{"title":"Vitrectomy for cases of diabetic retinopathy.","authors":"Nawazish Shaikh, Vinod Kumar, Aiswarya Ramachandran, Ramesh Venkatesh, Uday Tekchandani, Mudit Tyagi, Chaitra Jayadev, Mohit Dogra, Rohan Chawla","doi":"10.4103/IJO.IJO_30_24","DOIUrl":null,"url":null,"abstract":"<p><p>Microvascular complications of diabetic retinopathy (DR) may require surgical intervention in the form of vitrectomy. Since its inception, diabetic vitrectomy has evolved with introduction of better instruments, newer techniques, and smaller port sizes. Common indications for diabetic vitrectomy include nonresolving vitreous hemorrhage, tractional retinal detachment, epiretinal membrane, progression of fibrovascular membranes despite laser therapy, recalcitrant diabetic macular edema, and neovascular glaucoma. Preoperative systemic stabilization is essential prior to planning surgery. Surgical techniques commonly used in diabetic vitrectomy are segmentation, delamination, and rarely en-bloc dissection. Modification in surgical techniques such as chandelier-assisted bimanual dissection and pharmacological adjuvants improve surgical outcomes in these patients. Prognosis in these patients could be improved with early intervention. Studies evaluating the outcome of vitrectomy in patients with early proliferative DR are required to understand the appropriate time of intervention in patients. Treatment aimed at arresting the progression of DR and gene therapy are avenues that need further evaluation. The following review will focus on covering the epidemiology of DR, indications of vitrectomy, preoperative considerations, surgical procedures of diabetic vitrectomy, methods of membrane dissection, pharmacological adjuvants to vitrectomy, outcomes of diabetic vitrectomy, and future directions of diabetic vitrectomy.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"1704-1713"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Ophthalmology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4103/IJO.IJO_30_24","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OPHTHALMOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Microvascular complications of diabetic retinopathy (DR) may require surgical intervention in the form of vitrectomy. Since its inception, diabetic vitrectomy has evolved with introduction of better instruments, newer techniques, and smaller port sizes. Common indications for diabetic vitrectomy include nonresolving vitreous hemorrhage, tractional retinal detachment, epiretinal membrane, progression of fibrovascular membranes despite laser therapy, recalcitrant diabetic macular edema, and neovascular glaucoma. Preoperative systemic stabilization is essential prior to planning surgery. Surgical techniques commonly used in diabetic vitrectomy are segmentation, delamination, and rarely en-bloc dissection. Modification in surgical techniques such as chandelier-assisted bimanual dissection and pharmacological adjuvants improve surgical outcomes in these patients. Prognosis in these patients could be improved with early intervention. Studies evaluating the outcome of vitrectomy in patients with early proliferative DR are required to understand the appropriate time of intervention in patients. Treatment aimed at arresting the progression of DR and gene therapy are avenues that need further evaluation. The following review will focus on covering the epidemiology of DR, indications of vitrectomy, preoperative considerations, surgical procedures of diabetic vitrectomy, methods of membrane dissection, pharmacological adjuvants to vitrectomy, outcomes of diabetic vitrectomy, and future directions of diabetic vitrectomy.
摘要:糖尿病视网膜病变(DR)的微血管并发症可能需要以玻璃体切除术的形式进行手术干预。糖尿病玻璃体切割术自诞生以来,随着更好的器械、更新的技术和更小的手术孔尺寸的引入而不断发展。糖尿病玻璃体切除术的常见适应症包括:无法解决的玻璃体出血、牵引性视网膜脱离、视网膜外膜、激光治疗后纤维血管膜仍在发展、顽固性糖尿病黄斑水肿和新生血管性青光眼。在计划手术之前,术前系统稳定是至关重要的。糖尿病玻璃体切除术常用的手术技术有分割、分层,很少使用整体剥离。手术技术的改进,如吊灯辅助双臂剥离和药物辅助治疗,可改善这些患者的手术效果。早期干预可改善这些患者的预后。需要对早期增殖性 DR 患者的玻璃体切除术效果进行评估研究,以了解对患者进行干预的适当时机。旨在阻止 DR 进展的治疗和基因治疗也是需要进一步评估的途径。以下综述将重点介绍 DR 的流行病学、玻璃体切除术的适应症、术前注意事项、糖尿病玻璃体切除术的手术过程、膜剥离方法、玻璃体切除术的药物辅助治疗、糖尿病玻璃体切除术的结果以及糖尿病玻璃体切除术的未来发展方向。
期刊介绍:
Indian Journal of Ophthalmology covers clinical, experimental, basic science research and translational research studies related to medical, ethical and social issues in field of ophthalmology and vision science. Articles with clinical interest and implications will be given preference.