Pharmacologic Interventions for the Prevention and Treatment of Proliferative Vitreoretinopathy: A Systematic Review and Meta-Analysis
In brief
Pharmacologic adjuvants cut retinal redetachment risk by roughly 50% after detachment surgery
A systematic review of 69 studies (31 in meta-analysis) found no drug improved anatomical success, yet pooled pharmacologic therapy halved the chance of redetachment, mainly due to methotrexate and anti-VEGF signals. Evidence quality was low, so routine use cannot be recommended until larger trials confirm these findings.
- Journal
- Ophthalmology. Retina (Q1)
- Published
- 7 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Salem Abu Al-Burak, Ameen Alizada, Kareem Sadek, Abdelwahab Aleshawi, Rami Al-Dwairi, Hashem Abu Serhan
- PMID
- 42567411
- DOI
- 10.1016/j.oret.2026.08.002
Why clinicians should know about it
- Picked for Ophthalmology (top studies of the week, 9 August 2026): SR/MA of RCTs, pharmacologic adjuvants for PVR
- Picked for Anatomy (top studies of the week, 9 August 2026): Endometriosis operative complexity, gynecologic focus
Abstract
TOPIC: To evaluate the efficacy and safety of pharmacologic interventions (including 5-fluorouracil, low-molecular-weight heparin, methotrexate, corticosteroids, anti-VEGF agents, and retinoids) compared with control treatments for preventing or treating proliferative vitreoretinopathy (PVR) after rhegmatogenous retinal detachment repair. CLINICAL RELEVANCE: PVR is the leading cause of anatomical failure after retinal detachment surgery. Despite advances in vitreoretinal techniques, no pharmacologic adjuvant has been established, and management remains primarily surgical. METHODS: We registered our protocol with PROSPERO (CRD420261435402). We systematically searched four databases from inception to June 2026 for studies evaluating pharmacologic therapies for PVR prevention or treatment. Risk of bias was assessed using validated tools, and random-effects meta-analyses were performed to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs). RESULTS: Sixty-nine studies were included, with 31 contributing to meta-analysis. No significant improvement in anatomical outcomes was observed with 5-fluorouracil plus low-molecular-weight heparin for prevention (RR, 0.94; 95% CI, 0.59-1.51), methotrexate for established PVR (RR, 0.96; 95% CI, 0.86-1.07), corticosteroids (RR, 1.11; 95% CI, 0.93-1.33), or anti-VEGF therapy (RR, 0.72; 95% CI, 0.32-1.64). Overall, pharmacologic therapy was associated with reduced redetachment risk (RR, 0.52; 95% CI, 0.28-0.94), mainly driven by methotrexate and anti-VEGF subgroups. Retinoids showed a potential benefit for reattachment. Certainty of evidence was low to very low. CONCLUSION: Current evidence does not support routine pharmacologic adjuvant therapy for PVR. Methotrexate, anti-VEGF agents, and retinoids show promising signals but require confirmation in adequately powered randomized controlled trials.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.