Skip to main content
Erschienen in: Current Diabetes Reports 10/2016

01.10.2016 | Microvascular Complications—Retinopathy (JK Sun and PS Silva, Section Editors)

Surgery for Diabetic Eye Complications

verfasst von: María H. Berrocal, Luis A. Acaba, Alexandra Acaba

Erschienen in: Current Diabetes Reports | Ausgabe 10/2016

Einloggen, um Zugang zu erhalten

Abstract

New modalities for the treatment of diabetic eye complications have emerged in the past decade. Nevertheless, many severe diabetic retinopathy complications can only be treated with vitreoretinal surgery. Technological advances in pars plana vitrectomy have expanded the gamut of pathologies that can be successfully treated with surgery. The most common pathologies managed surgically include vitreous opacities and traction retinal detachment. The indications, surgical objectives, adjunctive pharmacotherapy, microincisional surgical techniques, and outcomes of diabetic vitrectomy for proliferative diabetic retinopathy and diabetic tractional retinal detachment will be discussed. With the availability of new microincisional vitrectomy technology, wide angle microscope viewing systems, and pharmacologic agents, vitrectomy can improve visual acuity and achieve long-term anatomic stability in eyes with severe complications from proliferative diabetic retinopathy.
Literatur
1.
Zurück zum Zitat The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial—Diabetic Retinopathy Vitrectomy Study Report 4. Ophthalmology. 1988;95:1321–34.CrossRef The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Clinical application of results of a randomized trial—Diabetic Retinopathy Vitrectomy Study Report 4. Ophthalmology. 1988;95:1321–34.CrossRef
2.
Zurück zum Zitat The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. Arch Ophthalmol. 1985;103:1644–52.CrossRef The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Two-year results of a randomized trial. Diabetic Retinopathy Vitrectomy Study report 2. Arch Ophthalmol. 1985;103:1644–52.CrossRef
3.
Zurück zum Zitat The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol. 1990;108:958–64.CrossRef The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5. Arch Ophthalmol. 1990;108:958–64.CrossRef
4.
Zurück zum Zitat The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial- -Diabetic Retinopathy Vitrectomy Study Report 3. Ophthalmology. 1988;95:1307–20.CrossRef The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe proliferative diabetic retinopathy in eyes with useful vision. Results of a randomized trial- -Diabetic Retinopathy Vitrectomy Study Report 3. Ophthalmology. 1988;95:1307–20.CrossRef
5.
Zurück zum Zitat Fujii GY, De Juan Jr E, Humayun MS, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12.CrossRefPubMed Fujii GY, De Juan Jr E, Humayun MS, Pieramici DJ, Chang TS, Awh C, et al. A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology. 2002;109:1807–12.CrossRefPubMed
6.
Zurück zum Zitat Fujii GY, De Juan Jr E, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109:1814–20.CrossRefPubMed Fujii GY, De Juan Jr E, Humayun MS, et al. Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology. 2002;109:1814–20.CrossRefPubMed
7.
8.•
Zurück zum Zitat Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016;161:36–43. This study presents results of vitrectomy done with 27g instrumentation for a variety of different pathologies.CrossRefPubMed Khan MA, Shahlaee A, Toussaint B, Hsu J, Sivalingam A, Dugel PU, et al. Outcomes of 27 Gauge Microincision Vitrectomy Surgery for Posterior Segment Disease. Am J Ophthalmol. 2016;161:36–43. This study presents results of vitrectomy done with 27g instrumentation for a variety of different pathologies.CrossRefPubMed
9.
Zurück zum Zitat da R Lucena D, Ribeiro JA, Costa RA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study). Br J Ophthalmol. 2009;93:688–91.CrossRefPubMed da R Lucena D, Ribeiro JA, Costa RA, et al. Intraoperative bleeding during vitrectomy for diabetic tractional retinal detachment with versus without preoperative intravitreal bevacizumab (IBeTra study). Br J Ophthalmol. 2009;93:688–91.CrossRefPubMed
10.
Zurück zum Zitat Rizzo S, Genovesi-Ebert F, Di Bartolo E, et al. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol. 2008;246:837–42.CrossRefPubMed Rizzo S, Genovesi-Ebert F, Di Bartolo E, et al. Injection of intravitreal bevacizumab (Avastin) as a preoperative adjunct before vitrectomy surgery in the treatment of severe proliferative diabetic retinopathy (PDR). Graefes Arch Clin Exp Ophthalmol. 2008;246:837–42.CrossRefPubMed
11.
Zurück zum Zitat Yeoh J, Williams C, Allen P, et al. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Clin Exp Ophthalmol. 2008;36:449–54.PubMed Yeoh J, Williams C, Allen P, et al. Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series. Clin Exp Ophthalmol. 2008;36:449–54.PubMed
