Removal of Fibrovascular Diabetic Membranes
The biggest problem in the surgery of advanced proliferative diabetic retinopathy with tractional retinal detachment concerns the removal of the fibrovascular membranes at the apex of the vitreal cone that exerts traction on the retina. These membranes can at times be very limited; this happens when there has been a precocious posterior vitreous detachment. In this case, after the vitreal cone has been removed and the point of the adhesion between the vitreous cortex and the membrane is cut, the retina returns to a flattened position. Sometimes, however, the epiretinal proliferations are very extensive and very closely attached to the underlying retina. This happens in cases in which there has been no posterior vitreous detachment or when such a posterior vitreous detachment has occured later and to a more limited degree (1,2). In these cases, the epicenter of the proliferation is usually in the optic disc or between the paramacular vascular arcades. In the latter cases, fibrovascular proliferations can extend bridge-like between the two arcades or remain attached to the central part of the retina (1,2,3). In these areas, if the detachment is not too old, the retina is sufficiently resistent. A new adhesion of the retina can be obtained by dividing the epiretinal tissues into small islands corresponding to the original fibrovascular stem (segmentation technique), (1,2,4,5), or by removing the epiretinal tissues completely.
KeywordsRetinal Detachment Proliferative Diabetic Retinopathy Epiretinal Membrane Posterior Vitreous Detachment Scleral Buckle
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