Surgical Diabetic Retinopathy Session

Diabetic Vitrectomy Strategies of Attack

Some important points when you deal with TRD:

• Prepare yourself with all weapons
• Don't start without chandelier
• Inject IV Injection before surgery
• Prepare the case system condition before surgery

Surgical Management of Diabetic Vitreous Hemorrhage

When diabetic patients experience chronic vitreous hemorrhage or complications with TRD, PPV is the preferred treatment option. However, a preoperative evaluation using a B-scan or OCT is necessary to accurately assess the status of the posterior and core vitreous.

Preoperative anti-VEGF can also help reduce intraoperative bleeding. During PPV, spiral vitreous rhexis after core vitrectomy can help induce PVD, while a triamcinolone injection can help detect any remnants of schisis posterior cortical vitreous that need removal. Additionally, endo laser photocoagulation is necessary.

It is important to note that good clinical assessment, patient counseling, and adequate medical treatment can help tailor the best management plan for the patient.

Surgical Management of Tractional Retinal Detachment

• Try to minimize the traction on the retina especially if thin and ischemic to avoid inducing iatrogenic breaks.
• Finding the correct plane is essential in peeling fibrovascular membranes.
• Always stain with triamcinolone to look for vitreoschisis which is very common in TRD cases.

Surgical Management of Combined Tractional and Rhegmatogenous Retinal Detachment

• Combined diabetic TRD/RRDs are some of the most challenging scenarios.
• Successful anatomical results may have poor visual outcomes due to macular ischemia.
• Dissection is more difficult because the retina is very mobile, no countertraction is present when fibrovascular tissue is lifted.
• It is important to remove all fibrovascular tissue and all traction near retinal breaks to allow retinal reattachment.