Vitrectomy in proliferative diabetic retinopathy, the last 10 years

This report aims to highlight the evolving trends in surgical management of this complex vitreoretinal disorder and provides some insight into current practice and evidence-based medicine. We will also report our own experiences and share 10 year anatomical and visual outcome in patients who underwent 20-gauge (20G) pars plana vitrectomy (PPV) for complications of PDR under the supervision of a single surgeon (THW) at a teaching hospital in south east London, UK.

Vitrectomy surgery

Smaller gauge transconjunctival sutureless vitrectomy offers theoretical advantages of shorter surgical time, less postoperative inflammation, faster visual recovery and improved patient comfort. But these benefits are balanced in complex vitreoretinal adhesion and fibrovascular proliferations - seen in PDR as a result of altered fluidics with reduced flow through the smaller probe as compared to 20G. Advances such as 25G ultra high speed PPV machinery⁹ that has better fluid dynamic control, high speed cutting rate (5000 cuts per minute) and viscodissection assisted microincision vitrectomy¹⁰ offer new options in microincision vitrectomy.

Anatomical and visual results following PPV in complications due to DR with different gauges of vitrectomy instrumentation are comparable. In a retrospective study of 101 eyes by Park et al.¹¹ no beneficial effects on anatomical and visual outcome were seen after direct comparison between 20- and 23-G PPV. However, there were more cases of hypotony in the 23-G PPV group.