiting RPE cell-induced matrix attachment in vitro and tractional retinal detachment in a rabbit model in vivo., Methods: Two disintegrins, echistatin from viper Echis carinatus and flavoridin from Trimeresurus flavoviridis, were used. The expression of integrins on the surface of bovine and rabbit RPE cells was examined by indirect immunofluorescent stain with specific anti-integrin monoclonal antibodies. The inhibitory effect of disintegrins on RPE cell-mediated ECM attachment and vitreous contraction was evaluated with cell adhesion and vitreous contraction assays. In the in vivo model, rabbit eyes were injected intravitreously with either homologous rabbit RPE cells alone or together with disintegrins to induce tractional retinal detachment. The cytotoxic effect of disintegrins was examined with a cell proliferation assay using the alamar blue method. Retinal toxicity of disintegrins was evaluated with electroretinograms and histologic examination of the rabbit eyes., Results: Bovine and rabbit RPE cells showed the positive staining for the integrins alpha 2 beta 1 and alpha 5 beta 1 on cell surface. Disintegrins, echistatin, and flavoridin inhibited RPE cell attachment to the ECM. The potency of disintegrins was 150 to 300 times higher than that of Gly-Arg-Gly-Asp-Ser (GRGDS) peptide. The disintegrins also inhibited RPE cell-induced vitreous contraction in a dose-dependent manner, whereas the GRGDS peptide had no effect. In the in vivo experiment, echistatin (50 microgram/ml) or flavoridin (80 microgram/ml) significantly inhibited RPE cell-induced tractional retinal detachment compared with the control group at week 2 (P< 0.05) and week 4 (P< 0.01) after surgery. Disintegrins were nontoxic to RPE cells and rabbit retina as evaluated by cytotoxicity tests, electroretinograms, and histologic examinations., Conclusions: The disintegrins were effective in inhibiting RPE cell attachment to the ECM and vitreous contraction in vitro. They also were effective in suppressing RPE cell-induced tractional retinal detachment in the rabbit eyes. They were nontoxic. Disintegrins and their analogs might be potential anti-adhesion therapeutic agents in the treatment of proliferative vitreoretinopathy.

Clinical and immunologic study of patients with detachment of the retina complicated by proliferative vitreoretinopathy (PVRP) revealed medium and high titers of S antibodies in the lacrimal and subretinal fluid of patients with stages A and B PVRP in 92 and 70%, respectively, and did not detect these antibodies in patients with stages C and D PVRP in 68 and 78.9%, respectively. A statistically reliable increase of IgG and IgA levels in the subretinal fluid was observed, as well as of IgA and SIgA in the lacrimal fluid of patients with dystrophic detachment of the retina. The levels of circulating immune complexes (CIC) in the blood serum were decreased, with CIC detected in the subretinal fluid of all the patients. The production of antibodies to S antigen ceased 3 months after the retina adhered to the eyeball. The results indicate the impact of immunological factors in the pathogenesis of dystrophic detachment of the retina.

Background: Several growth factors have been implicated in the development of proliferative eye diseases, and some of those are present in human vitreous (HV). The effects of HV on cellular responses which modulate proliferative cell processes were studied. This study describes the partial characterization of a vitreous factor activity which does not correspond to any of the previously reported growth factors in pathological HV., Methods: Vitreous humour was obtained from medical vitrectomies, from patients with PDR and PVR. The biological activity of the vitreous factor was determined by its ability to increase cytosolic calcium concentration ([Ca2+]i), increase production of inositol phosphates, and induce cell proliferation in the cell line EGFR T17. In some experiments other cell lines, such as NIH 3T3, 3T3-L1, FRTL5, A431, PC12, Y79, and GH3, were also employed. Measurement of [Ca2+]i in cell suspensions was performed using the fluorescent Ca2+ indicator fura-2. The activity of the factor present in HV was compared with other growth factors by means of: (a) [Ca2+]i mobilization pattern, (b) sequential homologous and heterologous desensitization of receptors, (c) effects of phorbol esters on their action, and (d) inactivation after treatment with different proteolytic enzymes., Results: The HV-induced cell proliferation and increases in [Ca2+]i concentration were characterized by a peculiar time pattern. The different approaches used ruled out its identity with PDGF, bFGF, EGF, TGF-beta, IGFs, TNF-alpha, NGF, and other compounds such as ATP, angiotensin I, and bradykinin. Vitreous factor actions are mediated by specific receptors apparently regulated by PKC. This factor is able to induce [Ca2+]i mobilization in most of the cell lines studied, indicating that its effects are not tissue specific., Conclusions: These results suggest the presence of a growth factor activity in pathological HV which may be due to the presence of an undescribed growth factor in the eye.

