The success rate of
retinal reattachment surgery has now reached over 90%. The major cause of failure is attributable to the development of
proliferative vitreoretinopathy (PVR). It is a complex process comprised of events that are similar to those of the wound healing response with
inflammation, migration and proliferation of a variety of cells. These membranes can exert
traction and reopen previously closed
retinal breaks, create new breaks, and distort or obscure the macula. In the early part of this century the success rate of
retinal reattachment surgery was virtually nil and it was not until a better understanding of the pathophysiology of
retinal detachment was gained that the success rate improved. It was Gonin who emphasised the relationship between
vitreous detachment and
traction resulting in
retinal tears that led to treatment aimed at closing
retinal breaks. To increase even further the final success rate in the treatment of 'simple
retinal detachments' a better understanding of the risk factors for PVR is needed in patients presenting with acute
retinal detachments. Such risk factors can be broadly divided under the headings of preoperative risk factors, best surgical management and possibly adjuvant
therapy.