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Surgical treatment for Diabetic Retinopathy

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Vitrectomy is indicated when progression of a tractional retinal detachment threatens the macula.

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Goal The goal of vitrectomy surgery is to relieve vitreoretinal traction to facilitate retinal reattachment.

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Vitreous Hemorrhage The least difficult surgical presentation is vitreous hemorrhage. a. May be with PVD and no fibrous proliferation, or b. Persistent attachment of the post hyaloids to the retina

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Dense vitreous hemorrhage Vitrectomy performed within the first 6 months increased the chances of better visual acuity. ( DRVS diabetic retinopathy vitrectomy study )

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Premacular Hemorrhage 1) Is subhyaloid hemorrhage overlying the macula. 2) Most of these hemorrhages clear spontaneously. 3) Some of eyes progress to develop premacular fibrosis and traction macular detachment.

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Anterrior to Posterior Traction

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Posterior Attachments Usually in Both Optic Nerve and Along the Vascular Arcades

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Fine neovasclar tufts growing at right angles to the retina and attached to the posterior hyaloid

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Fibrovascular proliferation growing from optic nerve along both vascular arcades (wolf-jaw configuration)

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Table top detachment

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Vitreous contraction producing traction retinal detachment

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Traction-rhegmatogenous detachments, breaks are typically near the vascular arcades and usually are round or oval shape

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Basic Diabetic Vitrectomy

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The central vitreous first is removed and then anterior to posterior traction is relieved.

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Vacuum removal of blood pooled in the posterior segment

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Areas of posterior hyaloid or thin membranes may be elevated gently with a pick or spatula

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Combined diathermy and suction allow removal of blood from an actively bleeding area

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Diathermy also is used to mark the edges of breaks for identification

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