Diabetic Vitrectomy Surgery

Diabetes has various eye complications. Diabetic eye disease may include cataract, glaucoma, diabetic retinopathy and vascular occlusions.

In Diabetic Retinopathy, the blood vessels of the retina become abnormal. Normally, the blood vessels in the retina do not leak, but with diabetes, they can develop tiny leaks, causing fluid or blood to seep into the retina. The retina then becomes wet and swollen, affecting the vision. The form of diabetic retinopathy caused by leakage of the retinal blood vessels is called Nonproliferative (or background) diabetic retinopathy or macular swelling.

Retinal blood vessels in diabetes can close and the retinal tissue, which depends on those vessels for nutrition, will no longer function properly. These areas of the retina then foster the growth of abnormal new blood vessels, called Neovascularisation, which causes blindness, by bleeding into the vitreous cavity. It can also cause the development of scar tissue, which can pull the retina loose (called a traction retinal detachment). Either of these serious problems, vitreous bleeding or traction retinal detachment, can result in severe visual loss or even blindness (total loss of vision). The form of diabetic retinopathy caused by closure of the blood vessels and in which neovascularisation develops (proliferates) is called Proliferative diabetic retinopathy.

• Laser Treatment

In Nonproliferative diabetic retinopathy eye laser treatment can seal the leaking blood vessels of the macula or reduce their leakage to allow the macula to dry. In Proliferative diabetic retinopathy, the laser destroys the diseased portion of the retina to stop the growth of neovascularisation (abnormal new blood vessels).

Essentially, the major purpose of laser treatment is to prevent further visual loss. Laser treatment may not always be best or even possible. The decision to use laser depends mostly on the type of diabetic retinopathy, its severity, and a judgment regarding how well it may respond to eye laser treatment.

• Diabetic Vitrectomy Surgery

Another diabetic retinopathy treatment is by the surgical removal of the vitreous gel in the eye, called a vitrectomy. 23-gauge technology is used in our clinic. This is an advanced small incision surgery and often does not need suturing.

The body will usually absorb blood from a vitreous haemorrhage, but that can take days, months or even years. If the vitreous haemorrhage does not clear within a reasonable time, or if a retinal detachment is detected, a vitrectomy procedure can be performed. During the vitrectomy operation the surgeon makes tiny incisions in the sclera (the white part of the eye). Using a microscope to look inside the eye and microsurgical instruments, the surgeon removes the vitreous haemorrhage and scar tissue from the retina if present. During the procedure, the retina may be treated with laser to reduce future bleeding or to fix a tear in the retina. A gas bubble may be placed in the eye to help the retina remain in its proper position. This gas bubble will eventually dissolve on its own and be replaced by the body’s own fluids.

Vitrectomy is used to achieve specific goals, which may limit or halt the progress of advanced diabetic eye disease. It is used to remove vitreous opacity (commonly vitreous haemorrhage, also intra-ocular fibrin, or cells) and/or fibrovascular proliferation. It is also used to allow completion of panretinal laser photocoagulation with the endolaser. It can also be used to relieve retinal traction or to achieve retinal reattachment.

After this operation, in order to facilitate proper healing, most people need to reduce their activity for a short period of time (usually a few days). Vision will be blurry for a few weeks after the operation. The eye will secrete clear fluid replacing that which was removed during the operation. The patient will also need to take eye drop medication for a few weeks following the diabetic retinopathy treatment procedure.

Laser or vitrectomy can sometimes be used in conjunction with anti-vegf injections. Diagnostic digital fluorescein angiography and Optical coherence tomography (OCT), performed at our clinic, assists us in the diagnosis.

« Back to Eye Laser Clinic news.