Surgical treatment of diabetic retinopathy

Abstract

Several complications of advanced diabetic retinopathy can be treated surgically. Vitrectomy can clear media opacities, relieve traction on the retina, and makes adequate laser treatment of the retina possible. Removal of premacular vitreous may also improve diabetic macular edema. Instrumentation, understanding of the pathophysiology, surgical skills as well as supplementary pharmacotherapy have improved surgical results. Indications and timing for surgery have considerably changed in the past decades and the threshold for surgery has been continuously lowered, as vitrectomy became safer. The primary disease of the retinal microvasculature with capillary occlusion and retinal ischemia is still the limiting factor, responsible for disappointing functional results in anatomically successfully operated eyes.

Macular morphologic findings on optical coherence tomography after microincision vitrectomy for proliferative diabetic retinopathy

“…Vitrectomy also has been performed to treat neovascular complications due to PDR including vitreous hemorrhage, tractional retinal detachment, and traction maculopathy, either alone or combined with anti-VEGF therapy [8][9][10][11][12][13]. Vitrectomy dramatically improves the visual prognosis in patients with PDR, although surgeons have been concerned about the intraoperative and postoperative complications associated with 20-gauge vitrectomy [14][15][16].…”

Black patients sustain vision loss while White and South Asian patients gain vision following delamination or segmentation surgery for tractional complications associated with proliferative diabetic retinopathy

“…6,14 The main aims of surgery are to clear the media opacities (usually blood) and divide or remove as many as possible of the adhesions causing retinal traction. Although several studies have evaluated the outcomes, complications and benefits of surgery for the complications of PDR, 6,[14][15][16] differences in outcome relative to ethnic origin have not been investigated. 17 This study sets out to explore the impact of the ethnicity of patients-White versus Black versus South Asian, on the treatment outcomes of the subgroup of patients who undergo vitrectomy with delamination and/or segmentation surgery for the traction complications of severe PDR.…”

Chirurgische Therapie des diabetischen Makulaödems

“…Neben den mechanischen Faktoren führt die Interaktion von AGEs mit ihren Rezeptoren (RAGE) an den Müllerzell-Fußplatten der Membrana limitans interna (ILM) zu einer proinflammatorischen Kaskade, die ihre Wirkung auch am äußeren Ende der Müllerzellen, im Bereich der Membrana limitans externa, entfalten kann [12]. [16]. Im Rahmen der Vitrektomie wird der anliegende präretinale Glaskörper entfernt und dadurch die hochvisköse Diffusionsbarriere zwischen innerer Retina und Glaskörperraum.…”