What are the indications for vitrectomy in the treatment of proliferative diabetic retinopathy?

Updated: Sep 02, 2021
  • Author: Abdhish R Bhavsar, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Vitrectomy may be necessary in cases of long-standing vitreous hemorrhage (where visualization of the status of the posterior pole is too difficult), tractional retinal detachment, and combined tractional and rhegmatogenous retinal detachment. More uncommon indications include epiretinal membrane formation and macular dragging.

According to The Diabetic Retinopathy Vitrectomy Study, vitrectomy is advisable for eyes with vitreous hemorrhage that fails to resolve spontaneously within 6 months. [47] Early vitrectomy (< 6 mo, mean of 4 mo) may result in a slightly greater recovery of vision in patients with type I diabetes.

When treatment is delayed, monitoring the status of the posterior segment by ultrasound is mandatory to watch for signs of macular detachment.

The purpose of surgery is to remove the blood to permit evaluation and possible treatment of the posterior pole, to release tractional forces that pull on the retina, to repair a retinal detachment, and to remove the scaffolding into which the neovascular complexes may grow. Laser photocoagulation through indirect delivery systems or through the EndoProbe can be performed as an adjunctive procedure during surgery to initiate or continue laser treatment.


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