surgical treatment for diabetic retinopathy
TRANSCRIPT
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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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