Surgical management of diabetic tractional retinal detachments.

Siva S R Iyer, Kathleen A Regan, Jordan M Burnham, Ching J Chen

Journal: Survey of ophthalmology 2020;64(6):780-809

PMID: 31077688

Full Text on Elsevier Science View on PubMed

Abstract

Tractional retinal detachment is an end-stage form of diabetic retinopathy that occurs when contractile forces in the vitreous and neovascular tissue lead to the detachment of the neurosensory retina. We review the literature related to the management of this disease. Preoperative planning includes appropriate patient selection, diagnostic and prognostic imaging, and medical optimization with reduction of systemic risk factors. Use of antivascular endothelial growth factor for preoperative treatment has had significant benefits for tractional retinal detachment repair in improving surgical efficiency and outcomes. Advances in microsurgical instrumentation are discussed, with attention to small-gauge vitrectomy with improved flow dynamics, viewing strategies, and lighting allowing bimanual surgery. Special emphasis is placed on bimanual surgical technique, choice of tamponade, and the avoidance of iatrogenic damage. Complications and special considerations are further explored. Based on our compilation of relevant literature, we propose a surgical algorithm for the management of these complex patients.

Address: Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA. Electronic address: [email protected].; Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA.; Vitreoretinal Institute, Baton Rouge, Louisiana, USA.; Department of Ophthalmology, University of Mississippi School of Medicine, Jackson, Mississippi, USA.

DOI: 10.1016/j.survophthal.2019.04.008

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MeSH Terms: Algorithms, Angiogenesis Inhibitors, Diabetic Retinopathy, Humans, Microsurgery, Preoperative Care, Retinal Detachment, Vitrectomy