12.
Zurück zum Zitat Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye. 2009;23:108–11.CrossRefPubMed Ishikawa K, Honda S, Tsukahara Y, Negi A. Preferable use of intravitreal bevacizumab as a pretreatment of vitrectomy for severe proliferative diabetic retinopathy. Eye. 2009;23:108–11.CrossRefPubMed
13.
Zurück zum Zitat Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology. 2009;116:927–38.CrossRefPubMed Oshima Y, Shima C, Wakabayashi T, et al. Microincision vitrectomy surgery and intravitreal bevacizumab as a surgical adjunct to treat diabetic traction retinal detachment. Ophthalmology. 2009;116:927–38.CrossRefPubMed
14.
Zurück zum Zitat Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina. 2016;36:137–47.CrossRefPubMed Eckardt C, Paulo EB. Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina. 2016;36:137–47.CrossRefPubMed
15.
Zurück zum Zitat Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A. Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol. 2003;135:169–77.CrossRefPubMed Massin P, Duguid G, Erginay A, Haouchine B, Gaudric A. Optical coherence tomography for evaluating diabetic macular edema before and after vitrectomy. Am J Ophthalmol. 2003;135:169–77.CrossRefPubMed
16.•
Zurück zum Zitat Nagiel A, Lalane RA, Sadda SR, Schwartz SD. Ultra-widefield fundus imaging: a review of clinical applications and future trends. Retina. 2016;36:660–78. Ultra-wide field imaging provides a panoramic view of the very peripheral retina. Angiography performed with this technology images areas of the retina not evaluated in the past.CrossRefPubMed Nagiel A, Lalane RA, Sadda SR, Schwartz SD. Ultra-widefield fundus imaging: a review of clinical applications and future trends. Retina. 2016;36:660–78. Ultra-wide field imaging provides a panoramic view of the very peripheral retina. Angiography performed with this technology images areas of the retina not evaluated in the past.CrossRefPubMed
17.
Zurück zum Zitat Falkner-Radler CI, Glittenberg C, Gabriel M, Binder S. Intrasurgical microscope-integrated spectral domain optical coherence tomography-assisted membrane peeling. Retina. 2015;35:2100–6.CrossRefPubMed Falkner-Radler CI, Glittenberg C, Gabriel M, Binder S. Intrasurgical microscope-integrated spectral domain optical coherence tomography-assisted membrane peeling. Retina. 2015;35:2100–6.CrossRefPubMed
18.
Zurück zum Zitat Robaszkiewicz J, Chmielewska K, Figurska M, Wierzbowska J, Stankiewicz A. Triple therapy: phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of bevacizumab for diffuse diabetic macular edema. Med Sci Monit. 2012;18:CR241–51.CrossRefPubMedPubMedCentral Robaszkiewicz J, Chmielewska K, Figurska M, Wierzbowska J, Stankiewicz A. Triple therapy: phaco-vitrectomy with ILM peeling, retinal endophotocoagulation, and intraoperative use of bevacizumab for diffuse diabetic macular edema. Med Sci Monit. 2012;18:CR241–51.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Berk Ergun S, Toklu Y, Cakmak HB, Raza S, Simsek S. The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage. Semin Ophthalmol. 2015;30:177–80.CrossRefPubMed Berk Ergun S, Toklu Y, Cakmak HB, Raza S, Simsek S. The effect of intravitreal bevacizumab as a pretreatment of vitrectomy for diabetic vitreous hemorrhage on recurrent hemorrhage. Semin Ophthalmol. 2015;30:177–80.CrossRefPubMed
20.
Zurück zum Zitat Michels RG, Rice TA, Rice EF. Vitrectomy for diabetic vitreous hemorrhage. Am J Ophthalmol. 1983;95:12–21.CrossRefPubMed Michels RG, Rice TA, Rice EF. Vitrectomy for diabetic vitreous hemorrhage. Am J Ophthalmol. 1983;95:12–21.CrossRefPubMed
21.
Zurück zum Zitat Chaudhry NA, Lim ES, Saito Y, et al. Early vitrectomy and endolaser photocoagulation in patients with type I diabetes with severe vitreous hemorrhage. Ophthalmology. 1995;102:1164–9.CrossRefPubMed Chaudhry NA, Lim ES, Saito Y, et al. Early vitrectomy and endolaser photocoagulation in patients with type I diabetes with severe vitreous hemorrhage. Ophthalmology. 1995;102:1164–9.CrossRefPubMed
22.
Zurück zum Zitat Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic traction retinal detachment involving the macula. Am J Ophthalmol. 1983;95:22–33.CrossRefPubMed Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic traction retinal detachment involving the macula. Am J Ophthalmol. 1983;95:22–33.CrossRefPubMed
23.
Zurück zum Zitat Arevalo JF, Maia M, Flynn Jr HW, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92:213–6.CrossRefPubMed Arevalo JF, Maia M, Flynn Jr HW, et al. Tractional retinal detachment following intravitreal bevacizumab (Avastin) in patients with severe proliferative diabetic retinopathy. Br J Ophthalmol. 2008;92:213–6.CrossRefPubMed
24.
