Therapeutics for Management of Proliferative Vitreoretinopathy Related to Rhegmatogenous Retinal Detachment: A Network Meta-Analysis

Purpose: To compare the efficacy and safety of adjunctive therapies for proliferative vitreoretinopathy (PVR) related to rhegmatogenous retinal detachment (RRD). Methods: A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Library for randomized controlled trials (RCTs) from January 2000 to December 2025. A Bayesian random-effects network meta-analysis was used to compare different therapies. Results: A total of 2,519 patients from 18 RCTs were included (1,339 receiving adjunctive treatments and 1,180 receiving placebo). Oral retinoic acid was associated with significantly higher primary (HR=2.86, 95%CI=1.16, 7.53) and final (HR=2.90, 95%CI=1.12, 7.50) retinal reattachment rates, improved visual acuity (MD=-0.89, 95%CI=-1.68, -0.08), and a lower incidence of postoperative macular pucker (HR=0.12, 95%CI=0.02, 0.50) compared to placebo. Oral prednisolone had a lower rate of PVR recurrence compared to placebo (HR=0.37, 95%CI=0.17, 0.79), while oral retinoic acid (HR=0.06, 95%CI=0.00, 0.50) and intravitreal dexamethasone (HR=0.23, 95%CI=0.05, 0.81) were associated with reduced rates of RRD reoperation. Conclusion: Oral retinoic acid ranked highest for primary outcomes in PVR associated with RRD; however, this finding was driven by a single RCT with limited sample size. Oral prednisolone reduced PVR recurrence, while intravitreal dexamethasone lowered reoperation risk, compared to placebo.