Objective: To define the vascular sequelae of retinectomy., Design: Clinical and angiographic survey of patients who had undergone retinectomy procedures., Patients: Twenty consecutive patients with ambulatory vision and attached posterior retina after retinectomy procedures underwent ophthalmic examination, including retinal biomicroscopy, indirect ophthalmoscopy with scleral indentation, and peripheral retinal fluorescein angiography., Results: Ten eyes (50%) showed anterior retinal neovascularization (NV), with vessels derived from the ciliary body or posterior retina. Neovascularization occurred in residual anterior retina adjacent to the retinectomy, in detached anterior retina demarcated by laser in quadrants not involved by retinectomy, and in fibrinous membranes extending anterior to the retinectomy edge. This was associated with postoperative vitreous hemorrhages in two patients. Iris NV and inferior iridectomy occlusion were strongly associated with retinal NV (Fisher's exact test, P < .005). No patient had neovascular glaucoma or optic disc NV during a median follow-up of 250 days (range, 121 to 465)., Conclusions: Retinectomy may have profound secondary effects on ocular vascular circulation, resulting in retinal NV in association with iris NV, occlusion of inferior iridectomies, and vitreous hemorrhage. Complete intraoperative removal of residual anterior retina to the ora serrata in quadrants involved by retinectomy, combined with prophylactic retinal laser treatment from the vitreous base to the ora in the remaining quadrants, is recommended to prevent the development of retinal NV and its associated complications.

Purpose: To determine whether the incidence of severe postoperative PVR in primary rhegmatogenous retinal detachment has decreased over the last twelve years., Materials and Methods: We prospectively evaluated 595 eyes of 554 consecutive patients with primary rhegmatogenous retinal detachment, referred before any failed attempt to reattach the retina, managed by the same surgeon between March 1983 and December 1994. The eyes were divided into two consecutive series: 275 eyes operated on from March 1983 through February 1988 (series no. 1), and 320 eyes operated on from February 1988 through December 1994 (series no. 2). We conducted univariate and multivariate statistical analyses to compare the incidence of postoperative PVR in the two consecutive series., Results: The overall incidence of postoperative PVR was 8.72% (24/275 eyes) in series no. 1, versus 2.81% (9/320 eyes) in series no. 2 (p < 0.01). The incidence of postoperative PVR in retinal detachments due to atrophic holes in lattice degeneration, oral dialyses, and macular holes in myopic eyes, was nil in both series. The incidence of postoperative PVR in retinal detachments due to horseshoe tears with mobile posterior edges was 1.16% (1/86 eyes) in series no. 1, and 0% (0/109 eyes) in series no. 2. The incidence of postoperative PVR in retinal detachments associated with horseshoe tears with curled posterior edges was 21.15% (11/52 eyes) in series no. 1 versus 3.2% (3/93 eyes) in series no. 2 (p < 0.001). The incidence of postoperative PVR in giant tears was 35.5% (11/31 eyes) in series no. 1. and 14.7% (5/34 eyes) in series no. 2 (chi square = 3.77; at the limit of significance). The incidence of postoperative PVR in retinal detachments du to paravascular tears of the post-equatorial region in myopic eyes was 25% (1/4 eyes) in series no. 1, and 14% (1/7 eyes) in series no. 2., Conclusion: In our own experience, the incidence of postoperative PVR in primary rhegmatogenous retinal detachment has decreased at a statistically significant level since 1988. We believe that the decreased incidence of postoperative PVR in our most recent series is mainly related to the use of laser photocoagulation retinopexy rather than cryopexy in the management of high risk eyes (retinal detachments associated with horseshoe tears with curled posterior edges, and giant tears).

Purpose: Clear lens extraction is a surgical procedure to correct high axial myopia. The authors explain how this technique may lead to serious vitreoretinal complications., Methods: The study included 41 eyes of 39 patients aged 25 to 58 years (mean, 37.5 years) with high axial myopia (14-29 diopters; mean, 19.5 diopters) operated on for retinal detachment after clear lens extraction. Retinal detachment occurred 1 month to 4 years after lens extraction, except for two eyes that also had intraoperative choroidal hemorrhages., Results: Twenty-six of the 41 eyes had undergone 360 degree prophylactic retinopexy on preequatorial areas; in four eyes, the retinal breaks occurred along the edge of the prior circumferential photocoagulation. Seventeen eyes exhibited proliferative vitreoretinopathy of various grades. The retina was reattached in 36 eyes. Only nine eyes achieved final visual acuity of 20/60 or better., Conclusions: Although the authors do not report the actual incidence of retinal detachment after clear lens extraction, they indicate that potentially blinding complications can occur after this surgical procedure, despite prophylactic treatments.

