[Vitrectomy in proliferative diabetic retinopathy. Preoperative factors for surgical procedure and postoperative...

In this study we evaluated the impact of preoperative factors on the choice of intraocular tamponades (balanced salt solution and gas or silicone oil) and postsurgical visual function in cases of vitrectomy for proliferative diabetic retinopathy. We studied 150 consecutive vitrectomies for proliferative diabetic retinopathy, which were carried out from October 1987 to February 1989. The extent of central or peripheral traction and retinal detachment were found to have a major influence on the choice of intraocular tamponades. Different types of diabetes, renal failure, and the time interval since the last vitreous hemorrhage showed no influence on the choice of intraocular tamponades. Visual acuity was improved after vitrectomy in the group with silicone oil tamponade, as well as in the control group with BSS or gas tamponade. Patients receiving silicone oil had more advanced stages of proliferative diabetic retinopathy and therefore more complicated postsurgical courses. Silicone oil is more likely to be avoided in cases without retinal detachment, where the risk of further vitreous hemorrhage is felt to be low and in cases with complete panretinal photocoagulation. The present study supports the therapeutic value of complete panretinal photocoagulation for proliferative diabetic retinopathy--even in cases where the proliferative retinopathy progresses and a vitrectomy is needed. It is demonstrated that many patients requiring vitrectomy did not receive sufficient photocoagulation earlier.