Non-surgical interventions for proliferative vitreoretinopathy—a systematic review

Proliferative Vitreoretinopathy (PVR) is the most common cause of surgical failure after retinal detachment (RD) repair, complicating up to 10% of spontaneous RD repairs and 50% of open globe injury-related RD. Early surgical intervention is currently the only intervention that reduces PVR incidence. An effective non-surgical intervention would be valuable in reducing PVR incidence and/or severity, particularly where access to surgery is limited or may be delayed. To define the evidence base for non-surgical management options to prevent and treat Proliferative Vitreoretinopathy (PVR) in retinal detachment and trauma, we searched PubMed, Clinicaltrials.gov, Medline and CINAHL for randomised controlled trials (RCTs) of non-surgical interventions to prevent or treat established PVR with no restriction on language or start date up until November 2024. All non-surgical interventions were considered with no restrictions. We considered outcomes of post-operative PVR (including retinal reattachment rate) and visual acuity and performed Risk of Bias (RoB) assessments using the Cochrane RoB2 tool. We identified 27 papers which included 1981 patients in studies of primary prevention and 1394 patients in studies of treatment of established PVR. While several studies of various agents individually demonstrated some improvements, the reviewers found concerns with RoB and the results were not replicated in the larger included studies. Multiple studies have investigated non-surgical interventions for PVR after RRD repair and trauma, but none have yet demonstrated clinically significant, repeatable benefits. Improved understanding of PVR pathobiology, along with larger prospective studies of existing preventative strategies may lead to the development of newer and more effective interventions.