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Good surgery better than medication in high-risk PVR patients, surgeon says
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WAILEA, Hawaii — Retinal detachment repair in proliferative vitreoretinopathy is still best handled with one successful operation rather than medical therapy, a surgeon said here.
 Dean Eliott |
"If we look at the high-risk detachments and if we look at eyes with established PVR, in 2009, it's the same as it was years ago. Really good surgery to repair the retinal detachment is more important than anything else. There are no other options," Dean Eliott, MD, said at Retina 2009. "There are considerable challenges in evaluating poential new compounds and strategies to prevent or treat PVR, so surgery is the way to go."
Dr. Eliott said the principle of successful PVR surgery is to do a complete vitrectomy with particular attention to the anterior vitreous base region. If the patient is aphakic or pseudophakic, it is easier to perform a 360° scleral depression and remove as much gel as possible. He said he does not routinely remove the lens unless it has an opacity. He does an encircling scleral buckle to secure the posterior edge of the vitreous base and cleans out the eye as much as possible.
Showing multiple studies of various medical treatments for PVR, Dr. Eliott said there was no benefit shown that would outweigh the success of surgery.
"As we know from the silicone oil study, you get the best result with one operation, so it's really critical that we do the right thing on this one operation in these types of eyes," he said. "None of these [medications] are in routine use, which is kind of disappointing because these were very lengthy, time-consuming, great studies, in my opinion. And there's always question of toxicity with these things. So, nobody is really using these."
I agree that the pharmacologic therapy for proliferative vitreoretinopathy has been disappointing. Dr. Dean Elliott, who has considerable experience in the management of complex vitreoretinal surgical challenges, also highlights the importance of scleral buckling, complete shaving of the vitreous base and peeling surface membranes as thoroughly as possible. Another important element in the surgical management of proliferative vitreoretinopathy is that if retinectomy is deemed appropriate, it should be generous. Typically, no less than 180º of the retina should be excised.
– Allen C. Ho, MD
OSN Retina/Vitreous Board Member