Retinal Reattachment Redo: Be Aware of Proliferative Vitreoretinopathy

Posted on: 4 November 2015

A detached retina results in permanent visual loss if it is not surgically reattached in a timely manner. While most retinal reattachment procedures are successful, less than ten percent of reattachment procedures require a second retinal reattachment surgery to correct proliferative vitreoretinopathy, a complication that can occur as a result of the eye's healing response. If you are facing surgery to reattach a detatched retina, you should understand how your retina detatched, why there is a small chance that it could happen again and what this complication means.

Retinal Detachment Review

The retina is a thin membrane located on the inside surface at the back of the eye. Situated near the optic nerve, its function is to receive and process light through the photoreceptor cells, which are called rods and cones. The processed image is then transmitted to the brain through the optic nerve. When the retina sustains a tear, vitreous gel that is contained within the eye leaks through the opening. As this fluid accumulates between the retina and the rear wall of the eye, the retina is pushed away from its proper position. This is the result known as retinal detachment. When the retina detaches, the following things occur:

  • The retina is separated from one of its two blood supplies
  • The retinal tissue is deprived of oxygen and nutrients
  • The retinal cells begin to die off
  • Loss of vision is incurred

Based upon the condition of the retina, your age, your eye health history and your overall health, one of three retina surgery procedures must be performed to reattach the retina and preserve your vision.

Secondary Detachment Complication

While most retinal reattachment procedures are successful, some patients experience a complication of a second detachment after the initial surgery. This complication is called proliferative vitreoretinopathy, or PVR, and it occurs when a proliferation of cells form scar tissue at the healing site. Think of PVR as a healing process on overdrive. As the scar tissue forms on the retina, it makes the retina stiff. The scar tissue pulls at the retina, which can cause new tears, and the retina detaches once again. Further vision loss is sustained, and surgical correction of a re-detached retina that has stiffened is more challenging. The procedure requires advanced techniques and specialized instruments, and the chance for successfully restoring vision is diminished.

Vitrectomy to Correct PVR

A vitrectomy is one of the three surgical options that are considered for initial reattachment of a detached retina, and it is the ideal choice for reattaching a secondary retinal detachment that results from PVR. During this procedure, the retinal surface of the eye is accessed in order to make the following repairs:

  • The scar tissue must be removed.
  • Any tears must be mended with a laser instrument.
  • The vitreous gel is removed from the rear chamber of the eye.
  • In place of the drained vitreous gel, a bubble of silicone oil or gas is inserted to keep the retina pushed back against the rear wall of the eye as it heals in place.

The advantage of using silicone oil instead of gas is that a gas bubble dissipates over a short period of time, whereas the silicone oil remains in place for as long as the retina needs to heal. This leads to the disadvantage of using silicone oil in that another surgical procedure will be required to remove the oil bubble once the retina is fully healed.

Healing and Visual Prognosis

The retinal specialist who performs your surgery will provide you with postoperative care instructions, which may include keeping your head in a certain position that is the most conducive for healing, medicated ophthalmological drops or ointments, and follow-up examinations. The odds for a return of vision after an initial retinal reattachment are favorable, but a return of lost vision following a procedure to correct PVR is less promising.

Despite the low chance of developing PVR, retinal reattachment is not an optional procedure. If at any time you observe any abnormalities in your field of vision, including floaters, shadows or flashes, it is vital to schedule an appointment as soon as possible with a local optometrist or ophthalmologist, such as Nevada Institute Of Ophthalmology, for an examination. When it comes to retinal detachment, the best chance for a favorable outcome is a prompt evaluation and retina surgery.