The options to minimize the surgical trauma to treat ocular diabetic complications and to improve postoperative recovery and quality of life require an individualized approach

摘要

Within the past ten years, small incision pars-plana vitrectomy, and refined microsurgical techniques, together with the introduction of various intravitreally applied drugs, significantly improved the anatomical and functional outcome. Unfortunately many diabetic patients with vitreoretinal complications also have cataract. In diabetic retinopathy, the benefit of simultaneous cataract surgery was long under debate due to possible side effects such as fibrinous reaction or secondary glaucoma. We review recent reports about the results of PPV for complication of diabetic retinopathy and the influence of a simultaneous cataract surgery, that compare different surgical approaches. Pars plana vitrectomy carried out with conventional 0,9 mm incisions (20G PPV) were related to higher incidences of postoperative inflammatory reactions and to a higher frequency of postoperative hypertensive events as compared to small incision vitrectomy (23G PPV). Postoperative recovery was faster in eyes with 23G surgery than after 20G surgery, with no delay by a simultaneous cataract surgery. A 23G-PPV improves the postoperative recovery and the quality of life for the diabetic patient. Cataract is no longer an obstacle for a vitreoretinal surgery. Postoperative recovery is faster and the new technique has less side effects than the conventional technique. In the future, a drug assisted vitrectomy will further reduce the surgical trauma. However, the new options are not equally benefitial for all patients. A further improvement in the quality of life will require a more individualized approach of microsurgical treatment for ocular complications of diabetes.