Current indications for pars plana vitrectomy in patients with proliferative diabetic retinopathy (PDR) include vitreous hemorrhage, tractional retinal detachment (TRD), combined tractional and rhegmatogenous retinal detachment (CTRRD), diabetic macular edema associated with posterior hyaloidal traction, and anterior segment neovascularization with media opacities. This chapter will review the indications, surgical objectives, adjunctive pharmacotherapy, microincision surgical techniques, and outcomes of diabetic vitrectomy for PDR, TRD, and CTRRD. With the availability of new microincision vitrectomy technology, wide-angle microscope viewing systems, and pharmacologic agents, vitrectomy can improve visual acuity and achieve long-term anatomic stability in eyes with severe complications from PDR.

BackgroundTo report our experience using 27-gauge pars plana vitrectomy (PPV) system for treating patients with combined tractional and rhegmatogenous retinal detachments (CTRRD) involving the macula associated with proliferative diabetic retinopathy (PDR).MethodsRetrospective noncomparative interventional cases series of 12 patients with CTRRD associated with PDR who underwent 3-port, transconjunctival 27-gauge PPV by a single surgeon. Main outcome measures were change in Snellen best corrected visual acuity (BCVA) and occurrence of intra- and post-operative complications.ResultsTwelve eyes from 12 patients (9 men and 3 women) underwent 27-gauge PPV. Mean follow-up was 17 months (range 8–26 months). Preoperatively, BCVA of 20/400 or better was recorded in only 2 of 12 (16.7%) eyes. Postoperatively, BCVA improved to 20/400 or better in 11 of 12 (91.7%) eyes at 6 months (P = 0.001). At last follow-up, BCVA of 20/400 or better was recorded in 10 of 12 (83.3%), in comparison to 2 (16.7%) eyes at baseline (P = 0.004). The only intraoperative complication was an iatrogenic break in 1 eye (8.3%). Postoperative complications included vitreous hemorrhage in 4 eyes (33.3%) and transient ocular hypertension in 3 eyes (25.0%). At final follow-up anatomic success was confirmed in all eyes.ConclusionThe current study findings suggest that 27-gauge PPV is a safe and promising surgical technology for treating patients with CTRRD involving the macula associated with PDR. Smaller gauge instruments and higher cutting rates may facilitate the dissection and shaving of fibrovascular membranes, while minimizing intra- and post-operative complications.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0091-x) contains supplementary material, which is available to authorized users.

Purpose: To present the first case of acute macular edema with serous retinal detachment after cataract surgery in a vitrectomized eye.Methods: A 63-year-old female patient, with history of pars plana vitrectomy and epiretinal membrane removal, underwent uneventful phacoemulsification surgery with injection of standard intracameral dose of cefuroxime (1 mg/0.1 mL of solution) at the end of the procedure.Results: First day after cataract surgery, visual acuity did not correlate with anterior segment findings, and funduscopic eye examination revealed acute macular edema with serous retinal detachment, which was confirmed by spectral domain optical coherence tomography. Fluorescein angiography showed no retinal or choroidal hyperpermeability. At 2-week follow-up visit, visual acuity had significantly improved, and there was complete resolution of macular edema and subretinal fluid. Conclusion:The current case suggests that acute macular edema with serous retinal detachment after cataract surgery with standard cefuroxime prophylaxis can occur even in vitrectomized eyes. A high level of suspicious is needed when visual acuity does not correlate with anterior segment findings immediately after cataract surgery. Similar to reports from nonvitrectomized eyes, visual prognosis was favorable.

The authors report a case of endophthalmitis after repeated injections of dexamethasone intravitreal implant (Ozurdex) for recurrent macular edema resulting from a branch vein occlusion.

Purpose: This article reports a case of presumed choroidal metastasis from an oncocytic carcinoma of the parotid gland. Methods: A 70-year-old man with history of an oncocytic carcinoma of the parotid gland presented owing to a 1-month history of progressive blurred central vision shortly after metastatic surveillance workup revealed liver, lung, and spine metastases. Fundus examination of the right eye showed a yellow choroidal mass surrounding the optic nerve and extending inferonasally, which is associated with subretinal fluid involving the foveal center. A-scan and B-scan ultrasonography were remarkable for a dome-shaped choroidal mass with medium-to-high internal reflectivity. Fluorescein angiography revealed pinpoint foci of hyperfluorescence over the choroidal lesion with late leakage. Magnetic resonance imaging of the brain showed evidence of metastatic disease to the cerebellum. While the patient underwent systemic chemotherapy, external beam radiotherapy was used to treat the eye. Results: Four months later, visual acuity improved, the tumor reduced in size, and the subretinal fluid resolved. Systemic workup disclosed no new metastases. Conclusion: Oncocytic carcinoma of the parotid gland is a rare and aggressive malignant neoplasm with frequent recurrences and distant metastases. The current case suggests that oncocytic carcinoma can metastasize to the choroid and, consequently, ocular metastasis surveillance is advised in these patients.