Transcript of Surgical treatment for Diabetic Retinopathy.
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- Surgical treatment for Diabetic Retinopathy
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- Vitrectomy is indicated when progression of a tractional
retinal detachment threatens the macula.
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- Goal The goal of vitrectomy surgery is to relieve vitreoretinal
traction to facilitate retinal reattachment.
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- Vitreous Hemorrhage The least difficult surgical presentation
is vitreous hemorrhage. a. May be with PVD and no fibrous
proliferation, or b. Persistent attachment of the post hyaloids to
the retina
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- Dense vitreous hemorrhage Vitrectomy performed within the first
6 months increased the chances of better visual acuity. ( DRVS
diabetic retinopathy vitrectomy study )
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- Premacular Hemorrhage 1) Is subhyaloid hemorrhage overlying the
macula. 2) Most of these hemorrhages clear spontaneously. 3) Some
of eyes progress to develop premacular fibrosis and traction
macular detachment.
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- Anterrior to Posterior Traction
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- Posterior Attachments Usually in Both Optic Nerve and Along the
Vascular Arcades
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- Fine neovasclar tufts growing at right angles to the retina and
attached to the posterior hyaloid
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- Fibrovascular proliferation growing from optic nerve along both
vascular arcades (wolf-jaw configuration)
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- Table top detachment
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- Vitreous contraction producing traction retinal detachment
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- Traction-rhegmatogenous detachments, breaks are typically near
the vascular arcades and usually are round or oval shape
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- Basic Diabetic Vitrectomy
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- The central vitreous first is removed and then anterior to
posterior traction is relieved.
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- Vacuum removal of blood pooled in the posterior segment
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- Areas of posterior hyaloid or thin membranes may be elevated
gently with a pick or spatula
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- Combined diathermy and suction allow removal of blood from an
actively bleeding area
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- Diathermy also is used to mark the edges of breaks for
identification
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