[Vitrectomy and photocoagulation for treatment of proliferative diabetic retinopathy]

To evaluate the efficacy of vitreous surgery and photocoagulation for treatment of a series of patients with proliferative diabetic retinopathy(PDR).

A consecutive series of PDR treated with vitrectomy and photocoagulation during February 1997 to May 2000 was retrospectively analyzed.

The series included 79 cases (38 male and 41 female) and 104 eyes [oculus dexter(OD), 26; oculus sinister(OS), 28; oculus uterque(OU), 25] with diabetic history for 0.5-37 (8.5 +/- 6.5) years and eye symptoms for 15 days to 1.5 years (1.5 +/- 1.5 years). Retinal photocoagulation was performed in 30 eyes with only once in 26 eyes before vitrectomy. Surgical techniques included standard vitrectomy, neovascular membrane peeling and fragmentation, endo--diathermy and endolaser. Silicone oil was injected in 59 eyes with active bleeding, retinal detachment, or severe ischemia. Cataract extraction was done in 63 eyes, of which 27 eyes with intraocular lens implantation. Visual acuity was light perception(LP), hand movement(HM), count fingers(CF), and > or = 0.02 in 15, 38, 22, and 29 eyes, respectively before operation. Visual improvement achieved in 84 eyes (80.8%) with > or = 0.1 in 41 eyes (39.4%). Visual acuity remained unchanged or decreased in 20 eyes (20.2%). Neovascular glaucoma occurred in two eyes after surgery.

Although the series of patients with PDR without sufficient retinal photocoagulation before operation, vitrectomy and endolaser improved the visual outcome in the majority of eyes. Silicone oil injected in eyes with severe ischemia, active bleeding or retinal detachment may provide chance for prompt laser coagulation after surgery in order to prevent progression of PDR.