Surgery best treatment for PVR at present, but drugs being investigated

DANA POINT, Calif. — Proliferative vitreoretinopathy is best treated with surgery for the time being, but several types of medical therapies are being investigated for use in the condition, a speaker here said.

Delivering the Millennium Lecture at the Ocular Drug and Surgical Therapy Update meeting here, Gary W. Abrams, MD, said proliferative vitreoretinopathy (PVR) often results in a complicated retinal detachment, and efforts at retinal reattachment often fail.

Surgery for PVR can include lensectomy in phakic eyes, scleral buckle, complete vitrectomy and complete membrane peeling, Dr. Abrams said. Retinectomy can also be performed, but Dr. Abrams noted the possibility of traction problems. He said surgeons much achieve hemostasis during the procedure and control inflammation postoperatively.

The likelihood of a successful surgical outcome can be increased if surgeons use a bimanual technique, injection of perfluorocarbon liquid and a wide-angle viewing system, Dr. Abrams said.

Drug therapies being investigated to treat PVR include corticosteroids and antiproliferative drugs such as daunorubicin, fluropyrimidines, retinoids, immunotoxins and tranilast, he added.

Other drugs being investigated interfere with the synthesis, secretion and posttranslational modification of collagen, he said. Drugs in these categories include antimetabolites such as 5-fluorouracil, mitomycin, penicillamine and cis-hydroxyproline. Still other potential drug treatments affect the binding of cells to components of the extracellular matrix, he said. These include heparin, low molecular weight heparin and RGDS tetrapeptide, he said.

Some of these drug therapies have yielded positive results in studies, Dr. Abrams said, but the potential for toxicity is unknown, and further studies are necessary.