1. Summary of programme area and objectives

1.1 Vitreoretinal surgery continues to evolve rapidly on a global scale. In recent years there has been a further refinement and development of surgical technology as well as increasing interest in the use of adjunctive agents for vitreoretinal disease. There has also been increased interest in the application of vitreoretinal surgical techniques to a wider range of diseases with the potential for new and improved treatments.

1.2 Within the United Kingdom several multi-centre studies have now been completed and the objective of this programme is for further collaboration between UK vitreoretinal surgical centres. The BEAVRS (Britain and Eire Association of Vitreoretinal Surgeons) group offers a basis for future collaborative work. A number of UK based vitreoretinal surgeons are now involved in international collaborations and UK vitreoretinal surgery is well placed to play a central role in future international studies. A number of centres continue to work collaboratively with laboratory scientists and an increasing number of trained vitreoretinal surgeons with laboratory experience will support the development and implementation of this programme.

  2. Programme plan

2.1 Retinal detachment

2.1.1 Vitreoretinal surgical units throughout the United Kingdom now audit the results of primary retinal detachment. The results of these audits together with further work on the investigation of service delivery should result in guidelines on best practice in the treatment of primary retinal detachment. Level of service recommendations will be made and guidelines in accordance with clinical governance proposed.

2.1.2 The potential for further investigation on the causes and epidemiology of retinal detachment as collaborative research within the United Kingdom should be exploited. The BEAVRS group potentially forms a basis for this.

2.1.3 A pan-European multi-centre study on the indications for scleral buckling versus primary vitrectomy for rhegmatogenous retinal detachment (the SPR trial) is currently running, and one site within the UK (Liverpool) is taking part in this. Further investigation of the indications for vitrectomy in primary detachment within the UK will be undertaken.

2.1.4 Clinically driven investigation into the basic science of retinal detachment will also be undertaken. The pathology of posterior vitreous detachment and the intra and peri-retinal pathological changes that determine the outcome of retinal detachment surgery are as yet uncertain. A better knowledge of these will help future vitreoretinal surgeons to improve the outcome of surgery in a variety of areas of vitreoretinal disease.

2.2 Proliferative vitreoretinopathy

2.2.1 Proliferative vitreoretinopathy (PVR) remains the most common cause of failure in retinal detachment surgery. Additionally the visual outcome for eyes with PVR is poor. A series of prospective randomised controlled trials focusing on the use of adjunctive agents (5 fluorouracil and low molecular weight heparin) is being undertaken and will inform future developments in the use of adjuncts to treat and prevent PVR.

2.2.2 Further research will focus on trials of neuro-protective and growth factor strategies to improve the visual outcome in PVR and this depends on the continued development of adequate animal models for this condition.

2.3 Trauma

2.3.1 The visual outcome in many cases of trauma requiring vitreoretinal surgery remains unsatisfactory. A central problem is the development of severe proliferative vitreoretinopathy. A major pan-European multi-centre trial has been proposed and awaits funding. This will provide important information on the use of adjuncts in the management of trauma and will additionally give high quality data on the outcomes of vitreoretinal surgery in eyes having sustained trauma.

2.4 Macular holes

2.4.1 A major prospective randomised clinical trial on the use of adjunctive serum to treat macular holes showed no significant advantage of adjunctive agents. Various questions remain unanswered in macular hole surgery, for example, the use of inner limiting membrane peeling, combined cataract surgery and vitrectomy for macular holes and the best posturing regime for tamponade agents used. Since surgery for macular hole is now undertaken by many centres throughout the United Kingdom a multi-centre approach to the investigation of these areas will be undertaken.

  3. Future development work in the programme during 2002/3

3.1 Epidemiological and Service Issues

· The use of adjunctive medications in vitreoretinal surgery especially posterior segment trauma and PVR and slow-release vehicles for adjuncts.

· Analysis of the surgical management of age-related macular degeneration.

3.2 Clinical and Laboratory Issues

· Further investigation of the causes and management of retinal detachment and proliferative vitreoretinopathy (PVR), including a fundamental study into combined gliosis and fibrosis.