PDF icon Download PDF
Klin Monbl Augenheilkd 2010; 227(3): 168-174
DOI: 10.1055/s-0029-1245300
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Proliferative Vitreoretinopathie – Pathogenese und Therapie

Proliferative Vitreoretinopathy – Pathogenesis and TherapyI. Iandiev1 , A. Bringmann1 , P. Wiedemann1
  • 1Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig AöR, Leipzig
Further Information

Publication History

Eingegangen: 16.12.2009

Angenommen: 26.2.2010

Publication Date:
16 March 2010 (online)

Also available ateRef
   Permissions and Reprints
Preview

Zusammenfassung

Die wichtigste Komplikation der Netzhautablösung und der vitreoretinalen Chirurgie ist die proliferative Vitreoretinopathie (PVR). Die PVR ist ein überaktivierter Prozess der Netzhautreparatur; die Proliferation von retinalen und Immunzellen führt zur Bildung von epiretinalen Membranen, deren Traktionen Netzhautablösungen verursachen. Dieser Artikel gibt einen kurzen Überblick über die Pathogenese und die chirurgische Behandlung der PVR sowie über bisherige Studien zur Testung von pharmakologischen Substanzen, die zur Inhibition der intraokulären Proliferation eingesetzt werden könnten. Zurzeit sind rein chirurgische Methoden das Mittel der Wahl zur Behandlung einer PVR. Eine PVR der Stadien B und C1 / C2 kann mit Buckelchirurgie behandelt werden. Ab dem Stadium C 3 sollte eine Vitrektomie durchgeführt werden.

Abstract

Proliferative vitreoretinopathy (PVR) is the most important complication of retinal detachment and vitreoretinal surgery. PVR is considered to represent a maladapted retinal wound repair process; proliferation of retinal and immune cells induces the formation of epiretinal membranes which cause tractional retinal detachment. This publication gives a brief overview on the pathogenesis and operative treatment of PVR as well as on adjunct pharmacological therapy which may target the components of the proliferative process. At the moment surgical approaches are the first choice for the treatment of PVR. Scleral buckling provides good anatomic results in the treatment of a PVR stage B or C1 / C2. From stage C 3 onwards vitrectomy offers advantage.

