PATHOGENIC MECHANISMS IN PROLIFERATIVE VITREORETINOPATHY

Landmarks in the development of treatment of retinal detachment includ e the recognition of the significance of retinal breaks that resulted in the distinction between rhegmatogenous retinal detachment (RRD) and exudative retinal detachment, the development of indirect ophthalmosc opy and scleral depression that-allow better visualization of the peri pheral area of the retina and better identification of retinal breaks, the recognition of the need to seal all retinal breaks, and the reali zation that vitreous traction is the major underlying cause of retinal tears and RRD. Scleral buckling procedures combine retinopexy to prov ide a scar around retinal breaks to seal them and scleral indentation to neutralize vitreous traction; they provided the first effective tre atment of RRD. As surgeons gained experience with scleral buckling, th ey became aware that some RRDs, particularly those with fixed folds an d/or a funnel configuration, often could not be repaired using this ap proach. It was thought that excessive vitreous traction was at fault, and the condition was called ''massive vitreous retraction.''(1).