Background: To evaluate the effect of perfluoroperhydrophenanthrene on the outcome of traumatic retinal detachment with proliferative vitreoretinopathy, a retrospective study of 111 patients was performed at 35 tertiary care centers, both private practice and institutional. We believed that perfluoroperhydrophenanthrene would assist in manipulating the retina during surgery, removing intraocular foreign bodies, draining suprachoroidal hemorrhage, and reattaching the retina because of the perfluorocarbon's high specific gravity., Methods: Of the 700 patients in the Vitreo study group, 111 with a history of trauma (109 had retinal detachment, 50 had proliferative vitreoretinopathy) were chosen for this study. Perfluoroperhydrophenanthrene was used intraoperatively to manipulate the retina hydrokinetically, remove intraocular foreign bodies, drain suprachoroidal hemorrhage, and to reattach the retina in the case of giant tears., Results: Logistic multiple regression analysis was used to identify factors as being predictive of poor visual outcome. Factors predictive of poor visual outcome were: type of trauma (p = 0.0065) (ruptured globe); presence of giant retinal tear (p = 0.0253); and low preoperative visual acuity (p = 0.044). At the last follow-up examination, the reattachment rate was 75.6% (i.e., 84 eyes). Of those 84 eyes, 55 (49.5%) had achieved a visual acuity of > or = 5/200 and 34 (30.6%) had a visual acuity of > or = 20/200. In cases complicated by proliferative vitreoretinopathy, the final reattachment rate was 66%, with 40% of the eyes studied obtaining a visual acuity of > or = 5/200., Conclusions: Perfluoroperhydrophenanthrene has been used intraoperatively in the management of traumatic retinal detachments without any apparent ill effects.

Purpose: To describe our technique of vitrectomy and silicone oil tamponade for managing retinal detachment and to report the last results according to the posterior and anterior proliferative vitreoretinopathy., Methods: A retrospective study was conducted in 108 patients who underwent vitreoretinal surgery and silicone oil tamponade for proliferative vitreo-retinopathy, 64% patients had already been operated without success and 42% underwent vitrectomy with SF6 or C3F8. Diffuse posterior proliferative vitreo-retinopathy (grade C3-D) was present in 64% patients and anterior proliferative vitreoretinopathy was present in 43.5%. Silicone oil was removed in 79% patients after a mean duration of 6.3 months. It was replaced by 16% C3F8. All patients were followed for a minimum of 6 months., Results: Before silicone oil removal, 55% of the retinas were reattached posterior to the scleral buckle with one operation, 78% after 2 operations and 88% after 3 or 4 operations. An average of 2.1 vitrectomy surgeries were performed. Reproliferation was correlated with the anterior proliferative vitreo-retinopathy (p < 0.001), posterior proliferative vitreo-retinopathy (p < 0.01) or previous vitrectomy (p < 0.05). The final visual acuity was 1/20 or better in 61% of the eyes and 2/10 or better in 30.5%. After silicone oil removal, 8% retinas redetached, 21% of the eyes had hypertony, 7.5% had hypotony and 7% of the corneas had dystrophy., Conclusion: Silicone oil tamponade was effective for the treatment of retinal detachments with proliferative vitreo-retinopathy. Since the main complications were hypertony and corneal dystrophy, silicone oil should be reserved for severe proliferative vitreo-retinopathy cases.

Background: In eyes with giant retinal tears, the rate of severe postoperative PVR and failure to permanently reattach the retina remains especially high in spite of technical advances in surgical management. This study was conducted to elucidate the clinical and surgical risk factors for severe postoperative PVR in such eyes., Patients and Methods: We reviewed the records of 68 consecutive patients (69 eyes) with giant retinal tears. Univariate and multivariate statistical analyses were used to evaluate the risk factors for severe PVR., Results: The rate of severe postoperative and failure to permanently reattach the retina were 43.5% (30/69 eyes). It was influenced at a statistically significant level by two independent risk factors: 1) the presence and severity of preoperative PVR and 2) the use of cryotreatment as compared to the use of ALP treatment. Severe postoperative PVR occurred in 63.6% (14/22 eyes) of eyes managed with cryotreatment versus 31.1% (14/45 eyes) of eyes managed with ALP treatment (P < 0.02). The rate of severe postoperative PVR was 64% (16/25 eyes) in eyes with grade C-D PVR preoperatively versus 31.8% (14/44 eyes) in eyes with no PVR or grade B PVR preoperatively (P < 0.01). In eyes managed with the use of ALP treatment the rate of severe postoperative PVR remained influenced at a statistically significant level (P < 0.005) by the presence of grade C-D PVR preoperatively. Grade C-D PVR was significantly more frequent preoperatively in patients with visual symptoms of 3 week-duration or more at initial examination (23/24 patients, 95.8%), than in those with visul symptoms under 3 week-duration (8/41 patients, 19.5%) (P: 0.0005)., Conclusion: The results suggest that the high incidence of severe postoperative PVR in giant retinal tears may be decreased by 1) early management before the occurrence of PVR and 2) the use of argon laser photocoagulation rather than cryotreatment as the method of creating a chorioretinal scar.