Zurück zum Zitat Arevalo JF, Sanchez JG, Saldarriaga L, et al. Retinal detachment after bevacizumab. Ophthalmology. 2011;118:2304 e3–e7. Arevalo JF, Sanchez JG, Saldarriaga L, et al. Retinal detachment after bevacizumab. Ophthalmology. 2011;118:2304 e3–e7.
25.
Zurück zum Zitat Berrocal MH. A minimalist approach to surgery for diabetic retinal detachment new tools allow evolution of surgical techniques. Retina Today. 2014;April:65–68. Berrocal MH. A minimalist approach to surgery for diabetic retinal detachment new tools allow evolution of surgical techniques. Retina Today. 2014;April:65–68.
26.
Zurück zum Zitat Hutton WL, Bernstein I, Fuller D. Diabetic traction retinal detachment. Factors influencing final visual acuity. Ophthalmology. 1980;87:1071–7.CrossRefPubMed Hutton WL, Bernstein I, Fuller D. Diabetic traction retinal detachment. Factors influencing final visual acuity. Ophthalmology. 1980;87:1071–7.CrossRefPubMed
27.
Zurück zum Zitat Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic tractionrhegmatogenous retinal detachment. Arch Ophthalmol. 1987;105:503–7.CrossRefPubMed Thompson JT, de Bustros S, Michels RG, Rice TA. Results and prognostic factors in vitrectomy for diabetic tractionrhegmatogenous retinal detachment. Arch Ophthalmol. 1987;105:503–7.CrossRefPubMed
28.
Zurück zum Zitat Yang CM, Su PY, Yeh PT, Chen MS. Combined rhegmatogenous and traction retinal detachment in proliferative diabetic retinopathy: clinical manifestations and surgical outcome. Can J Ophthalmol. 2008;43:192–8.CrossRefPubMed Yang CM, Su PY, Yeh PT, Chen MS. Combined rhegmatogenous and traction retinal detachment in proliferative diabetic retinopathy: clinical manifestations and surgical outcome. Can J Ophthalmol. 2008;43:192–8.CrossRefPubMed
29.
Zurück zum Zitat Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic rhegmatogenous retinal detachment. Am J Ophthalmol. 1983;95:34–44.CrossRefPubMed Rice TA, Michels RG, Rice EF. Vitrectomy for diabetic rhegmatogenous retinal detachment. Am J Ophthalmol. 1983;95:34–44.CrossRefPubMed
30.
Zurück zum Zitat Kaiser PK, Riemann CD, Sears JE, Lewis H. Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001;131:44–9.CrossRefPubMed Kaiser PK, Riemann CD, Sears JE, Lewis H. Macular traction detachment and diabetic macular edema associated with posterior hyaloidal traction. Am J Ophthalmol. 2001;131:44–9.CrossRefPubMed
31.
Zurück zum Zitat Hisatomi T, Enaida H, Matsumoto H, et al. Staining ability and biocompatibility of brilliant blue G: preclinical study of brilliant blue G as an adjunct for capsular staining. Arch Ophthalmol. 2006;124:514–9.CrossRefPubMed Hisatomi T, Enaida H, Matsumoto H, et al. Staining ability and biocompatibility of brilliant blue G: preclinical study of brilliant blue G as an adjunct for capsular staining. Arch Ophthalmol. 2006;124:514–9.CrossRefPubMed
32.
Zurück zum Zitat Diabetic Retinopathy Clinical Research Network Writing C, Haller JA, Qin H. et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology, 2010;117:1087–1093 e1083. Diabetic Retinopathy Clinical Research Network Writing C, Haller JA, Qin H. et al. Vitrectomy outcomes in eyes with diabetic macular edema and vitreomacular traction. Ophthalmology, 2010;117:1087–1093 e1083.
33.
Zurück zum Zitat Olmos LC, Sayed MS, Moraczewski AL, Gedde SJ, Rosenfeld PJ, Shi W, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab. Eye (Lond). 2016;30:463–72.CrossRef Olmos LC, Sayed MS, Moraczewski AL, Gedde SJ, Rosenfeld PJ, Shi W, et al. Long-term outcomes of neovascular glaucoma treated with and without intravitreal bevacizumab. Eye (Lond). 2016;30:463–72.CrossRef
35.
Zurück zum Zitat Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004;24:574–81.CrossRefPubMed Smiddy WE, Feuer W. Incidence of cataract extraction after diabetic vitrectomy. Retina. 2004;24:574–81.CrossRefPubMed
36.
Zurück zum Zitat Rice TA, Michels RG, Maguire MG, Rice EF. The effect of lensectomy on the incidence of iris neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy. Am J Ophthalmol. 1983;95:1–11.CrossRefPubMed Rice TA, Michels RG, Maguire MG, Rice EF. The effect of lensectomy on the incidence of iris neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy. Am J Ophthalmol. 1983;95:1–11.CrossRefPubMed
37.
Zurück zum Zitat Jaffe GJ, Lewis H, Han DP, Williams GA, Abrams GW. Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator. Am J Ophthalmol. 1989;108:170–5.CrossRefPubMed Jaffe GJ, Lewis H, Han DP, Williams GA, Abrams GW. Treatment of postvitrectomy fibrin pupillary block with tissue plasminogen activator. Am J Ophthalmol. 1989;108:170–5.CrossRefPubMed
Metadaten
Titel
Surgery for Diabetic Eye Complications
verfasst von
María H. Berrocal
Luis A. Acaba
Alexandra Acaba
Publikationsdatum
01.10.2016
Verlag
Springer US
Erschienen in
Current Diabetes Reports / Ausgabe 10/2016
Print ISSN: 1534-4827
Elektronische ISSN: 1539-0829
DOI
https://doi.org/10.1007/s11892-016-0787-6

