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Proliferative Vitreoretinopathy After Trauma

Proliferative vitreoretinopathy (PVR) is a pathological, exuberant scarring process that occurs during the course of many retinal diseases. It has a variety of clinical manifestations, all of which reflect intraocular proliferation. These include epiretinal and subretinal membranes, subretinal bands, contraction of the vitreous base, and many others. As a result, PVR is the most common etiology for failure of surgery in the setting of rhegmatogenous retinal detachment. Ocular trauma is a significant source of visual morbidity worldwide. Blunt, penetrating, and perforating injuries can all result in trauma to the posterior segment. Many of the key pathophysiological variables known to be necessary for the development of PVR are present as part of the woundhealing response that occurs soon after injury. As such, the development of PVR can complicate the already difficult management of these ocular injuries. Prior to the development of microsurgical and vitrectomy techniques, surgical outcomes in the setting of posterior segment trauma were often dismal. A study that reviewed patients with ruptured globes between 1952 and 1970 reported that only 6% achieved visual outcomes of 5/200 or better. Similar studies have been performed more recently and revealed the effects that improvements in principles of management, instrumentation, and techniques have had. In a study that reviewed ruptured globes between 1970 and 1981, 55% of patients achieved final visual acuity of 5/200 or better. An even more recent review found that 57% of patients achieved a visual result of 15/200 or better. Currently, one-third of patients achieve visual acuity of 20/40 or bet-