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Surgical treatment for Diabetic Retinopathy

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

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

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

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

Premacular HemorrhageIs subhyaloid hemorrhage overlying the macula.Most of these hemorrhages clear spontaneously. Some of eyes progress to develop premacular fibrosis and traction macular detachment.

Anterrior to Posterior Traction

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

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

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

Table top detachment

Vitreous contraction producing traction retinal detachment

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

Basic Diabetic Vitrectomy

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

Vacuum removal of blood pooled in the posterior segment

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

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

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

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