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Review
. 2016 Jan-Mar;11(1):93-9.
doi: 10.4103/2008-322X.180697.

Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks

Patrick Oellers  1 , Tamer H Mahmoud  1
Affiliations
Review

Surgery for Proliferative Diabetic Retinopathy: New Tips and Tricks

Patrick Oellers et al. J Ophthalmic Vis Res. 2016 Jan-Mar.

Abstract

Over the recent years, retina specialists have enjoyed significant improvements in the surgical management of proliferative diabetic retinopathy including improved preoperative planning, vitreoretinal instrumentation and new surgical maneuvers. In this review, we present new tips and tricks such as preoperative pharmacotherapy approaches including pegaptanib injection and biodegradable dexamethasone implantation, bimanual vitrectomy techniques and the concept of mixing small gauges as well as valved cannulas and intraoperative optical coherence tomography. With advanced surgical planning and sophisticated operative maneuvers tailored to the individual patient, excellent outcomes can be achieved even in severe cases of diabetic tractional detachment.

Keywords: 27 Gauge; Bimanual Surgery; Chandelier; Dexamethasone; Macugen; Microscope Integrated Optical Coherence Tomography; Ozurdex; Pegaptanib; Proliferative Diabetic Retinopathy; Tractional Retinal Detachment; Valved Cannula; Vitrectomy.

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Figures

Figure 1
Figure 1
Use of preoperative pegaptanib (Macugen). (a) Spectral--domain (SD) optical coherence tomography (OCT) demonstrates tractional retinal detachment threatening the macula. (b) Corresponding SD-OCT image 2 months after pegaptanib injection reveals stable retinal detachment without further traction at the macula.
Figure 2
Figure 2
Use of preoperative biodegradable dexamethasone implant (Ozurdex). (a) Wide-field photograph demonstrates proliferative diabetic retinopathy and tractional retinal detachment with severe fibrovascular proliferation. (b) Two weeks after Ozurdex (arrow) injection, proliferative diabetic retinopathy appears more quiescent. (c-f) Corresponding early and late frame fluorescein angiograms before and after Ozurdex show consolidation of neovasclarization.
Figure 3
Figure 3
Intraoperative photo demonstrating Ozurdex implant in the vitreous cavity. Note that the implant (arrow) may become mobile during surgery. It is best to keep it in place after surgery at the inferior vitreous base and under silicone oil.
Figure 4
Figure 4
Flowchart algorithm describing our approach to patients with proliferative diabetic retinopathy with tractional retinal detachment. FVP, fibrovascular proliferation; TRD-RRD, combined tractional and rhegmatogenous retinal detachment; A-P, anterior-posterior, PRP, panretinal photocoagulation; G, gauge; C3 F8, perfluoroproprane gas; SF6, sulfur hexafluoride gas.
See this image and copyright information in PMC

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