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Surgical management of proliferative diabetic retinopathy

  • Steve T. Charles

Abstract

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.

Keywords

Diabetic Retinopathy Proliferative Diabetic Retinopathy Trabecular Meshwork Vitreous Hemorrhage Subretinal Fluid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Cohen HB, McMeel W, Franks EP. Diabetic traction detachment. Arch Opthalmol 1979; 97: 1268.CrossRefGoogle Scholar
  2. 2.
    Flinn C, Charles S. The natural history of diabetic extramacular traction detachment. Arch Ophthalmol 1981; 99: 66.PubMedCrossRefGoogle Scholar
  3. 3.
    Blankenship GW. Preoperative iris rubeosis and diabetic vitrectomy results. Ophthalmology 1980; 87: 176.PubMedGoogle Scholar
  4. 4.
    Scuderi 1, Blumenkranz M, Blankenship G. Regression of diabetic rubeosis iridis following successful surgical reattachment of the retina by vitrectomy. Retina 1982; 2: 193.PubMedCrossRefGoogle Scholar
  5. 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
  6. 6.
    Blankenship G, Cortez R, Machemer R. The lens and pars plana vitrectomy for diabetic retinopathy complications. Arch Ophthalmol 1979; 97: 1263.PubMedCrossRefGoogle Scholar
  7. 7.
    Blankenship GW. The lens influence on diabetic vitrectomy results; report of a prospective randomized study. Arch Ophthalmol 1980; 98: 2196.PubMedCrossRefGoogle Scholar
  8. 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. 9.
    Glaser BM. Relationship of cataract extraction and rubeosis in diabetes mellitus. Ophthalmology 1983; 90: 819.Google Scholar
  10. 10.
    Schachat AP, Oyakawa RT, Michels RG, Rice TA. Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications. Ophthalmology 1983; 90: 522.PubMedGoogle Scholar
  11. 11.
    Blankenship GW, Machemer R. Pars plana vitrectomy for the management of severe diabetic retinopathy, an analysis of results 5 years after surgery. Ophthalmology 1978; 85(6): 553.PubMedGoogle Scholar
  12. 12.
    Michels RG. Vitrectomy for the complication of diabetic retinopathy. Arch Ophthalmol 1979; 96(2): 237.CrossRefGoogle Scholar
  13. 13.
    Aaberg T. Clinical results in vitrectomy for diabetic traction retinal detachment. Am 1 Ophthalmol 1989; 88(2): 246.Google Scholar
  14. 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. 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
  16. 16.
    Michels RG: Vitrectomy for complications of diabetic retinopathy. Arch Ophthalmol 1978; 96: 237.PubMedCrossRefGoogle Scholar
  17. 17.
    Charles S. Vitreous surgery for diabetic traction detachment. Presented at: Frontiers in Ophthalmology. Phoenix, AZ, February 18, 1982.Google Scholar
  18. 18.
    Rice TA, Michels RG. Long-term anatomic and functional results of initially-successful vitrectomy for diabetic retinopathy. Am J Ophthalmol 1980; 90: 297.PubMedGoogle Scholar
  19. 19.
    Blankenship CW. Stability of pars plana vitrectomy results for diabetic retinopathy complications, a comparison of five-year and six-month postvitrectomy findings. Arch Ophthalmol 1981; 99: 1009.PubMedCrossRefGoogle Scholar
  20. 20.
    Rice TA, Michels RG, Palmer L. Late results of initially-successful vitrectomy in diabetes. Dev Ophthalmol 1981; 2: 286.PubMedGoogle Scholar
  21. 21.
    Blankenship GW, Machemer R. Long-term diabetic vitrectomy results, report of 10 year followup. Ophthalmology 1985; 92: 503.PubMedGoogle Scholar
  22. 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
  23. 23.
    Glaser BM, D’Amore PA, Michels RG, Patz A, Fenselau AH. Demonstration of vasoproliferative activity from mammalian retina. J Cell Biol 1980; 84: 298.PubMedCrossRefGoogle Scholar
  24. 24.
    Glaser BM, D’Amore PA, Michels RG, Brunson SK, Fenselau AH, Rice TA, Patz A. The demonstration of angiogenic activity from ocular tissues: preliminary report. Ophthalmology 1980; 87: 440.PubMedGoogle Scholar
  25. 25.
    Glaser BM, D’Amore PA, Lutty GA, Fenselau AH, Patz A. Chemical mediators of intraocular neovascularization. Trans Ophthalmol Soc UK 1980; 100: 369.PubMedGoogle Scholar
  26. 26.
    Glaser BM, D’Amore PA, Michels RG. The effects of human intraocular fluid on vascular endothelial cell migration: correlation with intraocular neovascularization. Ophthalmology 1981; 88: 986.PubMedGoogle Scholar
  27. 27.
    Vallee B. Biochemistry 1985; 24: 5480.PubMedCrossRefGoogle Scholar
  28. 28.
    Glaser BM, Campochiaro PA, Davis JL, Saito M. Retinal epithelial cells release an inhibitor of neovasculanzation. Arch Ophthalmol 1985; 103: 1870.PubMedCrossRefGoogle Scholar
  29. 29.
    Wolbarsht ML, Landers MB. The rationale of photocoagulation therapy for proliferative diabetic retinopathy — a review and a model. Ophthalmic Surg 1980; 11: 235.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1998

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  • Steve T. Charles

There are no affiliations available

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