Purpose: To determine whether preoperative choroidal detachment associated with primary rhegmatogenous retinal detachment is an independent risk factor for postoperative PVR., Material and Methods: One hundred eighty nine primary rhegmatogenous retinal detachments in 187 consecutive patients, initially operated on by the same surgeon, were enrolled in a prospective study. Ten eyes showed preoperative choroidal detachment associated with retinal detachment. Owing to the small number of eyes with preoperative choroidal detachment, we conducted the statistical analysis using the calculation of relative risk., Results: The correlation between preoperative choroidal detachment and preoperative PVR grade C-D was statistically significant (RR: 9.03; confidence interval: 2.91-28). Postoperative PVR occurred, or recurred, in one of the 10 eyes with preoperative choroidal detachment (10%), and 10 of the 179 eyes with no choroidal detachment (5.58%). The difference between the two groups is not statistically significant (RR: 1.79; confidence interval: 0.25-12.64). All eyes which developed postoperative PVR showed one or two recognized independent risk factors for postoperative PVR (preoperative PVR grade C-D and/or retinal tears > or = 90 degrees)., Conclusion: With the treatment modalities used in the present series (preoperative and postoperative steroids, and vitreoretinal microsurgery) preoperative choroidal detachment associated with primary rhegmatogenous retinal detachment no longer appears to be an independent risk factor for postoperative PVR.

Purpose: To have the knowledge of the diagnosis in time and the choice of operations of retinal detachment with vitreous hemorrhage., Methods: Sixty eight eyes in 68 cases of retinal detachment with vitreous hemorrhage were reviewed and the main factors affect the operative effect were analysed., Results: Retinal detachment with vitreous hemorrhage usually causes PVR. The successful rate of the operation is low by scleral blucking procedure only, but it can be raised when the operation is combined with vitrectomy., Conclusions: Owing to the vitreous hemorrhage which has influence on the examination of fundus, it is difficult to make the diagnosis and treatment of retinal detachment. Furthermore, vitreous hemorrhage is easy to cause intraocular inflammatory reaction and PVR. Once the diagnosis is definite, the operation should be taken as soon as possible.

Background: The present study was set up to evaluate the influence of perfluorocarbon liquids on the postoperative anatomical and functional results as well as on the complication rates in eyes with proliferative vitreoretinopathy (PVR)., Methods: Sixty five consecutive eyes (64 patients) with PVR in different stages requiring surgical intervention where liquid perfluorocarbons were used were compared with 64 consecutive eyes (62 patients) operated without the help of perfluorocarbon immediately before this time. Both groups were similar with regard to severity of PVR, number of operations, and initial visual acuity. The observation period was shorter in the perfluorocarbon group because they were operated more recently (17.4 months as against 24.4 months)., Results: The anatomical as well as the functional success rates were not significantly higher in the perfluorocarbon group (69% v 61% and 65% v 53% respectively). However, in cases operated on without perfluorocarbons where reproliferation would occur it was of much greater severity than in cases where perfluorocarbons were used. The number of uncured cases with contraction of the retina at least in the inferior half was more than twice as high in the group operated on without perfluorocarbon. Combined with massive reproliferation secondary glaucoma and bullous or band keratopathy were more frequent in eyes treated before the use of perfluorocarbon., Conclusion: The intraoperative use of perfluorocarbon liquids in vitreoretinal surgery does not prevent postoperative reproliferation but does reduce its severity.

