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Surgical treatment of diabetic retinopathy

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Abstract

Several complications of advanced diabetic retinopathy can be treated surgically. Vitrectomy can clear media opacities, relieve traction on the retina, and makes adequate laser treatment of the retina possible. Removal of premacular vitreous may also improve diabetic macular edema. Instrumentation, understanding of the pathophysiology, surgical skills as well as supplementary pharmacotherapy have improved surgical results. Indications and timing for surgery have considerably changed in the past decades and the threshold for surgery has been continuously lowered, as vitrectomy became safer. The primary disease of the retinal microvasculature with capillary occlusion and retinal ischemia is still the limiting factor, responsible for disappointing functional results in anatomically successfully operated eyes.

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References

  1. Bartz-Schmidt KU, Thumann G, Psichias A, Krieglstein GK, Heimann K (1999) Pars plana vitrectomy, endolaser coagulation of the retina and the ciliary body combined with silicone oil endotamponade in the treatment of uncontrolled neovascular glaucoma. Graefes Arch Clin Exp Ophthalmol 237:969–975

    Article  CAS  PubMed  Google Scholar 

  2. Benson GT, Flynn HW, Blankenship GW (1989) Posterior chamber intraocular lens implantation during diabetic pars plana vitrectomy. Ophthalmology 96:603–610

    PubMed  Google Scholar 

  3. Blankenship GW (1980) The lens influence on diabetic vitrectomy results. Report of a prospective randomized study. Arch Ophthalmol 98:2196–2198

    CAS  PubMed  Google Scholar 

  4. Charles S, Flinn CE (1981) The natural history of diabetic extramacular traction retinal detachment. Arch Ophthalmol 99:66–68

    CAS  PubMed  Google Scholar 

  5. Diabetes Control and Complications Trial Research Group (1995) Progression of retinopathy with intensive versus conventional treatment in the Diabetes Control and Complications Trial. Diabetes Control and Complications Trial Research Group. Ophthalmology 102:647–661

    Google Scholar 

  6. Diabetic Retinopathy Vitrectomy Study Group (1990) Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol 108:958–964

    Google Scholar 

  7. Donnelly R, Idris I, Forrester JV (2004) Protein kinase C inhibition and diabetic retinopathy: a shot in the dark at translational research. Br J Ophthalmol 88:145–151

    Article  CAS  PubMed  Google Scholar 

  8. Elliott A, Flanagan D (1990) Macular detachment following laser treatment of proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 228:438–441

    CAS  PubMed  Google Scholar 

  9. Gandorfer A, Kampik A (2000) Pars plana vitrectomy in diabetic retinopathy. From pathogenetic principle to surgical strategy. Ophthalmologe 97:325–330

    Article  CAS  PubMed  Google Scholar 

  10. Gandorfer A, Messmer EM, Ulbig MW, Kampik A (2000) Resolution of diabetic macular edema after surgical removal of the posterior hyaloid and the inner limiting membrane. Retina 20:126–133

    CAS  PubMed  Google Scholar 

  11. von Graefe A (1863) Perforation von abgelösten Netzhäuten und Glaskörpermembranen. Graefes Arch Ophthalmol 9:84–104

    Google Scholar 

  12. Helbig H, Kellner U, Bornfeld N, Foerster MH (1996) Grenzen und Möglichkeiten der Glaskörperchirurgie bei diabetischer Retinopathie. Ophthalmologe 93:647–654

    Article  CAS  PubMed  Google Scholar 

  13. Helbig H, Kellner U, Bornfeld N, Foerster MH (1998) Rubeosis iridis after vitrectomy for diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 236:730–733

    Article  CAS  PubMed  Google Scholar 

  14. Hoerauf H, Roider J, Bopp S, Lucke K, Laqua H (1995) Endotamponade with silicon oil in severe proliferative retinopathy with attached retina. Ophthalmologe 92:657–662

    CAS  PubMed  Google Scholar 

  15. Ikeda T, Sawa H, Koizumi K, Yasuhara T, Kinoshita S, Tano Y (1998) Vitrectomy for proliferative diabetic retinopathy with asteroid hyalosis. Retina 18:410–414

