Surgical management of proliferative diabetic retinopathy
Laser photocoagulation is highly effective in halting progression and often induces regression of proliferative diabetic retinopathy. Appropriately timed vitrectomy, when indicated, adds a further surgical intervention in the struggle to preserve sight in diabetes. Charles emphasizes the distinction between a need for immediate surgery in traction retinal detachment involving the macula, neovascular glaucoma, and anterior vitreous cortex fibro-vascular proliferation and a temporizing strategy of unilateral vitreous hemorrhage when the contralateral eye retains functional vision. Recognizing that patients with multi-system diseases may require vitrectomy for ‘emotional and social reasons’, individualized evaluation for surgery is appropriate. Deciding when to do which surgical procedure for the diabetic eye demands a mixture of experience and patience. For the non-retinal specialist, two key points may be emphasized: (i) A unilateral vitreous hemorrhage in the absence of other enumerated risk factors is not in itself reason for vitrectomy and may be followed by repetitive ultrasound scans, (ii) After a vitreous hemorrhage, delay in referral to a surgeon skilled in vitreous surgery may miss the opportunity to restore sight.
KeywordsDiabetic Retinopathy Proliferative Diabetic Retinopathy Trabecular Meshwork Vitreous Hemorrhage Subretinal Fluid
Unable to display preview. Download preview PDF.
- 5.Little HL. Rubeosis indis after vitrectomy for complications of diabetic retinopathy. In: Little HL, Jack RL, Patz A, Forsham P (eds.), Diabetic Retinopathy, Thieme-Stratton, Inc., New York; 1983: 315–340.Google Scholar
- 8.Rice TA, Michels RG, Maguire MG, Rice EF. The effects of lensectomy on the incidence of ins neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy. Am 1 Ophthalmol 1983; 95: 1.Google Scholar
- 9.Glaser BM. Relationship of cataract extraction and rubeosis in diabetes mellitus. Ophthalmology 1983; 90: 819.Google Scholar
- 13.Aaberg T. Clinical results in vitrectomy for diabetic traction retinal detachment. Am 1 Ophthalmol 1989; 88(2): 246.Google Scholar
- 14.Rice TA, Michels RG. Complications of vitrectomy. In: Little HL, Jack RL, Patz A, Forsham P (eds.), Diabetic Retinopathy, Thieme-Stratton, Inc., New York; 1983: 315–340.Google Scholar
- 15.Michels RG. Vitreous surgery in proliferative diabetic retinopathy. In: Shimizu K, Oosterhuis IA (eds.), Acta XXIII Concilium Ophthalmologicurm, Part 1, Excerpta Medica, Amsterdam/Oxford; 1979: 420.Google Scholar
- 17.Charles S. Vitreous surgery for diabetic traction detachment. Presented at: Frontiers in Ophthalmology. Phoenix, AZ, February 18, 1982.Google Scholar
- 22.Blankenship GW. Pars plana vitrectomy for diabetic retinopathy, a report of 8 years’ experience. Modern Problems in Ophthalmology, pp. 376–386. S. Karger AG, Medical and Scientific Publishers, Basel, Switzerland, 1979.Google Scholar