Vitrectomy in Diabetic Retinopathy

Abstract

Diabetic vitrectomy is a complicated vitreoretinal surgery due to the complex interaction of various factors. Indications of vitrectomy in diabetes patients would comprise of non-resolving vitreous haemorrhage, taut posterior hyaloid causing vitreo-papillary traction, vitreomacular traction, non-resolving macular edema due to epiretinal membrane, posterior pole tractional retinal detachment or combined retinal detachment. Pre-operative systemic evaluation, a thorough clinical evaluation with ancillary investigations like ultrasound and optical coherence tomography are important for planning the surgery. In this chapter, we would be discussing the basic principles of PVD induction, surgical steps and techniques involved in diabetic vitrectomy. Complications associated can be intraoperative or post-operative. Intra-operative complications would include corneal edema, cataract, bleeding and iatrogenic breaks. Post-operative complications can be divided into early and late, which include vitreous cavity bleeding, raised intraocular pressure, reproliferation, epiretinal membrane, cataract, glaucoma and hypotony.

Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy

“…In patients with severe PDR, PPV is a treatment option to restore vision and prevent additional complications. Indications for PPV are non-clearing vitreous hemorrhage, rubeosis of the iris with vitreous hemorrhage, rhegmatogenous and tractional retinal detachment, macula-involving tractional retinal detachment, and progressive fibrovascular proliferation [ 57 , 58 ]. Recently, PRP and anti-VEGF therapies have been studied as alternatives and adjuncts to PPV.…”