Background: Previous studies have shown that grade B proliferate vitreoretinopathy (PVR) is a considerable risk factor for the development of severe postoperative PVR. We conducted a prospective study to elucidate which surgical procedures used in retinal detachment management may stimulate the PVR process in such eyes., Materials and Methods: The study included 156 eyes of 152 consecutive patients with rhegmatogenous retinal detachment complicated by grade B PVR referred before any failed surgery and operated on between 1983 and 1993. The parameters evaluated by multivariate statistical analysis included the cumulative circumferential extent of the retinal tears, the extent of the scleral buckle, gas injection, vitrectomy, the method used for retinopexy, and the time of surgical management during the period of the study., Results: The incidence of severe postoperative PVR was 25.8% in eyes managed with cryotreatment versus 2.2% in eyes managed with argon laser photocoagulation (P = 0.001). The rate of severe postoperative PVR was not influenced by the other surgical variables., Conclusion: We conclude that cryotherapy may be a risk factor for the development of severe postoperative PVR in retinal detachments associated with grade B PVR.

Aims: This study aimed to evaluate both the mean time intervals between retinal disease and the development of proliferative vitreoretinopathy (PVR) and the time intervals at which recurrent PVR develops following various kinds of vitreoretinal disease and surgery., Methods: One hundred and thirty six consecutive cases of PVR that were seen and operated on between 1991 and 1994 were evaluated retrospectively. Intervals between onset of disease and PVR or recurrent PVR were noted. Conditions leading to PVR, surgical procedures, and the final anatomical and functional results were evaluated., Results: Before PVR was noted for the first time, an average of 1.06 vitreoretinal surgical procedures were performed (range 0 to 3). A mean of 1.99 surgeries were performed to control PVR or to reach an end stage where further surgery would have been unreasonable (range 0 to 5). The average (median) time interval between the onset of the retinal disease and PVR was 2.0 months (range 0.5 to 45 months). The median time intervals between surgery and recurrence for the second, third, or fourth times was also 2.0 months (range 0.5 to 34 months)., Conclusions: PVR starts earliest at 2 weeks after an event and subsequently quietens down within a maximum of 45 months after treatment (median 2 months). PVR may recur more than once but the time course of the disease is likely to be the same for each recurrence.

Purpose: Proliferative vitreoretinopathy (PVR) is characterized by cell proliferation and membrane formation on the vitreoretinal cavity of the eye. The membranes are composed of extracellular matrix, mainly collagen type I. To explore the possible mechanisms involved in PVR membrane formation, the authors analyzed the role of vitreous humor on collagen turnover., Methods: The authors studied vitreous samples from ten patients with PVR and from five donor eyes (keratoplasty) as the control group. Human lung fibroblasts were used to study the influence of vitreous on collagen synthesis and cell proliferation. Neutralizing antibodies against transforming growth factor-beta 2 (TGF-beta 2) were used to inhibit the fibroblast collagen synthesis induced by the vitreous samples. Collagenolytic activity was analyzed in vitreous fluid using 3H-labeled collagen., Results: The authors found that samples obtained from patients with PVR significantly increased collagen synthesis (2979 +/- 963.26 versus 800 +/- 232 dpm of 3H-proline incorporated per milligram of vitreous-incubated protein; P < 0.00043), without affecting fibroblast replication. The collagen synthesis induced by the vitreous samples was inhibited by anti-TGF-beta 2 antibodies in both groups (0 and 481 +/- 59 dpm of 3H-proline incorporated per milligram of vitreous-incubated protein for control and PVR samples, respectively). Collagenolytic activity was considerably lower in vitreous derived from PVR samples compared with the control group (19.9 +/- 20.3 versus 234.1 +/- 19.1 micrograms of degraded collagen per milligram of vitreous-incubated protein; P < 0.0032)., Conclusion: These results suggest that a combined mechanism, including an increase of collagen synthesis mediated at least in part by TGF-beta 2 and a decrease of collagen degradation, may contribute to the exaggerated deposition of collagen observed in PVR membranes, and that vitreous should be considered as a part of the microenvironment that is participating actively in the pathogenesis of this vitreoretinal disorder.

Despite the recent progress in vitreous surgery, treatment of proliferative vitreoretinopathy (PVR) is still difficult. Even if the reattachment of the retina is successful, visual prognosis is often unsatisfactory. Identification of clinical risk factors for PVR provides useful guidelines for planning the management of rhegmatogeneous retinal detachment. This review summarized the current concept for pathogenesis, clinical risk factors, and medical treatment for PVR. The presence of retinal breaks and the breakdown of the blood-retinal barrier are prerequisite to development of PVR. Almost all risk factors for PVR are associated with intravitreal dispersion of retinal pigment epithelial cells or the breakdown of the blood-retinal barrier.

