52.1General Considerations

52.1.1 Indications

There are several possible indications for PPV in patients with diabetes: macular edema (see Chap. 49), vitreous hemorrhage (see Sect. 25.2.7.1 and Chap. 62), and proliferative disease with the newly formed membranes threatening or actually causing TRD.

In eyes with the TRD involving the macula,1 the decision to indicate surgery is easy; it is much more of a dilemma when the macula itself is spared, the VA is full (see Sect. 46.1.1), but the ophthalmologist notices that the TRD is gradually approaching the center. Based on extensive counseling, the patient has to choose between two options, neither of which is really reassuring.

•Wait until the macula is also detached. By this time the VA already dropped and may not be fully restored even if all goes well during surgery.

•Operate before the macula detaches. Vision may still be full, apparently threatened more by the operation than the disease.

Pearl

As a general rule, the earlier surgery is performed in an eye with PDR, the better the chances of a good anatomical and functional outcome.

1 The disease is rarely allowed to progress this far in developed countries with well-organized screening and treatment protocols, but is surprisingly common in most other societies.

F. Kuhn, Vitreoretinal Surgery: Strategies and Tactics,

DOI 10.1007/978-3-319-19479-0_52