Vitrectomy becomes necessary for diabetic retinopathy in three main situations. The first is a dense vitreous haemorrhage that has not cleared spontaneously after an adequate waiting period, typically four to six weeks, where the blood in the vitreous cavity prevents the retina from being examined or treated with laser. The second is a traction retinal detachment, where fibrovascular membranes attached to new vessels on the retinal surface have contracted and pulled the retina away from the eye wall, or are threatening to do so. The third is when dense fibrovascular membranes are present that cannot be treated with laser or injection alone. The procedure is performed in a theatre under local or general anaesthesia, using fine microsurgical instruments introduced through three small incisions in the sclera. The vitreous gel is removed, fibrovascular membranes are carefully peeled from the retinal surface, and the retina is reattached if it has detached. A gas bubble or silicone oil may be used at the end of surgery to help maintain the retina in position. Visual outcomes are best when surgery is performed before traction detachment has involved the central macula, which is why early specialist review of any sudden visual change in a patient with diabetes is essential.
Written by Dr. Usha Shree, MBBS, DNB Ophthalmology, FICO, FVRS, Vitreo-Retina Specialist, Kasturi Nagar, Bengaluru. 12 years. 10,000+ patients. Phone: +91 96633 58193.