The main idea of this paper was to investigate the influence of proliferative reaction in vitreous body, in case of serious injuries of the eyeball on the development of complications. It was shown that the presence of hemophthalmia which intensified PVR process and anteroposterior traction influenced the intensity of PVR and also the development of retinal ablation. The complete perforation of the posterior wall of the eye ball (duplex perforation) with the small foreign body would produce bigger scar on the posterior wall than in case of singular perforations, which would usually be enough to control anteroposterior traction towards vitreous body and prevent retinal ablation.

To determine the correlation between the types of glycosaminoglycans (GAGs) and the features of rhegmatogenous retinal detachment, we analyzed the types of GAGs in the subretinal fluid of 20 eyes with rhegmatogenous retinal detachment. The GAGs were analyzed by cellulose acetate two-dimensional electrophoresis. Hyaluronic acid alone (HA type) was found in 10 of the 20 eyes. A combination of chondroitin sulfate (chSA) and HA was present (chSA type) in 3 of the 20 eyes. A combination of dermatan sulfate (DS) and HA (DS type) was present in 7 of the 20 eyes. No correlation was found between the type of GAGs and the extent, the duration of detachment, location, size or type of break in the 20 eyes. Some correlation was found between the type of GAGs and the grade of vitreous haze, proliferative vitreoretinopathy (PVR) and the number of surgeries. Retinal detachment with a demarcation line resulted in subretinal strand formation in the DS type eyes, while no such formation was seen in the subretinal space of the eyes of the chSA type. Vitreous haze of grade ( ) was seen in one eye of the DS type, but not seen in the other types. All 3 eyes with PVR of grade C were the DS type. The 2 eyes with reoperated surgeries were the DS type. The presence of DS may indicate an advanced condition of retinal detachment.

Background: The evaluation of further risc factors predesposing failure in retinal detachment surgery than those already known to be associated with PVR was the goal of this retrospective study., Patients and Methods: The data from 130 cases with unilateral rhegmatogenous retinal detachment treated initially with buckling procedures, were retrospectively reviewed to investigate pre-, intra- and postoperative factors which may predispose anatomical failure in retinal detachment surgery. None of the selected consecutively operated eyes had risk factors, which have already been associated with an unfavourable outcome, such as the presence of preoperative macular holes, PVR or assumed PVR-inducing factors, such as ocular trauma, giant retinal tears, vitreous hemorrhage, previous vitrectomy, cryopexy and laser photocoagulation., Results: The anatomic success rate after scleral buckling procedures was 78.5% and the overall success rate after multiple surgery including vitrectomy increased to 94.6%. 102 (78.5%) cases, treated with a maximum of two scleral buclking operations were statistically compared to the 28 cases which needed further vitreoretinal surgery. The statistical analysis revealed as preoperative risk factors for failure in rhegmatogenous retinal detachment surgery 1) retinal detachment exceeding two retinal quadrants (p < 0.05) and 2) size of the retinal tear larger than 60 degrees (p < 0.05), whereas postoperative risk factors were 1) presence of subretinal hemorrhage (p < 0.01) and 2) persistent subretinal fluid at least two days after surgery (p < 0.01). Eyes with preoperative visual acuity less than 0.1, pseudophacic eyes with posterior chamber intraocular lenses and eyes with severe intraoperative hypotony also showed a tendency to unfavourable outcome, but without a statistically significant level., Conclusions: Possible ways of interfering in the retinal reattachment process and the clinical importance of these evaluated factors are discussed. They should be taken in consideration for the prognosis of the postoperative anatomical result and treatment modalities if further surgery is required.

Review of current knowledge concerning the etiology and factors associated with development and clinical course of PVR is presented. Special attention was paid to the role of blood-retinal barrier break and iatrogenic factors. The new conception that PVR could be compared with "wound healing" reaction, in which autoimmunological mechanisms were involved is also discussed.

Purpose: Proliferative vitreoretinopathy occurs when cells migrate into the vitreous humor, where they proliferate and produce a membrane composed of extracellular matrix. Interleukin-1-beta (IL-1-beta) may be involved in these processes because it is chemotactic and mitogenic, and it stimulates metalloproteinase production. In the present study, the effects of intravitreally injected IL-1-beta on retinal membrane formation and the associated changes in metalloproteinase content of vitreous humor were examined., Methods: Rabbit eyes were injected with IL-1-beta in a buffer, with or without the prior creation of retinal holes. Control eyes received the buffer alone or no injection, with or without retinal holes. Animals were examined by slit lamp biomicroscopy and indirect ophthalmoscopy for 1 month. Zymography was performed on a portion of vitreous humor to assess collagenase content, and the remaining tissue was subjected to histologic analysis., Results: Intraocular IL-1-beta induced perilimbal vessel engorgement, keratic precipitates, synechiae, flare, lens deposits, optic disk hyperemia, and granulomatous formations that gradually subsided during the first week. Intravitreal injection of IL-1-beta in eyes with preexisting retinal holes additionally induced membrane formation. Zymographic analysis of vitreous humor from animals sacrificed 24 hours after IL-1-beta injection showed a 100-kd and a 65-kd gelatinase, whereas control vitreous humor contained predominantly a single gelatinase species of approximately 65 kd. Retinal holes did not affect IL-1-beta induction of the 100-kd gelatinase., Conclusions: IL-1-beta induces a 100-kd gelatinase in the vitreous humor and epiretinal membrane formation in eyes containing preexisting retinal holes. The presence of retinal holes and abnormal production of cytokines may lead to a cascade of events, including aberrant extracellular matrix remodeling, that result in proliferative diseases of the eye.

