01 Aug Vitrectomy for Diabetic Retinopathy
There are two times when a patient needs vitrectomy eye surgery for diabetic retinopathy. Patients with either a vitreous hemorrhage and/or a diabetic retinal detachment will require a vitrectomy.
Both occur when the diabetic retinopathy has advanced to “proliferative diabetic retinopathy.” By definition, abnormal blood vessels, called neovascularization have developed somewhere on the retina.
Neither case requires emergency surgery.
What is Proliferative Diabetic Retinopathy
Neovascularization, the abnormal blood vessels, is very fragile. These delicate blood vessels have grown somewhere inside the eye; usually on the surface of the retina.
There are 3 types of neovascular tissue named based on the location; neovascularization elsewhere (NVE), neovascularization of the disc (NVD) or neovascularization on the iris (NVI).
Regardless, just remember proliferative diabetic retinopathy, by definition, means abnormal blood vessels are somewhere in the eye!
At times, these delicate blood vessels may bleed and cause a vitreous hemorrhage. Blood accumulates inside the eye and blocks the vision. Patients can’t see “out” and doctors can’t see “in.”
Though the vision loss can be dramatic, and as long as nothing else could have caused the bleeding (i.e. a retinal tear can also cause a vitreous hemorrhage), we usually wait for the blood to clear. This may take several weeks or longer.
If the blood doesn’t clear, a vitrectomy is needed to remove the blood not absorbed by mother nature.
Diabetic Retinal Detachment
Untreated neovascular tissue may “proliferate” or grow inside the eye. The tissue may creep along the surface of the retina much the same way ivy grows along the ground…moving slowly from one point to another.
With time, the NV may contract and start to detach the retina. This type of “traction” retinal detachment is different than retinal detachments sustained by non-diabetic patients.
A retinal detachment caused by diabetes requires vitrectomy surgery to physically cut away or remove the offending tissue pulling up on the retina.
What Does This Mean?
In both cases, laser treatment (panretinal photocoagulation or PRP) is needed to stop the neovascularization.
In the case of a vitreous hemorrhage, if the blood is not absorbed, laser can be performed at the same time as the operation. If the blood does absorb, laser treatment can be performed in the office.
For patients with a diabetic retinal detachment; however, an operation is often the best and only choice.
With routine eye examination, the neovascular tissue is often detected before bleeding or retinal detachment has occurred. Treatment can be initiated, operations avoided, and vision preserved!
DanPosted at 04:05h, 03 August
Can the AVASTIN injections stop the progression of the porliferative diabatic retinopathy?
Many thanks Doc.
Randall V. Wong, M.D.Posted at 14:25h, 13 August
Avastin/Lucentis and other anti-VEGF injections temporarily stop Proliferative Diabetic Retinopathy. The issue with PDR is the lack of oxygenation. Avastin doesn’t address the root of the problem.
Ken EPosted at 16:38h, 03 August
Another great article. I look forward to your writings and answers to questions. Before my vitreous problems, I had no interest in the anatomy of my eyes and the issues that surround them. You are doing a great service to those of us looking for credible info on the web. Thank you, Dr. Wong
Randall V. Wong, M.D.Posted at 11:35h, 15 August
As always, thank you for your support.
FOV patientPosted at 13:16h, 13 August
Dear Dr. Wong,
I wanted to get your opinion about the outcome of non-PVD induced FOV on one of the eyes. It went complication free and surgeon did lasering for retinal thinning on periphery.
Wher I move my eyes to right, I see certain streaks of light in my lower vision (which means superior retina). As soon as eye movement to the right stops, these streaks of lights disappear. These are quite not the flashes I was seeing before but rather streaks that only show against white backgrounds on eye movement. I see these streaks only on rapid movements. In dark room, I dont see these streaks but rather see a quick flash of light on right periphery when moving eyes to right (means it is on nasal quadrant of retina).
Are these symptoms because of traction of peripheral vitreous on peripheral retina? Surgeon says he sees no tears.
What should I make of this?
Randall V. Wong, M.D.Posted at 10:44h, 17 August
It could be from slight pulling on the retina yet the force isn’t strong enough to cause tears. I would agree that is the most likely scenario.
It is possible, too, that you are noticing some of the aqueous (water) vitreous interface.
FOV patientPosted at 08:29h, 14 August
I’d really appreciate your reply, Dr. Wong.
Randall V. Wong, M.D.Posted at 10:47h, 17 August
Dear FOV patient,
Answered. I try and answer comments every week -two weeks. Wasn’t ignoring you.
FOV patientPosted at 13:10h, 17 August
Thank you Dr. Wong.
If it is slight traction on retina, what can I do to relieve this traction? Do you think this will decrease over time? I am only few weeks out of surgery (about 7 weeks).
Do you think that due to this slight traction on retina, I am at increased risk for tears/detachments? I do have peripheral retinal thinning (lattice).
Surgeon has given me green light to go to gym but I am scared as I dont want this traction to become strong and create tears.
What would be your advice to me?
Thank you so much.
FOV patientPosted at 17:24h, 06 September
Dear Dr. Wong,
I await your response.
Do your non-pvd induced FOV patients complain of peripheral floaters 2-3 months after the surgery?
Randall V. Wong, M.D.Posted at 20:52h, 12 September
Dear FOV patient,
Usually not. Remember, not every PVD is noticed by patients!
Hassan DesoukyPosted at 17:52h, 18 October
Dear Mr Wong
I have sent you an E mail in 18/10/2012
please, read it and answer me quickly
Randall V. Wong, M.D.Posted at 08:16h, 22 October
I have replied to your email.