PREOPERATIVE PROLIFERATIVE VITREORETINOPATHY IN OPEN-GLOBE INJURIES: Chronological Observations Based on the Inner Wound Tract Aspect.

Abstract

To characterize chronological clinicopathological changes in the inner wound tract of Zone III open-globe injuries (OGIs) and clarify the early evolution of proliferative vitreoretinopathy (PVR). Patients with Zone III OGIs who underwent initial pars plana vitrectomy (PPV) were enrolled from the multicenter prospective Eye Injury Vitrectomy Study. Tissue from the inner wound tract was collected during surgery for hematoxylin and eosin and periodic acid-Schiff staining. PVR progression was further confirmed retrospectively from intraoperative videos. Thirty-seven eyes were analyzed. Histopathology demonstrated a sequential course: initial inflammation and exudation, followed by fibroblast migration and fibrous membrane formation. Hemorrhagic clots progressively organized, replaced by fibrous tissue, and eventually evolved into scar tissue with declining cellularity. Retinal structures remained largely preserved within 14 days. Beyond this stage, thinning of the nuclear layer and vacuolar degeneration of the nerve fiber layer were evident. Thereafter, nuclear loss, disorganization, and loosening were observed in the retina, with compressed nuclei in regions adjacent to epimembranes. Clinically, proliferative activity appeared by 7 to 14 days and intensified after two weeks, coinciding with irreversible retinal remodeling. PVR develops rapidly after OGIs, with proliferative activity detectable within the first week and significant retinal disorganization after two weeks. Early PPV may preserve retinal integrity and limit progression, but acute-phase surgery faced technical risks, underscoring the need for individualized timing of intervention.