Proliferative vitreoretinopathy (PVR) is one of the main failure causes of retinal detachment repair. In this paper, 25 cases of vitreous surgery used in the PVR D3 are analyzed. The diagnosis of PVR depended on the classification of the American Retina Society Terminology Committee. Vitrectomy and peeling were carried out in all of the patients. Intraocular tamponade included silicone oil and gas tamponade. Follow-up is more than 3 months. The anatomic successful rate was 68% and 11 cases arrived 20/400 or better. The complications included vitreous hemorrhage, cataract, silicone oil into anterior chamber, PVR recurrent and so on. The authors suggest that vitrectomy combined with peeling and intraocular tamponade be key for the treatment of PVR D3. Silicone oil tamponade may improve the patients' prognosis. PVR formation is connected with the operative irritation, giant tear, trauma and vitreous hemorrhage. Adaptation and time of the vitreous surgery are discussed in this paper, too.

Since 1980, the fibroblast model creating experimental proliferative vitreoretinopathy has been used to evaluate the antiproliferative effect of various drugs. In previous studies radiation therapy was found to reduce effectively intraocular proliferation in this model. We therefore investigated the effect of high energy electrons in a standard perforating injury model creating a traumatic proliferative vitreoretinopathy. In 36 eyes we performed a 8 mm pars plana incision and injected 0.4 ml of 80% fibronectin solution intravitreally. Ten rabbits (20 eyes) received radiation therapy with a Betatron accelerator in a total dosage of 3000 cGy to each eye divided into 10 single fractions starting on the first post-operative day. Maximum concentration of the dose was focused to the posterior vitreous. The other 9 rabbits, 18 eyes, served as control. In our perforating injury model we observed a reduction of retinal detachment rate of 72% in the controls to 55% in the treated group. The effect of radiation therapy with high energy electrons and total dosage of 3000 cGy was not statistically significant in experimental traumatic proliferative vitreoretinopathy.

Proliferative vitreoretinopathy (PVR) remains the most common cause of failure in retinal detachment surgery. Surgical procedures for its repair entails complex and extensive instrumentation besides technical skill. The success rate varies widely with high incidence of redetachment. Keeping this in view, we evaluated the role of intravitreal daunorubicin as an anti-mitiotic agent in the inhibition of PVR. Our study concluded that 5 micrograms of intravitreal daunorubicin effectively inhibited PVR in the rabbit eye and the dosage was safe and nontoxic. The half-life of the drug was determined to be about 140 minutes, suggesting a prolonged intravitreal concentration sufficient to prevent fibroblast proliferation.

Purpose: To identify the clinical risk factors for the development of severe proliferative vitreoretinopathy (PVR) after retinal detachment surgery., Methods: A retrospective study of 1020 patients with either no PVR or with PVR of grade C1 or less at initial examination was conducted. After surgery, severe PVR was defined as grade C2 or worse. The data relating to 94 variables were evaluated by univariate analysis and stepwise logistic regression., Results: Severe PVR developed after surgery in 107 patients (10.5%). Ten significant predictive variables were identified: minor intra- or postoperative hemorrhage, grade A preoperative PVR, preoperative choroidal detachment, giant tears, air tamponade, detachment involving more than 2 quadrants, cumulative break area larger than 3 optic disks, postoperative choroidal detachment, signs of uveitis at initial examination, and grade B preoperative PVR., Conclusion: The results indicate that in addition to the size of breaks, extent of detachment, and presence of preoperative inflammation or low-grade PVR, iatrogenic problems also are important factors in the pathogenesis of severe PVR after surgery for retinal detachment.

