Surgical management of diabetic retinopathy

Abstract

Surgery for late complications of proliferative diabetic retinopathy remains the cornerstone of management even in patients who have received optimal laser photocoagulation and medical therapy. With improvisation in the surgical techniques and development of micro-incision surgical techniques for vitrectomy, the indications for surgical intervention are expanding to include diabetic macular edema with a greater number of patients undergoing early intervention. This review describes the current indications, surgical techniques, adjunctive anti-vascular endothelial growth factor therapy, surgical outcomes, and postoperative complications of pars plana vitrectomy for proliferative diabetic retinopathy and macular edema.

Keywords: Diabetic Macular Edema; Diabetic Retinopathy; Pars Plana Vitrectomy; Proliferative Diabetic Retinopathy.

Figure 1

Color fundus photograph of the right eye showing fibrovascular proliferation extending from nasal half of the optic disc to the fovea causing macular pucker. The patient underwent 23-gauge transconjuctival pars plana vitrectomy

Figure 2

Same eye as in Figure 1, 3 months later showing release of traction over the fovea with normal foveal contour

Figure 3

Color photograph of the left eye showing tractional retinal detachment. The patient underwent 23-gauge transconjunctival pars plana vitrectomy

Figure 4

Same eye as in Figure 3, 2 months postoperatively, showing a flat retina. The best corrected visual acuity improved from 20/200 to 20/40 postoperatively