Abstract
Purpose :
Proliferative vitreoretinopathy (PVR) is a dreaded complication of otherwise successful retinal detachment repair. Pharmacologic therapies have demonstrated preclinical success, but clinical applications continue to be limited and surgical treatment remains the mainstay of treatment. We performed a retrospective histopathologic analysis of surgically removed PVR membranes to evaluate for unique cellular subpopulations contributing to disease heterogeneity.
Methods :
A retrospective review of surgical samples submitted for histopathologic analysis was conducted from 2020 to 2022. 14 PVR membrane samples from 13 patients were identified, processed, and subjected to routine histopathologic analysis with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) staining. Immunohistochemistry was used to identify cellular subpopulations. Glial cells were identified using glial fibrillary acidic protein (GFAP), histiocytes were identified by CD163 or PU-1, and retinal pigment epithelial (RPE) cells were identified by keratin (MNF116) and/or SOX-10.
Results :
The most frequent indication for surgery was recurrent and/or chronic retinal detachment (n= 13). The intraoperative location of the PVR membrane was described by the surgeon. 5 eyes had subretinal membranes, 5 eyes had pre- or epiretinal membranes, 3 eyes had both subretinal and preretinal membranes, and the eviscerated eye did not describe the location. 8 membranes were composed primarily of glial cells, 2 were composed primarily of histiocytes, 2 were composed primarily of RPE cells, and 1 contained relatively equal proportions of RPE cells, glial cells, and histiocytes. 8 of 14 eyes had undergone previous instillation of silicone oil. Interestingly, 6 of 8 demonstrated a histiocytic inflammatory reaction to silicone oil. One patient had 2 samples from surgeries 4 months apart. The first sample consisted largely of RPE cells, while the second contained mainly glial cells, suggesting that the composition of PVR can evolve as the disease progresses.
Conclusions :
PVR is a cellularly heterogeneous process, with unique immunohistologic subcategories that may evolve over time or with therapy. This may explain why a unifying treatment has not yet been identified. Further understanding and subclassification of PVR may lead to the development of patient-tailored therapies or prophylaxis in the future.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.