Proliferative vitreoretinopathy (PVR) was the focus of the Friday Euretina session on vitreoretinal surgery.
The session began with a discussion of pathophysiology, classification, and risk stratification by Martin Zinkernagel, MD (Germany). New approaches to risk stratification going beyond clinical phenotype was the focus of talks given by Tommaso Rossi, MD (Italy) and Salvador Pastor-Idoate, PhD (Spain).
Dr. Rossi described his group’s research aiming to develop a proteomic approach for defining PVR risk. He reported findings from a study analysing aqueous samples collected from patients who were about to undergo primary surgery for retinal detachment that showed significant differences in the baseline molecular signatures comparing age- and sex-matched groups who after 1 year of follow-up did or did not develop recurrent RD. The differences in protein signatures reflected enriched metabolisms in RD and suggested that recurrent RD is associated with early alterations in cell adhesiveness pathways. Although there is a lot of work yet to be done, Dr. Rossi suggested that the identified proteins may represent potential biomarkers as targets for prognostic assessment and therapy.
Continuing on the topic of identifying a method that would provide reliable individual prediction of PVR after primary RD surgery, Dr. Pastor-Idoate discussed the evolution from clinical risk scores to patient-level susceptibility, genetic and molecular biomarkers, and multimodal/artificial intelligence approaches. His presentation included data from his group investigating TP53-associated susceptibility and retinal injury response, human retinal RNA-seq findings, and exploratory multimodal prediction data from RAISE-VISION. In his conclusion, Dr Pastor-Idoate cautioned that identifying a method for better PVR prediction is not simply about demonstrating that it has a higher area under the curve. Rather, it must be able to predict the correct clinical event and provide information beyond clinical phenotype alone. In addition, new predictive models must be validated and calibrated externally. Ultimately, then, they must be shown to improve clinical decision-making, he said.
Talks by Boris Stanzel, MD (Germany) and Grazia Pertile, MD (Italy) centred on surgery. Reviewing evidence about the efficacy of adjuvant pharmacotherapy with methotrexate, Dr. Stanzel presented outcomes data from two European cohorts of patients operated on for retinal detachment due to PVR that showed the use of adjuvant repeat intravitreal methotrexate in a more complex surgical and disease burden population was associated with more successful oil removal and fewer re-detachments. In the last talk of the session, Grazia Pertile, MD (Italy) described considerations when performing surgery in eyes with established PVR. She outlined key steps and further demonstrated her technique with a series of videos. Dr. Pertile emphasised the need for first “visualising the situation” to understand the existing forces as this information will guide the most appropriate surgical approach. She also recommended proceeding to release traction before staining, explaining that staining may not be complete if it is done first.
