Early pars plana vitrectomy for proliferative diabetic retinopathy: update and review of current literature

Abstract

Purpose of reviewDiabetic retinopathy (DR) is one of the leading causes of preventable vision loss in the world and its prevalence continues to increase worldwide. One of the ultimate and visually impairing complications of DR is proliferative diabetic retinopathy (PDR) and subsequent tractional retinal detachment. Treatment modalities, surgical techniques, and a better understanding of the pathophysiology of DR and PDR continue to change the way we approach the disease. The goal of this review is to provide an update on recent treatment modalities and outcomes of proliferative diabetic retinopathy and its complications including tractional retinal detachment. Recent findingsPanretinal photocoagulation (PRP), anti-vascular endothelial growth factor (anti-VEGF), and pars plana vitrectomy are the mainstay of PDR treatment. However, PRP and anti-VEGF are associated with significant treatment burden and multiple subsequent treatments. Early vitrectomy is associated with vision preservation, less treatment burden, and less subsequent treatments than therapy with PRP and anti-VEGF. SummaryConcerning costs, high rates of noncompliance in the diabetic population and significant rates of subsequent treatments with initial PRP and anti-VEGF, early vitrectomy for diabetic retinopathy in patients at risk of PDR is a cost-effective long-term stabilizing treatment for diabetics with advanced disease.

A Delphi method based consensus statement for surgical management of proliferative diabetic retinopathy in India

“…As per the literature, the timing of surgery is debatable, with no meaningful evidence favoring early over delayed surgery in recent times. [ 4 5 7 ] The DRVS showed the benefit of early surgery in eyes with nonclearing VH but defined early surgery as before 3 months. [ 10 ] However, this study was done more than two decades ago.…”

“…The AAO-preferred practice pattern also recommends early surgery but does not specify a cut-off time period for this. [ 4 ] More recent studies show a trend toward better outcomes with early surgery (≤4 weeks),[ 5 7 ] though most have small sample sizes and significant methodological challenges to make robust recommendations. Based on our results, it is reasonable to consider 4 weeks as the pivotal time point when a decision to undertake vitrectomy should be made, with slightly earlier intervention when there are tractional elements at play as evidenced by ultrasound and slightly delayed surgery in pretreated eyes.…”

“…Surgical strategies have also evolved over time with relatively early surgery recommended for fresh VH currently. [ 4 5 6 7 ] Despite evolving literature, controversies and knowledge gaps still exist in many scenarios involving surgical management of DR. Additionally, there are significant variations used by different surgeons to achieve the best outcomes for their patients. [ 3 ] To address these lacunae, we present consensus criteria generated from leading vitreoretinal (VR) surgeons of India addressing the management of DR, with an emphasis on surgical decision-making.…”

The interplay of autophagy and oxidative stress in the pathogenesis and therapy of retinal degenerative diseases

“…Once advanced proliferative DR (PDR) develops, an ophthalmologist may recommend an alternative surgery called vitrectomy [ 211 ], a procedure to remove vitreous gel containing blood from leaking vessels and scar tissue in the back of your eye. However, the procedure is associated with some risks, including ocular infection, cataract formation and retinal detachment.…”

Wnt inhibitory 1 ameliorates neovascularization and attenuates photoreceptor injury in an oxygen‐induced retinopathy mouse model

“…1,2 Currently, surgical vitrectomy, laser photocoagulation, and intraocular injections with angiostatic compounds like anti-vascular endothelial growth factor (VEGF) are the only available treatments for RNV. 3,4 Although numerous studies confirm that anti-VEGF treatment is effective and widely used in management of retinal pathological neovascularization, there are multiple drawbacks to anti-VEGF treatment that requires further scrutiny and refinement. These drawbacks include expensive repeated intravitreal administration, enhanced surgical complications, and possible visual acuity loss after chronic treatment.…”