Introduction:

Diabetes mellitus is the most common cause of proliferative vascular retinopathy, which also includes retinal venous occlusive disease, Sickle cell retinopathy and retinopathy of prematurity. The underlying abnormality in these disorders is retinal ischemia, which may ultimately lead to the formation and contraction of proliferative fibrovascular membranes with subsequent vitreous hemorrhage and/or retinal detachment.

In 1971, Machemer and associates, developed pars plana vitrectomy, to treat nonclearing vitreous hemorrhage, due to proliferative diabetic retinopathy. Since that time, there have been significant advances in understanding the disease process, instrumentation and surgical techniques.  Recent clinical trials such have clarified role of surgery, laser and anti-VEGF agents.

Synopsis:

This course will highlight the Vitreoretinal relationships important for vitreoretinal surgery in diabetic retinopathy and outlines strategies for medical and surgical therapy based on the pathoanatomy and pathophysiology. In didactic format, this course will highlight the recent clinical trials, role of laser, anti-VEGF therapy and vitrectomy in the management of diabetic macular edema and proliferative diabetic retinopathy.  Classic and recent indications for treatment and timing for vitreous surgery will be discussed. The choice of instrumentation and comparison between different gauges will be illustrated.

Large numbers of videos will be shown demonstrating different techniques, both unimanual and bimanual, for complete dissection of the fibrovascular tissue, adherent posterior hyaloid, ILM peeling, vitreous base shaving, retinal reattachment, endolaser and finally choice of intraocular tamponade. Recent techniques for using small gauge vitrectomy systems to perform probe segmentation/delamination without the need for the classic scissors, will be largely demonstrated.

The course will also demonstrate the use and timing of anti-VEGF as a preoperative adjunct to vitrectomy in eyes with active proliferative diabetic retinopathy.

The indications, techniques, advantages and disadvantages for combined phacoemulsification, posterior chamber IOL and vitrectomy will be demonstrated.

Objectives:

At the end of the course, attendees will be able to:

1-      Understand the vitreoretinal relationship in eyes with complicated proliferative diabetic retinopathy.

2-      Recommend appropriate treatment for diabetic macular edema.

3-      Make a correct judgment regarding case selection and timing of surgery.

4-      Choose the most appropriate instrumentation and surgical strategy to dissect the fibrovascular tissue, adherent posterior hyaloid and ILM, leaving the retina completely clean and mobile.

5-      Management of challenging intraoperative situations.

6-      Management of postoperative complications and achieving long term stabilization of the proliferative process.