The Classification of Retinal Detachment with Proliferative Vitreoretinopathy

We studied the inhibitory effect of triamcinolone acetonide on experimental intraocular proliferation. Autotransplantation of fibroblasts from rabbit rump skin into the vitreous cavity resulted in intravitreal strand formation and traction retinal detachment in 36 of 43 eyes (84%) over a period of three months. A single intravitreal injection of 1 mg of triamcinolone acetonide inhibited fibroblast growth and significantly reduced the number of retinal detachments in 15 of 44 eyes (34%). Retinal neovascularization caused by fibrous strands coming into contact with vacularized retina was also reduced by triamcinolone acetonide (31 of 43 control eyes [72%] vs eight of 44 treated eyes [18%]). Intravitreal corticosteroid therapy may be an important adjunct to the therapy of perforating injuries and massive periretinal proliferation.

Massive periretinal proliferation (MPP), a serious complication of retinal detachment, is caused by proliferation and fibrous metaplasia of cells mostly deriving from retinal pigment epithelium and retinal glial cells. Contracting fibrous membranes in the vitreous, and on and also under the retina, cause the intraocular changes of MPP. Early signs such as increased 'tobacco dust', pigmented and unpigmented clumps in the vitreous, and subtle preretinal and even retroretinal membranes are usually overlooked. The late signs such as starfolds, irregular retinal folds, circumferential folds, and funnel-shaped detachments are well known. The pathogenesis of the clinically visible signs is described, and a 4-stage classification of the disease is given.

Perforating injuries were produced in the posterior segment of rabbit eyes. We studied the inhibitory effect of a slowly water-soluble corticosteroid, dexamethasone alcohol, on fibroblast growth. The treated group received a single intravitreal injection of 1 mg of the corticosteroid. The eyes were observed for four weeks. Transvitreal proliferation was significantly decreased and wound healing was delayed as compared to a control group. Inhibition of intraocular proliferation by high doses of intravitreally injected corticosteroid may be useful in the treatment of eyes with penetrating and perforating injuries.