Pharmacology and Vitreoretinal Surgery (Developments in Ophthalmology)

More
than 35 years have passed since the advent of pars plana vitrectomy,
and vitreoretinal surgery has developed to highly sophisticated
techniques to treat retinal diseases. Removal of the vitreous gel and
hemorrhage not only clears the optical axis of the eye, but enables the
surgeon to approach the retina and the vitreoretinal interface directly,
thereby relieving traction and removing pathological tissue, such as
epiretinal membranes. Peeling off the internal limiting membrane has
proven to be a safe and effective technique in macular surgery,
resulting in macular hole closure. Twenty years ago, nobody would have
imagined this. Today, final success rates beyond 90% can be achieved in
macular and reattachment surgery.
However, there are limitations of current vitreoretinal surgery
techniques, which are mechanically based. Removal of the vitreous is
incomplete, especially at the vitreo retinal interface and at the
vitreous base. This may lead to persistent or recurrent traction on the
retina, resulting in retinal tear formation or reproliferation. More
aggressive removal of the vitreous by mechanical means, however, carries
the risk of damaging the retina. When epiretinal membranes are removed
in PVR cases and in diabetic eyes with traction retinal detachment,
gliotic scar tissue is removed but neural retina is not treated. Thus,
despite anatomical reattachment, visual results are often disappointing.
Pharmacology-assisted vitreoretinal surgery can help to overcome these limitations.

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