    CAS  PubMed  Google Scholar 

  16. Jaccoma EH, Conway BP, Campochiaro PA (1985) Cryotherapy causes extensive breakdown of the blood-retinal barrier—a comparison with argon photocoagulation. Arch Ophthalmol 103:1728–1730

    CAS  PubMed  Google Scholar 

  17. Jonas JB, Hayler JK, Sofker A, Panda-Jonas S (2001) Intravitreal injection of crystalline cortisone as adjunctive treatment of proliferative diabetic retinopathy. Am J Ophthalmol 131:468–471

    Article  CAS  PubMed  Google Scholar 

  18. Körner F, Körner U (1988) Diabetische Retinopathie und Photokoagulation. Enke, Stuttgart

    Google Scholar 

  19. Lahey JM, Francis RR, Kearney JJ (2003) Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases. Ophthalmology 110:1335–1339

    Article  PubMed  Google Scholar 

  20. Laqua H (1980) Rubeosis iridis following pars plana vitrectomy. Klin Monatsbl Augenheilkd 177:24–30

    CAS  PubMed  Google Scholar 

  21. Machemer R, Buettner H, Norton RWD, Parel JM (1971) Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 75:813–820

    CAS  PubMed  Google Scholar 

  22. Messmer E, Bornfeld N, Oehlschlager U, Heinrich T, Foerster MH, Wessing A (1992) Epiretinal membrane formation after pars plana vitrectomy in proliferative diabetic retinopathy. Klin Monatsbl Augenheilkd 200:267–272

    CAS  PubMed  Google Scholar 

  23. Meyer-Schwickerath G (1959) Lichtkoagulation. Enke, Stuttgart

    Google Scholar 

  24. Nasrallah FP, Jalkh AE, Van Coppenolle F, Kado M, Trempe CL, McMeel JW, Schepens CL (1988) The role of the vitreous in diabetic macular edema. Ophthalmology 95:1335–1339

    CAS  PubMed  Google Scholar 

  25. Pauleikhoff D, Engineer B, Wessing AS (1997) Die Kryokoagulation in der Therapie der proliferativen diabetischen Retinopathie. Klin Monatsbl Augenheilkd 210:147–152

    CAS  PubMed  Google Scholar 

  26. Pendergast SD, Hassan TS, Williams GA, Cox MS, Margherio RR, Ferrone PJ, Garretson BR, Trese MT (2000) Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol 130:178–186

    Article  CAS  PubMed  Google Scholar 

  27. Shinoda K, O’Hira A, Ishida S, Hoshide M, Ogawa LS, Ozawa Y, Nagasaki K, Inoue M, Katsura H (2001) Posterior synechia of the iris after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation. Jpn J Ophthalmol 45:276–280

    Article  CAS  PubMed  Google Scholar 

  28. Smiddy WE, Flynn HW Jr (1999) Vitrectomy in the management of diabetic retinopathy. Surv Ophthalmol 43:491–507

    Article  CAS  PubMed  Google Scholar 

  29. Thompson JT, de Bustros S, Michels RG, Rice TA (1987) Results and prognostic factors in vitrectomy for diabetic traction-rhegmatogenous retinal detachment. Arch Ophthalmol 105:503–507

    CAS  PubMed  Google Scholar 

  30. United Kingdom Prospective Diabetes Study Group (1998) Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 352:837–853

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Augenklinik, UniversitätsSpital Zürich, Frauenklinikstrasse 24, 8091, Zürich, Switzerland

    Horst Helbig & Florian K. P. Sutter

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  1. Horst Helbig
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  2. Florian K. P. Sutter
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Correspondence to Horst Helbig.

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Helbig, H., Sutter, F.K.P. Surgical treatment of diabetic retinopathy. Graefe's Arch Clin Exp Ophthalmol 242, 704–709 (2004). https://doi.org/10.1007/s00417-004-0977-9

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  • DOI: https://doi.org/10.1007/s00417-004-0977-9

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