Weitere Artikel der Ausgabe 10/2016

Current Diabetes Reports 10/2016 Zur Ausgabe

Pathogenesis of Type 1 Diabetes (A Pugliese, Section Editor)

Biomarkers of β-Cell Stress and Death in Type 1 Diabetes

Pathogenesis of Type 1 Diabetes (A Pugliese, Section Editor)

The Role of the Intestinal Microbiome in Type 1 Diabetes Pathogenesis

Health Care Delivery Systems and Implementation in Diabetes (EB Morton-Eggleston and ME McDonnell, Section Editors)

Academic Detailing in Diabetes: Using Outreach Education to Improve the Quality of Care

Pharmacologic Treatment of Type 2 Diabetes (HE Lebovitz and G Bahtiyar, Section Editors)

What Are We Learning from the FDA-Mandated Cardiovascular Outcome Studies for New Pharmacological Antidiabetic Agents?

Treatment of Type 1 Diabetes (M Pietropaolo, Section Editor)

Immune Intervention and Preservation of Pancreatic Beta Cell Function in Type 1 Diabetes

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

„Überwältigende“ Evidenz für Tripeltherapie beim metastasierten Prostata-Ca.

22.05.2024 Prostatakarzinom Nachrichten

Patienten mit metastasiertem hormonsensitivem Prostatakarzinom sollten nicht mehr mit einer alleinigen Androgendeprivationstherapie (ADT) behandelt werden, mahnt ein US-Team nach Sichtung der aktuellen Datenlage. Mit einer Tripeltherapie haben die Betroffenen offenbar die besten Überlebenschancen.

So sicher sind Tattoos: Neue Daten zur Risikobewertung

22.05.2024 Melanom Nachrichten

Das größte medizinische Problem bei Tattoos bleiben allergische Reaktionen. Melanome werden dadurch offensichtlich nicht gefördert, die Farbpigmente könnten aber andere Tumoren begünstigen.

CAR-M-Zellen: Warten auf das große Fressen

22.05.2024 Onkologische Immuntherapie Nachrichten

Auch myeloide Immunzellen lassen sich mit chimären Antigenrezeptoren gegen Tumoren ausstatten. Solche CAR-Fresszell-Therapien werden jetzt für solide Tumoren entwickelt. Künftig soll dieser Prozess nicht mehr ex vivo, sondern per mRNA im Körper der Betroffenen erfolgen.

Frühzeitige HbA1c-Kontrolle macht sich lebenslang bemerkbar

22.05.2024 Typ-2-Diabetes Nachrichten

Menschen mit Typ-2-Diabetes von Anfang an intensiv BZ-senkend zu behandeln, wirkt sich positiv auf Komplikationen und Mortalität aus – und das offenbar lebenslang, wie eine weitere Nachfolgeuntersuchung der UKPD-Studie nahelegt.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.