POST-SURGICAL OUTCOMES AND COMPLICATIONS IN VITREORETINAL SURGERY: AN ANALYSIS OF PROLIFERATIVE VITREORETINOPATHY (PVR) AND ITS PROGNOSTIC IMPACTS

Abstract

Proliferative vitreoretinopathy (PVR) is the leading cause of surgical failure after treatment for rhegmatogenous retinal detachment, with an estimated incidence of 5% to 10% of cases. The pathogenesis involves an exacerbated inflammatory and scarring response, with proliferation of retinal pigment epithelial cells, glial cells, and fibroblasts, which differentiate into myofibroblasts, culminating in the formation of epiretinal and subretinal contractile membranes. These membranes exert traction on neural tissue, potentially leading to redetachment and a poor visual prognosis. The preferred therapeutic approach is pars plana vitrectomy, often combined with complex procedures such as relaxing retinectomy, to neutralize the traction vectors. Postoperative anatomical stabilization depends on the use of intraocular tamponades, such as expandable gases (SF₆, C₃F₈) and silicone oil, whose prolonged use is associated with complications such as retinal toxicity, emulsification, and secondary ocular hypertension. The elucidation of molecular cascades involving pro-inflammatory cytokines such as transforming growth factor beta (TGF-β) has fostered research into adjuvant pharmacological therapies, including antiproliferative agents and immune response modulators, with the aim of optimizing surgical outcomes. Personalizing the therapeutic strategy, based on stratification of clinical severity and individual inflammatory response, emerges as a determining factor for anatomical and functional success.