Current management of diabetic tractional retinal detachments
Twenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Indian Journal of Ophthalmology |
| Subjects: | |
| Online Access: | http://www.ijo.in/article.asp?issn=0301-4738;year=2018;volume=66;issue=12;spage=1751;epage=1762;aulast=Stewart |
| _version_ | 1818308621790871552 |
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| author | Michael W Stewart David J Browning Maurice B Landers |
| author_facet | Michael W Stewart David J Browning Maurice B Landers |
| author_sort | Michael W Stewart |
| collection | DOAJ |
| description | Twenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular endothelial growth factor have become popular. But despite these treatments PDR may progress uncontrollably to advanced pathologies such as traction retinal detachments (TRDs), combined traction/rhegmatogenous retinal detachments (TRD/RRDs), vitreous hemorrhages, rubeosis iridis, and traction maculopathies, which produce mild-to-severe loss of vision. TDR have long been the most common indication for PDR-related vitreoretinal surgery. Vitrectomy surgery is indicated for recent (<6 months duration) TRD involving the macula, progressive TRD that threatens the macula, and recent data suggest that chronic macula-involving TRDs (>6 months duration) may also benefit. Combined TRD/RRD represents a particularly challenging surgical condition but advances in surgical instrumentation, dissection techniques, and post-operative tamponade have produced excellent success rates. The recent development of small-gauge vitrectomy systems has persuaded most surgeons to switch platforms since these appear to produce shorter surgical times and quicker post-operative recoveries. Pre-operative injections of bevacizumab are frequently administered for persistent neovascularization to facilitate surgical dissection of pre-retinal fibrosis and reduce the incidence of post-operative hemorrhages. Recent trends toward earlier surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed. |
| first_indexed | 2024-12-13T07:17:11Z |
| format | Article |
| id | doaj.art-f45a10b6d418401fb8d54740268056c8 |
| institution | Directory Open Access Journal |
| issn | 0301-4738 1998-3689 |
| language | English |
| last_indexed | 2024-12-13T07:17:11Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Ophthalmology |
| spelling | doaj.art-f45a10b6d418401fb8d54740268056c82022-12-21T23:55:32ZengWolters Kluwer Medknow PublicationsIndian Journal of Ophthalmology0301-47381998-36892018-01-0166121751176210.4103/ijo.IJO_1217_18Current management of diabetic tractional retinal detachmentsMichael W StewartDavid J BrowningMaurice B LandersTwenty-five percent of diabetes-related vision loss stems from complications of proliferative diabetic retinopathy (PDR). Panretinal photocoagulation has been the preferred treatment of high-risk PDR for decades and more recently intravitreal injections of drugs that inhibit the actions of vascular endothelial growth factor have become popular. But despite these treatments PDR may progress uncontrollably to advanced pathologies such as traction retinal detachments (TRDs), combined traction/rhegmatogenous retinal detachments (TRD/RRDs), vitreous hemorrhages, rubeosis iridis, and traction maculopathies, which produce mild-to-severe loss of vision. TDR have long been the most common indication for PDR-related vitreoretinal surgery. Vitrectomy surgery is indicated for recent (<6 months duration) TRD involving the macula, progressive TRD that threatens the macula, and recent data suggest that chronic macula-involving TRDs (>6 months duration) may also benefit. Combined TRD/RRD represents a particularly challenging surgical condition but advances in surgical instrumentation, dissection techniques, and post-operative tamponade have produced excellent success rates. The recent development of small-gauge vitrectomy systems has persuaded most surgeons to switch platforms since these appear to produce shorter surgical times and quicker post-operative recoveries. Pre-operative injections of bevacizumab are frequently administered for persistent neovascularization to facilitate surgical dissection of pre-retinal fibrosis and reduce the incidence of post-operative hemorrhages. Recent trends toward earlier surgical intervention and expanded indications are likely to continue as surgical instrumentation and techniques are further developed.http://www.ijo.in/article.asp?issn=0301-4738;year=2018;volume=66;issue=12;spage=1751;epage=1762;aulast=StewartDiabetesdiabetic retinopathytractional retinal detachmentvitrectomy |
| spellingShingle | Michael W Stewart David J Browning Maurice B Landers Current management of diabetic tractional retinal detachments Indian Journal of Ophthalmology Diabetes diabetic retinopathy tractional retinal detachment vitrectomy |
| title | Current management of diabetic tractional retinal detachments |
| title_full | Current management of diabetic tractional retinal detachments |
| title_fullStr | Current management of diabetic tractional retinal detachments |
| title_full_unstemmed | Current management of diabetic tractional retinal detachments |
| title_short | Current management of diabetic tractional retinal detachments |
| title_sort | current management of diabetic tractional retinal detachments |
| topic | Diabetes diabetic retinopathy tractional retinal detachment vitrectomy |
| url | http://www.ijo.in/article.asp?issn=0301-4738;year=2018;volume=66;issue=12;spage=1751;epage=1762;aulast=Stewart |
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