Surgery in Diabetic Retinopathy

Diabetic retinopathy (DR) is a progressive microvascular complication of diabetes mellitus and a leading cause of visual impairment worldwide. While early stages are managed through glycemic control, anti-VEGF therapy, and laser photocoagulation, advanced stages often require surgical intervention. Vitreoretinal surgery plays a pivotal role in treating complications such as non-clearing vitreous hemorrhage, tractional retinal detachment (TRD), combined tractional-rhegmatogenous retinal detachment, and macular traction syndromes. Pars plana vitrectomy (PPV) remains the cornerstone technique, allowing removal of vitreous opacities, fibrovascular membranes, and tractional elements while enabling endolaser photocoagulation and intraocular tamponade. Advances in small-gauge vitrectomy systems, wide-angle visualization, and bimanual techniques have significantly improved anatomical and functional outcomes. Adjuvant pharmacological agents, including preoperative anti-VEGF injections, reduce intraoperative bleeding and facilitate membrane dissection. Despite progress, surgery carries risks, including recurrent hemorrhage, neovascular glaucoma, iatrogenic retinal breaks, and persistent macular edema. Careful patient selection, timing of intervention, and individualized surgical planning remain critical to optimizing outcomes. Future perspectives include integration of intraoperative optical coherence tomography (iOCT), robotic-assisted vitreoretinal surgery, and combination therapies targeting both vascular and inflammatory pathways. Surgical management in DR continues to evolve, offering hope for vision preservation in patients with advanced disease stages where medical therapy alone is insufficient.