Primary Retinal Detachment

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10 Retinal Detachment Repair: Outlook for the Future
Fig. 10.15. Proliferative vitreoretinopathy
Finally, let us not forget drug treatment and pharmacotherapy
in the area of retinal detachment. One of the main nemeses of
retinal detachment surgeons is proliferative vitreoretinopathy
(PVR) (Fig. 10.15). This is the result of a biological process gone
awry. Cellular elements already in the eye and, in some cases in the
blood, proliferate, lay down collagen, and cause collagen contraction.
This biological process results in membrane formation, recurrent
retinal detachment, and macular pucker. There has been
widespread study of the classical antiproliferatives to reduce the
risk of PVR or to limit it. These drugs, such as 5FU and Daunomycin,
are intrinsically toxic. We will soon be using the techniques
of molecular biology and intelligent drug design to create more
sophisticated anti-proliferative drugs. Such drugs may take the
shape of the hammerhead ribozyme, which cleaves mRNA involved
in proliferation and other processes (Fig. 10.16). These types
of drugs are similar to antisense, but unlike antisense are recycled
intracellularly [9]. Thus, they may be able to be applied into the
eye and remain active in cells for months or longer. There will
be other ways to block this biological process, including acting on
inflammation, proliferative pathways, and cytokine pathways. The