Network meta-analysis compares adjunctive therapies for proliferative vitreoretinopathy

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 (hazard ratio [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 with placebo. Oral prednisolone had a lower rate of PVR recurrence compared with 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 with placebo.