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Purpose:

Eyes with diabetic traction detachment (DTRD) can differ in severity. Systemic control and medication is also very important, which may play a role in the intraoperative and postoperative follow-up. One important complication during surgery is bleeding; when cannot be contolled effectively during pars plana vitrectomy, can cause difficulty in membrane dissection, and even complicate the procedure with retinal tear formation. Preoperative injection of anti-vegf intravitreally can reduce dramatically the intraoperative bleeding, which should be performed in certain time range. Using endodiathermy, on the other hand is another tool surgeons use to control the intraoperative bleeding. My way of using endodiathermy is to apply it onto the fibrovascular traction membranes to elevate them from the retina and create a plane for safer delamination.

Methods:

Transconjunctival pars plana vitrectomy for the treatment of DTRD is demonstrated. As a surgical technique, after removal of vitreous, intravitreal triamcinolone is injected to check for vitreoschisis and removal of posterior hyaloid. Tractional membranes are identified. 23-g, or 25-gauge endodiathermy probes, which are thinner at the end are used during PPV. Endodiathermy probe is used with a medium power onto the membrane avoiding any retinal tissue. With the heat energy the membrane is constricted and lifted above the retinal plane. After that membrane delamination is performed with a small-guage high-cut vitrectomy probe or bimanually with a forceps and a horizontal scissor. After membrane delamination, endolaser is performed, and endotamponade is given.

Results:

In all eyes with DTRD, endodiathermy effectively helped to lift the membranes. This technique also helped to decrease the bleeding from the fibrovascular membranes during delamination. Membranes could be delaminated in all eyes. Endodiathermy was not effective when performed onto vitreous gel. No retinal tear occurred. No complication related with this technique was encountered. In all eyes retinas were attached.

Conclusion:

Pars plana vitrectomy for the management of diabetic traction detachments can vary in severity, and intraoperative bleeding can even complicate the surgical manoeuvers. Small-gauge endodiathermy probes are elegant enough to apply to the fibrovascular traction membranes only, to constrict them and cause them to lift above the retinal planes, avoiding any retinal tissue. This creates a tissue plane for the vitrector/ scissors to delaminate safely. It also decreases bleeding from the membranes during delamination, provides better vision, which may decrease complications like retinal tear formation.