Combined Tractional and Rhegmatogenous Retinal Detachment in Proliferative Diabetic Retinopathy

Combined tractional and rhegmatogenous retinal detachment (combined RD, CTRRD) is a serious complication of proliferative diabetic retinopathy (PDR). The detached retina has a rhegmatogenous detachment-like convex configuration, usually extending to the ora serrata, and is associated with fibrovascular tissue of varying severity (Thompson et al., Arch Ophthalmol 105:503–572, 1987; Rice et al., Am J Ophthalmol 95:34–44, 1983). Retinal breaks are likely to appear when tractional force acts on the thin retina in PDR patients and are usually situated adjacent to the proliferative tissue or at previous laser scars. Thick proliferative membranes, retinal folds, or vitreous opacity may obstruct the detection of retinal breaks. Although it occurs less frequently than pure tractional retinal detachment (TRD), this complication warrants prompt vitreous surgery. There are few studies on the clinical manifestations and surgical results of this complication as a distinct entity (Yang et al., Can J Ophthalmol 43:192–198, 2008; Hsu et al., J Ophthalmol 2014:917375, 2014; Cruz-Inigo and Berrocal, Int J Retina Vitreous 3:38, 2017). As the use of anti-vascular endothelial growth factor (VEGF) agents became more common, either alone or in combination with other agents, in treating PDR complications, clinical features and surgical success rates were likely altered because anti-VEGF agents may induce fibrous contractions, possibly causing more TRD or combined RD. The clinical presentations, risk factors, treatment methods, and outcomes are discussed in this chapter.