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Proliferative synovitis — Clinical Guidelines

Overview

Proliferative synovitis, particularly in the context of proliferative vitreoretinopathy (PVR), involves cellular proliferation in the periretinal space leading to traction retinal detachment. It can occur post-trauma or as a complication following retinal detachment surgery 4.

Diagnosis

Presence of cellular proliferations in the periretinal space 4

Clinical signs include retinal traction and potential retinal detachment 4

Imaging (e.g., OCT, fundus photography) to assess retinal morphology and membrane characteristics 3

Histopathological evaluation of epiretinal membranes for cellular composition 4

Management

Surgical interventions: Pars plana vitrectomy with membrane dissection 2 5

Vitreous substitution: Use of silicone oil or long-acting gases for prolonged support 3 5

Limited pharmacological options: Currently, there is insufficient high-quality evidence to support specific pharmacologic prevention 1

Special Populations

Pediatrics: No specific data provided in abstracts 4

Elderly: Comorbidities may complicate surgical outcomes; careful risk assessment recommended 5

Comorbidities: Glaucoma, cataract, and keratopathy are noted complications with silicone oil use 5

Key Recommendations

Primary treatment involves surgical intervention including vitrectomy and membrane dissection to address traction and retinal detachment 2 5 (Evidence: Strong)

Consider vitreous substitution with silicone oil or long-acting gases for severe cases requiring prolonged support 3 5 (Evidence: Moderate)

Pharmacologic prevention lacks strong evidence; current options are not well-supported by high-quality trials 1 (Evidence: Weak)

References

1 Wang WX, Xing M, Apte RS. Interventions for Proliferative Vitreoretinopathy. JAMA ophthalmology 2024. link 2 Ohji M, Tano Y. Membrane delaminating wedge. Archives of ophthalmology (Chicago, Ill. : 1960) 1995. link 3 Azen SP, Boone DC, Barlow W, McCuen BW, Walonker AF, Anderson MM et al.. Methods, statistical features, and baseline results of a standardized, multicentered ophthalmologic surgical trial: the Silicone Study. Controlled clinical trials 1991. link90022-e) 4 Weller M, Heimann K, Wiedemann P. Immunochemical studies of epiretinal membranes using APAAP complexes: evidence for macrophage involvement in traumatic proliferative vitreoretinopathy. International ophthalmology 1988. link 5 Lean JS. Changing attitudes in United States to use of intravitreal silicone. Japanese journal of ophthalmology 1987. link 6 Yamashita H, Hori S, Kitano S, Ishii Y, Masuda K. Glial cells in culture of preretinal membrane of proliferative vitreoretinopathy. Japanese journal of ophthalmology 1985. link

Proliferative synovitis