Schlüsselwörter

proliferative Vitreoretinopathie - Buckelchirurgie - Pars-plana-Vitrektomie

Key words

proliferative vitreoretinopathy - scleral buckling - pars plana vitrectomy

Literatur

  • 1 Hooymans J M, De Lavalette V W, and O ey AG. Formation of proliferative vitreoretinopathy in primary rhegmatogenous retinal detachment.  Doc Ophthalmol. 2000;  100 39-42 [PubMed]
    Search in Google Scholar
  • 2 Koerner F. Clinical diagnosis of proliferative vitreoretinopathy.  Klin Monatsbl Augenheilkd. 1989;  194 383-388
    Search in Google Scholar
  • 3 Heimann K, Wiedemann P. ProliferativeVitreoretinopathy. Kaden Verlag; 1989
    Search in Google Scholar
  • 4 Machemer R. et al . An updated classification of retinal detachment with proliferative vitreoretinopathy.  Am J Ophthalmol. 1991;  112 159-165 [PubMed]
    Search in Google Scholar
  • 5 Wiedemann P. Growth factors in retinal diseases: proliferative vitreoretinopathy, proliferative diabetic retinopathy, and retinal degeneration.  Surv Ophthalmol. 1992;  36 373-384 [PubMed]
    Search in Google Scholar
  • 6 Charteris D G, Sethi C S, Lewis G P. et al . Proliferative vitreoretinopathy – developments in adjunctive treatment and retinal pathology.  Eye. 2002;  16 369-374 [PubMed]
    Search in Google Scholar
  • 7 Bringmann A, Pannicke T, Grosche J. et al . Müller cells in the healthy and diseased retina.  Prog Retin Eye Res. 2006;  25 397-424 [PubMed]
    Search in Google Scholar
  • 8 Guidry C. The role of Müller cells in fibrocontractive retinal disorders.  Prog Retin Eye Res. 2005;  24 75-86 [PubMed]
    Search in Google Scholar
  • 9 Mitamura Y, Takeuchi S, Matsuda A. et al . Hepatocyte growthfactor levels in the vitreous of patients with proliferative vitreoretinopathy.  Am J Ophthalmol. 2000;  129 678-680 [PubMed]
    Search in Google Scholar
  • 10 Gamulescu M A, Chen Y, He S. et al . Transforming growth factor β2-induced myofibroblastic differentiation of human retinal pigment epithelial cells: regulation by extracellular matrix proteins and hepatocyte growth factor.  Exp Eye Res. 2006;  83 212-222 [PubMed]
    Search in Google Scholar
  • 11 Hollborn M, Francke M, Iandiev I. et al . Early activation of inflammation- and immune response-related genes after experimental detachment of the porcine retina.  Invest Ophthalmol Vis Sci. 2008;  49 1262-1273
    Search in Google Scholar
  • 12 Tseng W, Cortez R T, Ramirez G. et al . Prevalence and risk factors for proliferative vitreoretinopathy in eyes with rhegmatogenous retinal detachment but no previous vitreoretinal surgery.  Am J Ophthalmol. 2004;  137 1105-1115 [PubMed]
    Search in Google Scholar
  • 13 Heimann H, Bartz-Schmidt K U, Bornfeld N. et al . Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment Study Group. Scleral buckling versus primary vitrectomy in rhegmatogenous retinal detachment: a prospective randomized multicenter clinical study.  Ophthalmology. 2007;  114 2142-2154 [PubMed]
    Search in Google Scholar
  • 14 Wiedemann P, Meier P. Endoresektiondes malignen Melanoms.  Spectrum Augenheilk. 2001;  15 242-244 [PubMed]
    Search in Google Scholar
  • 15 Sobaci G. et al . Deadly weapon-related open-globe injuries: outcome assessment by the ocular trauma classification system.  Am J Ophthalmol. 2000;  129 47-53
    Search in Google Scholar
  • 16 Dunker S. et al . The effect of retinal cryoapplication on the vitreous.  Retina. 1997;  17 338-343
    Search in Google Scholar
  • 17 Bonnet M. Clinical factors predisposing to massive proliferative vitreoretinopathy in rhegmatogenous retinal detachment.  Ophthalmologica. 1984;  188 148-152
    Search in Google Scholar
  • 18 Mietz H, Kirchhof B, Heimann K. Anterior proliferative vitreoretinopathy in trauma and complicated retinal detachment. A histopathologic study.  Ger J Ophthalmol. 1994;  3 15-18 [PubMed]
    Search in Google Scholar
  • 19 Kreissig I, Simader E, Rose D. Role of segmental buckling surgery in treatment of stages B and C proliferative vitreoretinopathy detachment. A long-term follow-up.  Klin Monatsbl Augenheilkd. 1994;  205 336-343 [PubMed]
    Search in Google Scholar
  • 20 Brazitikos P D, Androudi S, Christen W G. et al . Primarypars plana vitrectomy versus scleral buckle surgery for the treatment of pseudophakic retinal detachment: a randomized clinical trial.  Retina. 2005;  25 957-964 [PubMed]
    Search in Google Scholar
  • 21 Ivanisevic M. Conventional retinal surgery for rhegmatogenous retinal detachment with proliferative vitreoretinopathy.  Acta Med Croatica. 1995;  49 207-209 [PubMed]
    Search in Google Scholar
  • 22 Starzycka M, Bednarz A, Sobieraj A. Probability of successful operation in very severe retinal detachment using scleral buckling procedure.  Klin Oczna. 1992;  94 194-196 [PubMed]
    Search in Google Scholar
  • 23 McDonald H R. et al . Surgical results for proliferative vitreoretinopathy.  Eur J Ophthalmol. 1994;  4 211-217 [PubMed]
    Search in Google Scholar
  • 24 Tseng J J, Barile G R, Schiff W M. et al . Influence of relaxing retinotomy on surgical outcomes in proliferative vitreoretinopathy.  Am J Ophthalmol. 2005;  140 628-636
    Search in Google Scholar
  • 25 Faude F, Lambert A, Wiedemann P. 360 degrees retinectomy in severe anterior PVR and PDR.  Int Ophthalmol. 1998;  22 119-123 [PubMed]
    Search in Google Scholar
