Injection Subconjunctival or Intravitreal

Blumenkranz et al. (47) studied the effects of direct 5-FU injection in eyes of 22 consecutive patients undergoing retinal detachment repair for advanced PVR. Eighteen patients had vitrectomy combined with scleral buckle and either air or SF6 gas injection. Three had scleral buckle repair only and one that had previously undergone vitrectomy had fluid-gas exchange alone. 

No serious systemic or ocular complications were observed, and retinal reattachment was achieved in 60% of patients postoperatively. The number of patients studied was small. However, the authors believed this therapy resulted in an improved success rate compared with other studies of the reattachment rate following surgery for advanced PVR without use of silicone oil and that the reattachment rate was comparable with the reattachment rate achieved in studies using silicone oil tamponade (47). 

Dexamethasone alcohol and triamcinolone acetonide have been studied in PVR animal models (30-33). These agents are particularly suited for local delivery as they are both relatively lipophilic, and therefore, may be administered as a suspension. The crystalline drug then acts as a depot, providing relatively long-term intraocular levels of steroid that can be given at high doses without apparent retinal toxicity (33). While direct delivery of corticosteroids has been demonstrated to be both safe and effective in the treatment of PVR, few studies have been performed in humans (31,32). 

Drugs have been placed in the intraocular infusate during vitrectomy surgery to repair rhegmatogenous retinal detachment with PVR. This method can produce local delivery of a relatively high drug dose, avoid systemic complications, and minimize additional surgical risk. 

Daunorubicin hydrochloride (daunomycin hydrochloride) is an anthracycline antibiotic that inhibits cellular proliferation by a variety of mechanisms, including DNA binding, free radical formation, membrane binding, and metal-ion chelation (49). A number of studies examining efficacy and toxicity in an animal model of PVR have been performed (50-56). Prior to 1998, experience with daunorubicin in human trials was more limited (57-59). 

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