Skip to main content

Advertisement

Log in

Surgery for Diabetic Eye Complications

  • Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

New modalities for the treatment of diabetic eye complications have emerged in the past decade. Nevertheless, many severe diabetic retinopathy complications can only be treated with vitreoretinal surgery. Technological advances in pars plana vitrectomy have expanded the gamut of pathologies that can be successfully treated with surgery. The most common pathologies managed surgically include vitreous opacities and traction retinal detachment. The indications, surgical objectives, adjunctive pharmacotherapy, microincisional surgical techniques, and outcomes of diabetic vitrectomy for proliferative diabetic retinopathy and diabetic tractional retinal detachment will be discussed. With the availability of new microincisional 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 proliferative diabetic retinopathy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial—Diabetic Retinopathy Vitrectomy Study Report 4. Ophthalmology. 1988;95:1321–34.

    Article  Google Scholar 

  2. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. Arch Ophthalmol. 1985;103:1644–52.

    Article  Google Scholar 

  3. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol. 1990;108:958–64.

    Article  Google Scholar 

  4. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial- -Diabetic Retinopathy Vitrectomy Study Report 3. Ophthalmology. 1988;95:1307–20.

    Article  Google Scholar 

  5. Fujii GY, De Juan Jr E, Humayun MS, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12.

    Article  PubMed  Google Scholar 

  6. Fujii GY, De Juan Jr E, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109:1814–20.

    Article  PubMed  Google Scholar 

  7. Eckardt C. Transconjunctival sutureless 23-gauge vitrectomy. Retina. 2005;25:208–11.

    Article  PubMed  Google Scholar 

  8. Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016;161:36–43. This study presents results of vitrectomy done with 27g instrumentation for a variety of different pathologies.

    Article  PubMed  Google Scholar 

  9. da R Lucena D, Ribeiro JA, Costa RA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study). Br J Ophthalmol. 2009;93:688–91.

    Article  PubMed  Google Scholar 

  10. Rizzo S, Genovesi-Ebert F, Di Bartolo E, et al. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol. 2008;246:837–42.

    Article  CAS  PubMed  Google Scholar 

  11. Yeoh J, Williams C, Allen P, et al. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Clin Exp Ophthalmol. 2008;36:449–54.

    PubMed  Google Scholar 

  12. Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye. 2009;23:108–11.

    Article  CAS  PubMed  Google Scholar 

  13. Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology. 2009;116:927–38.

    Article  PubMed  Google Scholar 

  14. Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina. 2016;36:137–47.

    Article  PubMed  Google Scholar 

  15. Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A. Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol. 2003;135:169–77.

    Article  PubMed  Google Scholar 

  16. Nagiel A, Lalane RA, Sadda SR, Schwartz SD. Ultra-widefield fundus imaging: a review of clinical applications and future trends. Retina. 2016;36:660–78. Ultra-wide field imaging provides a panoramic view of the very peripheral retina. Angiography performed with this technology images areas of the retina not evaluated in the past.

    Article  PubMed  Google Scholar 

  17. Falkner-Radler CI, Glittenberg C, Gabriel M, Binder S. Intrasurgical microscope-integrated spectral domain optical coherence tomography-assisted membrane peeling. Retina. 2015;35:2100–6.

    Article  PubMed  Google Scholar 

  18. Robaszkiewicz J, Chmielewska K, Figurska M, Wierzbowska J, Stankiewicz A. Triple therapy: phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of bevacizumab for diffuse diabetic macular edema. Med Sci Monit. 2012;18:CR241–51.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Berk Ergun S, Toklu Y, Cakmak HB, Raza S, Simsek S. The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage. Semin Ophthalmol. 2015;30:177–80.

    Article  PubMed  Google Scholar 

  20. Michels RG, Rice TA, Rice EF. Vitrectomy for diabetic vitreous hemorrhage. Am J Ophthalmol. 1983;95:12–21.

    Article  CAS  PubMed  Google Scholar 

  21. Chaudhry NA, Lim ES, Saito Y, et al. Early vitrectomy and endolaser photocoagulation in patients with type I diabetes with severe vitreous hemorrhage. Ophthalmology. 1995;102:1164–9.

    Article  CAS  PubMed  Google Scholar 

  22. Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic traction retinal detachment involving the macula. Am J Ophthalmol. 1983;95:22–33.

    Article  CAS  PubMed  Google Scholar 

  23. Arevalo JF, Maia M, Flynn Jr HW, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92:213–6.

    Article  CAS  PubMed  Google Scholar 

  24. Arevalo JF, Sanchez JG, Saldarriaga L, et al. Retinal detachment after bevacizumab. Ophthalmology. 2011;118:2304 e3–e7.

  25. Berrocal MH. A minimalist approach to surgery for diabetic retinal detachment new tools allow evolution of surgical techniques. Retina Today. 2014;April:65–68.

  26. Hutton WL, Bernstein I, Fuller D. Diabetic traction retinal detachment. Factors influencing final visual acuity. Ophthalmology. 1980;87:1071–7.

    Article  CAS  PubMed  Google Scholar 

  27. Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic tractionrhegmatogenous retinal detachment. Arch Ophthalmol. 1987;105:503–7.

    Article  CAS  PubMed  Google Scholar 

  28. Yang CM, Su PY, Yeh PT, Chen MS. Combined rhegmatogenous and traction retinal detachment in proliferative diabetic retinopathy: clinical manifestations and surgical outcome. Can J Ophthalmol. 2008;43:192–8.

    Article  PubMed  Google Scholar 

  29. Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic rhegmatogenous retinal detachment. Am J Ophthalmol. 1983;95:34–44.

    Article  CAS  PubMed  Google Scholar 

  30. Kaiser PK, Riemann CD, Sears JE, Lewis H. Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001;131:44–9.

    Article  CAS  PubMed  Google Scholar 

  31. Hisatomi T, Enaida H, Matsumoto H, et al. Staining ability and biocompatibility of brilliant blue G: preclinical study of brilliant blue G as an adjunct for capsular staining. Arch Ophthalmol. 2006;124:514–9.

    Article  PubMed  Google Scholar 

  32. Diabetic Retinopathy Clinical Research Network Writing C, Haller JA, Qin H. et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology, 2010;117:1087–1093 e1083.

  33. Olmos LC, Sayed MS, Moraczewski AL, Gedde SJ, Rosenfeld PJ, Shi W, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab. Eye (Lond). 2016;30:463–72.

    Article  CAS  Google Scholar 

  34. Davis MD. Vitreous contraction in PDR. Arch Ophthalmol. 1965;74:741–51.

    Article  CAS  PubMed  Google Scholar 

  35. Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004;24:574–81.

    Article  PubMed  Google Scholar 

  36. Rice TA, Michels RG, Maguire MG, Rice EF. The effect of lensectomy on the incidence of iris neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy. Am J Ophthalmol. 1983;95:1–11.

    Article  CAS  PubMed  Google Scholar 

  37. Jaffe GJ, Lewis H, Han DP, Williams GA, Abrams GW. Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator. Am J Ophthalmol. 1989;108:170–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to María H. Berrocal.

Ethics declarations

Conflict of Interest

María H. Berrocal is a consultant for Alcon and Allergan.

Luis A. Acaba and Alexandra Acaba declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Microvascular Complications—Retinopathy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berrocal, M.H., Acaba, L.A. & Acaba, A. Surgery for Diabetic Eye Complications. Curr Diab Rep 16, 99 (2016). https://doi.org/10.1007/s11892-016-0787-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11892-016-0787-6

Keywords

Navigation