Anterior proliferative vitreoretinopathy is characterized by epiretinal proliferation that extends anteriorly over the vitreous base, and may, in addition to the cells usually contributing to proliferative vitreoretinopathy, also contain cells of ocular structures located in that area. We examined 11 complete globes with aPVR that were enucleated after previous severe trauma or perforating injuries (n = 8) and complicated retinal detachment (n = 3) by a panel of immunohistochemical markers. We found presence of RPE, glial cells, macrophages and fibrocytes, as consistently reported in PVR membranes. In addition, T-cell lymphocytes were present in 6 of the cases, and cells expressing the common leucocyte antigen on 8 cases. Cells staining positive for the intracytoplasmic contractile filament alpha-smooth muscle actin were present in 5 cases and cells staining for desmin in one case. Collagen type IV was part of most of the membranes, and vessels with leakage of plasma factors were present in more than half of the cases.

Purpose: A technique for managing giant retinal tears without proliferative vitreoretinopathy (PVR) is presented, and visual outcome, anatomic reattachment, and postoperative complications are discussed., Methods: A total of 25 consecutive cases of retinal detachment from giant retinal tears in eyes without PVR that had not previously undergone surgery were reviewed. A surgical technique combining pars plana vitrectomy, perfluoro-octane, and fluid-gas exchange was used. Scleral buckling was performed in 23 (92%) of 25 eyes, and pars plana lensectomy was performed in 11 (69%) of the 16 phakic eyes. A minimum follow-up period of 6 months was documented in each case., Results: Of the 25 eyes, redetachment occurred in 3 (12%) after the initial procedure, and further surgery was necessary to successfully reattach the retina. A total of 9 secondary procedures were performed in 7 (28%) of the 25 eyes. Final retinal reattachment was achieved in all 25 eyes. Final Snellen visual acuity was 20/80 or better in 18 (72%) patients and 20/200 or better in 21 (84%) patients., Conclusion: The anatomic and visual results of this method of surgical treatment of giant retinal tears without PVR compare favorably to those achieved with techniques that use a nonbuckling approach, but with reduced ocular morbidity.

To further characterize the content and nature of cyclitic membranes (n = 4), ringschwielen (n = 3) and a subretinal strand on sections of complete globes with long-standing retinal detachment after trauma (n = 7) or retinal reattachment surgery (n = 1), we applied a panel of cellular and extracellular antibodies using the APAAP (alkaline phosphatase and monoclonal anti-alkaline phosphatase) technique. Only one cyclitic membrane from an eye that was enucleated two months after trauma was positive for glial fibrillary acidic protein, demonstrating the presence of glial cells. All cyclitic membranes contained macrophages and expressed intracellular contractile proteins. Ringschwielen stained consistently for cells of epithelial origin (RPE) with cytokeratin and for macrophages. The subretinal strand stained for cytokeratin, macrophages and alpha-smooth muscle actin, supporting cellular contraction in the genesis of this form of proliferative vitreoretinopathy.

The pathogenesis of proliferative vitreoretinopathy remains poorly understood and a large variety of hypotheses have been developed in an attempt to investigate cellular proliferations that follow rhegmatogenous retinal detachment. Several growth promoting factors have been identified within the vitreous body and proliferative membranes from patients with PVR. Their enzymatic, chemotactic, mitogenic or proinflammatory properties make them good candidates, either alone or more probably in a synergistic manner. They may be involved at different levels in the successive stages of PVR, cell migration, proliferation or vitreoretinal contraction. Numerous ocular and even extra-ocular structures may be involved as retina, pigment epithelium, ciliary body and serum, contain large amounts of these growth factors. Immune mediated inflammatory reactions have also been described and vitreoretinal strands exert additional mechanical effects. Current pathogenetic hypotheses suggest that PVR results from a wound healing process induced by retinal breaks and detachment of the neuroepithelium, when is reached a threshold of biological stimulation. Cell proliferation is unfortunately often overstimulated and the proliferating cells invade the vitreous cavity. If surgery is not capable of efficiently blocking the proliferation, it will be autostimulated and lead to a complete vitreoretinal retraction.

Eyes at the risk of developing severe PVR postoperatively are limited to those affected with retinal detachment associated with horseshoe tears. This study is conducted to determine the relationship of horseshoe tears and PVR. 101 failure cases following surgery of retinal detachment with simple horseshoe tears were reviewed. The PVR group was compared with the group without PVR. The results indicate that vitreous gel liquefaction and posterior vitreous detachment are essential reasons of retinal detachment with horseshoe tears. Vitreous hemorrhage, uveitis, choroidal detachment and multiple operations are predisposing factors. It is the clinical evidence developed PVR that horseshoe tears with a curled and fixed posterior edge or the anterior flaps are smaller in size than the area of the exposed pigment epithelial cells.