Prophylaxis

Since treatment of an established PVR has a poor prognosis, prevention remains the surgeon's best hope. The following list shows certain surgeon-controlled variables that may help reduce the PVR risk.

• Timing of surgery. Early vitrectomy in high risk eyes [18, 49] appears to reduce the PVR risk, probably by removing the inflammation-inciting elements from the eye.

• Atraumatic surgery. Avoiding intraoperative complications such as hemorrhage or retinal damage (see above) eliminates certain PVR-in-citing factors.

• Complete surgery. Removal of all vitreous, i.e., posteriorly (PVD), anteriorly (vitreous base and retrolental area), and all proliferative membranes [1], reduces the medium/scaffold on which cells can proliferate.

• Destruction of RPE cells in certain high-risk injuries. Since these cells are the primary culprit in PVR development, their elimination in the

37 Whether intra- or postoperative.

38 Whether intra- or postoperative.

39 By keeping the macula attached.

Table 2.9.5 Pharmaceutical options in preventing/treating PVR

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