Surgical management of the late complications of proliferative diabetic retinopathy

Abstract

The late complications of proliferative diabetic retinopathy (PDR) comprise vitreous haemorrhage, tractional retinal detachment, combined tractional-rhegmatogenous retinal detachment, and severe fibrovascular proliferation (including macular distortion or dragging, tractional macular oedema, and media opacity due to fibrovascular tissue). This article will review the indications, techniques, and outcomes of vitrectomy surgery to treat these conditions. A careful assessment of the surgical anatomy, with particular attention to the configuration of vitreoretinal attachments, is important when determining the precise surgical procedure required. The surgical outcome after diabetic vitrectomy has steadily improved with advances in vitreoretinal surgical instrumentation and technique. Significant post-operative complications may, however, occur including cataract formation, recurrent vitreous cavity haemorrhage (early or delayed), rhegmatogenous retinal detachment, and neovascular glaucoma. Most patients will regain or retain useful vision after diabetic vitrectomy, although the visual outcome does remain unpredictable. The development of adjunctive pharmacotherapy should enable further improvements in visual outcome in the future.

Intra-silicone oil injection of methotrexate at the end of vitrectomy for advanced proliferative diabetic retinopathy

“…The surgical plane was less clearly defined in these cases and the surgical procedures were categorized as major complexity procedures. 2 All patients had retinal breaks before or at the time of surgery (TRD/RRD). The case group consisted of eyes that underwent surgery from January 2013 to January 2014.…”

“…2 Although a growing number of eyes with TMD and TRD/RRD are successfully treated with a single procedure, retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) is still a major cause of failure of the surgery. 2,3 Previous studies have shown increased expression of inflammatory cytokines and growth factors in both PDR and PVR. [4][5][6] Considering the major role of inflammatory mediators, it is rational to consider anti-inflammatory medications as a potential modality for prevention of proliferation of post-vitrectomy membranes.…”

“…2 Recent tractional macular detachment (TMD) or macula threatening tractional retinal detachment (TRD), and combined tractionalrhegmatogenous retinal detachment (TRD/ RRD) are also currently considered as important indications for vitreoretinal surgery. 2 Although a growing number of eyes with TMD and TRD/RRD are successfully treated with a single procedure, retinal re-detachment associated with fibrovascular proliferation or proliferative vitreoretinopathy (PVR) is still a major cause of failure of the surgery. 2,3 Previous studies have shown increased expression of inflammatory cytokines and growth factors in both PDR and PVR.…”

Outcomes of vitrectomy in severe complications of proliferative diabetic retinopathy

“…The incidence of recurrent VH in PDR was reported in 13-54% of cases [4][5][6][7]; in our study this incidence was 11%.…”

“…The combination of high cutting speeds and small gauge instruments allows successful surgery in severe complications of PDR. PPV gives the possibility of removal of the fibrovascular tissue and blood from the vitreous cavity [5,6]. However, there is a risk of surgically induced complications, such as bleeding and VH, iatrogenic retinal breaks, recurrent RD, and glaucoma.…”