3. Surgical treatment for Diabetic Retinopathy

6. Vitrectomy is indicated when progression of a tractional retinal detachment threatens the macula.

11. Goal The goal of vitrectomy surgery is to relieve vitreoretinal traction to facilitate retinal reattachment.

12. Vitreous Hemorrhage The least difficult surgical presentation is vitreous hemorrhage. a. May be with PVD and no fibrous proliferation, or b. Persistent attachment of the post hyaloids to the retina

13. Dense vitreous hemorrhage Vitrectomy performed within the first 6 months increased the chances of better visual acuity. ( DRVS diabetic retinopathy vitrectomy study )

14. Premacular Hemorrhage 1) Is subhyaloid hemorrhage overlying the macula. 2) Most of these hemorrhages clear spontaneously. 3) Some of eyes progress to develop premacular fibrosis and traction macular detachment.

15. Anterrior to Posterior Traction

16. Posterior Attachments Usually in Both Optic Nerve and Along the Vascular Arcades

17. Fine neovasclar tufts growing at right angles to the retina and attached to the posterior hyaloid

18. Fibrovascular proliferation growing from optic nerve along both vascular arcades (wolf-jaw configuration)

19. Table top detachment

20. Vitreous contraction producing traction retinal detachment

21. Traction-rhegmatogenous detachments, breaks are typically near the vascular arcades and usually are round or oval shape

22. Basic Diabetic Vitrectomy

23. The central vitreous first is removed and then anterior to posterior traction is relieved.

24. Vacuum removal of blood pooled in the posterior segment

25. Areas of posterior hyaloid or thin membranes may be elevated gently with a pick or spatula

26. Combined diathermy and suction allow removal of blood from an actively bleeding area

27. Diathermy also is used to mark the edges of breaks for identification

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