Diabetic Retinopathy: Surgical Aspects

Abstract

Vision loss due to diabetic retinopathy can be devastating and results from numerous complications, including macular edema, retinal and choroidal ischemia, vitreous hemorrhage, tractional retinal detachments, epiretinal membranes (with or without vitreoretinal traction), and papillopathy [1, 2]. The Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) showed that proper blood pressure and blood glucose control can delay the progression of diabetic retinopathy [3–5]. Additionally, local therapies such as focal macular laser, panretinal photocoagulation, intravitreal anti-vascular endothelial growth factor (VEGF), and intravitreal steroids can delay progression of retinopathy and treat associated vision-threatening complications [6]. Nevertheless, some patients continue to progress and require surgical intervention with pars plana vitrectomy (PPV) for optimal vision [6]. An estimated 5% of patients with proliferative diabetic retinopathy required PPV despite laser treatment and good glycemic and hypertensive control in the Early Treatment Diabetic Retinopathy Study (ETDRS) cohort [7].