  • 26 Barile G R. et al . Neovascular complications associated with rubeosis iridis and peripheral retinal detachment after retinal detachment surgery.  Am J Ophthalmol. 1998;  126 379-389 [PubMed]
    Search in Google Scholar
  • 27 Bourke R D, Cooling R J. Vascular consequences of retinectomy.  Arch Ophthalmol. 1996;  114 155-160 [PubMed]
    Search in Google Scholar
  • 28 Silva D J, Kwan de A, Bunce C. et al . Predicting visual outcome following retinectomy for retinal detachment.  Br J Ophthalmol. 2008;  92 954-958 [PubMed]
    Search in Google Scholar
  • 29 Mouries O, Bonnet M. C2F6 in the treatment of retinal detachment associated to PVR: therapeutic trial.  J Fr Ophtalmol. 1992;  15 601-604 [PubMed]
    Search in Google Scholar
  • 30 Yamamoto S, Takeuchi S. Silicone oil and fluorosilicone.  Semin Ophthalmol. 2000;  15 15-24 [PubMed]
    Search in Google Scholar
  • 31 Quiram P A, Gonzales C R, Hu W. et al . Outcomes of vitrectomy with inferior retinectomy in patients with recurrent rhegmatogenous retinal detachments and proliferative vitreoretinopathy.  Ophthalmology. 2006;  113 2041-2047 [PubMed]
    Search in Google Scholar
  • 32 Heimann H, Stappler T, Wong D. Heavy tamponade 1: a review of indications, use, and complications.  Eye. 2008;  22 1342-1359 [PubMed]
    Search in Google Scholar
  • 33 Jonas J B. et al . Retinal redetachment after removal of intraocular silicone oil tamponade.  Br J Ophthalmol. 2001;  85 1203-1207 [PubMed]
    Search in Google Scholar
  • 34 Halberstadt M, Domig D, Kodjikian L. et al . PVR recurrence and the timing of silicon oil removal.  Klin Monbl Augenheilkd. 2006;  223 361-366
    Search in Google Scholar
  • 35 Jonas J B, Budde W M, Knorr H L. Timing of retinal redetachment after removal of intraocular silicone oil tamponade.  Am J Ophthalmol. 1999;  128 628-631 [PubMed]
    Search in Google Scholar
  • 36 Coll G E. et al . Perfluorocarbon liquid in the management of retinal detachment with proliferative vitreoretinopathy.  Ophthalmology. 1995;  102 630-638 [PubMed]
    Search in Google Scholar
  • 37 Wong D, Williams R L, German M J. Exchange of perfluorodecalin for gas or oil: a model for avoiding slippage.  Graefes Arch Clin Exp Ophthalmol. 1998;  236 234-237 [PubMed]
    Search in Google Scholar
  • 38 Behar-Cohen F, Le Rouic J F, Chauvaud D. Long-term comparative anatomic results of retinal detachment with vitreoretinal proliferation operated with or without using liquid perfluorocarbons.  J Fr Ophtalmol. 1999;  22 853-858
    Search in Google Scholar
  • 39 Wu W C, Kuo S L, Chen J Y. Management of severe proliferative vitreo-retinopathy with perfluorocarbon liquids and silicone oil.  Kaohsiung J Med Sci. 1999;  15 611-6 [PubMed]
    Search in Google Scholar
  • 40 Mitamura Y, Yamamoto S, Yamazaki S. Corneal endothelial cell loss in eyes undergoing lensectomy with and without anterior lens capsule removal combined with pars plana vitrectomy and gas tamponade.  Retina. 2000;  20 59-62 [PubMed]
    Search in Google Scholar
  • 41 Korobelnik J F. et al . Silicone oil removal combined with macular pucker dissection: a retrospective review of 14 cases.  Retina. 1998;  18 228-232 [PubMed]
    Search in Google Scholar
  • 42 Meurs J C. et al . Rubeosis of the iris in proliferative vitreoretinopathy.  Retina. 1996;  16 292-295 [PubMed] (4)
    Search in Google Scholar
  • 43 Lewis van H, Verdaguer J I. Surgical treatment for chronic hypotony and anterior proliferative vitreoretinopathy.  Am J Ophthalmol. 1996;  122 228-235 [PubMed]
    Search in Google Scholar
  • 44 Wiedemann P. et al . Adjunctive daunorubicin in the treatment of proliferative vitreoretinopathy: results of a multicenter clinical trial.  Am J Ophthalmol. 1998;  126 550-559 [PubMed]
    Search in Google Scholar
  • 45 Asaria R HY, Kon C H, Bunce C. et al . Adjuvant 5-fluorouracil and heparin prevents proliferative vitreoretinopathy : Results from a randomized, double-blind, controlled clinical trial.  Ophthalmology. 2001;  108 1179-1183 [PubMed]
    Search in Google Scholar
  • 46 Charteris D G, Aylward G W, Wong D. et al . A randomized controlled trial of combined 5-fluorouracil and low-molecular-weight heparin in management of established proliferative vitreoretinopathy.  Ophthalmology. 2004;  111 2240-2245
    Search in Google Scholar
  • 47 Hollborn M, Tenckhoff S, Jahn K. et al . Changes in retinal gene expression in proliferative vitreoretinopathy: glial cell expression of HB-EGF.  Mol Vis. 2005;  11 397-413 [PubMed]
    Search in Google Scholar
  • 48 Behrens-Baumann W, Vogel M. Experimental study on drug therapy of „tractionretinal detachment” after posterior penetrating eye injury in the rabbit.  Graefes Arch Clin Exp Ophthalmol. 1986;  224 513-519
    Search in Google Scholar
  • 49 Cheema R A, Peyman G A, Fang T. et al . Triamcinolone acetonide as an adjuvant in the surgical treatment of retinal detachment with proliferative vitreoretinopathy.  Ophthalmic Surg Lasers Imaging. 2007;  38 365-370
    Search in Google Scholar
  • 50 Lewis G, Mervin K, Valter K. et al . Limiting the proliferation and reactivity of retinal Müller cells during experimental retinal detachment: the value of oxygen supplementation.  Am J Ophthalmol. 1999;  128 165-172
    Search in Google Scholar

Prof. Dr. Peter Wiedemann

Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig AöR

Liebigstr. 10 – 14

04103 Leipzig

Phone: ++ 49/3 41/9 72 16 50

Email: augen@medizin.uni-leipzig.de