Vitrectomy for Proliferative Diabetic Retinopathy

This chapter provides an in-depth overview of surgical considerations, techniques, postoperative complications, and outcomes of advanced diabetic retinopathy surgery with emphasis on surgery for vitreous hemorrhage and tractional retinal detachment (TRD). Diabetic vitreoretinal surgery poses unique challenges for the vitreoretinal surgeon due to the strong adhesions between vitreous/epiretinal membranes and the fragile diabetic retina. Vitreoschisis, splitting of the posterior hyaloid layer, a consequence of anomalous posterior vitreous detachment is present in a significant number of eyes with diabetic TRD. Identification of the vitreoschisis leaflets is important to access the correct cleavage plane between the fibrovascular membranes/posterior hyaloid and the retina. Surgery involves dissection of diabetic membranes and traction, endolaser treatment, and the use of vitreous tamponade as required. The authors also discuss the pros and cons of preoperative anti-vascular endothelial growth factor medications use, conservative vs. extensive diabetic membranes dissection, internal limiting membrane peel, and the use of gas vs. silicone oil tamponade. They also examine the important postoperative complications such as vitreous cavity hemorrhage and vitrectomy fibrin syndrome.