Vitrectomy for Advanced Proliferative Diabetic Retinopathy – A Practical Approach


ABSTRACT

Objectives:

To provide young vitreoretinal surgeons with a practical approach to vitrectomy for advanced proliferative diabetic retinopathy.

Design and Methods:

At Groote Schuur hospital, University of Cape Town, 50% of all vitrectomies performed in the unit are for the complications of diabetes. Present limitations in primary and secondary prevention of diabetic retinopathy in Cape Town, South Africa, mean that many diabetic patients present with advanced retinal complications requiring vitrectomy. The mean Snellen visual acuity of the eyes for surgery is 2/60, 20% of the fellow eyes are considered inoperable at presentation and 94% of cases require dissection of diabetic proliferative membranes. We aim to share some clinical pearls that we have gained from our experience with these difficult surgical cases.

Results:

Short video clips with reference to relevant literature will be used to highlight certain aspects of vitreoretinal surgery for proliferative diabetic retinopathy with tractional retinal detachments or combined tractional-rhegmatogenous retinal detachments. This will include fibrovascular complex dissection techniques including segmentation and bimanual delamination; strategies to find the correct dissection plane and to identify vitreoschisis; management of chronic viscous subretinal fluid; and choice of tamponading agents. The use of preoperative Avastin as well as the diagnosis and management of port-site proliferation will be discussed.

Conclusion:

This educational lecture is aimed at giving young vitreoretinal surgeons practical tips on the surgical management of these challenging cases.


CONTACT DETAILS

 

Jonel Steffen
University of Cape Town, Division of Ophthalmology
Ward D4, Groote Schuur hospital
Private Bag, Observatory, Cape Town
7937, South Africa
Email : j.steffen@uct.ac.za
Work Phone: +27214045060





AUTHORS

Dr Steffen, J. Division of Ophthalmology, Groote Schuur hospital, University of Cape Town, Cape Town, South Africa

Dr Rice, JC. Division of Ophthalmology, Groote Schuur hospital, University of Cape Town, Cape Town, South Africa

Fricke, OH.  Department of Ophthalmology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden