Purpose:

Diabetic traction detachment (DTRD) can differ in severity. Systemic control and medication is very important and may play a role in intraoperative and postoperative follow-up. One important complication during surgery is bleeding; when this cannot be controlled effectively during pars plana vitrectomy, it can cause difficulty in membrane dissection, and even complicate the procedure with retinal tear formation. Preoperative injection of intravitreal anti-VEGF can reduce the intraoperative bleeding dramatically and should be performed within a certain time range. Endodiathermy is another tool surgeons can 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. In this video 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-g endodiathermy probes, which are thin 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-gauge high-cut vitrectomy probe or bimanually with a forceps and a horizontal scissor. Following membrane delamination, endolaser is performed, and endotamponade is given.

Take home message:

Pars plana vitrectomy for the management of diabetic traction detachments can vary in severity, and intraoperative bleeding can even complicate the surgical maneuvers. 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.