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Vitrectomy – Surgical Management of Diabetic Retinopathy

Diabetic retinopathy is the damage to the blood vessels of the eye’s retina that happens when a patient has long-term diabetes. It is the leading cause of blindness for Americans of working age. Both type 1 and type 2 diabetes patients are at risk of developing diabetic retinopathy.

The chance of developing diabetic retinopathy also increases for those with severe diabetes for an extended period of time and also for those whose diabetes has been poorly managed. Practically everyone with diabetes for more than 3 decades will eventually show signs of diabetic retinopathy.

There are a couple of stages of diabetic retinopathy. Initially, the non-proliferative kind develops. Later on, it progresses into the proliferative type, which signifies that the disease has become advanced and severe.

Symptoms of Diabetic Retinopathy

Unfortunately, there are no obvious signs of the disease until the damage to the eyes has become really severe. Diabetic patients must have their eyes checked regularly, as there are no symptoms until there is major bleeding in the eye.

Once it has become severe, the symptoms may include the following:

•    Blurred vision
•    Floaters
•    Missing areas of vision or shadows
•    Slow loss of eyesight
•    Trouble with night vision.

The non-proliferative kind is characterized by the following:

•    Blocked blood vessels
•    Microaneurysms wherein the blood vessels in the eye are bigger in certain areas.
•    Retinal hemorrhages wherein there is some bleeding and leaking fluid into the patient’s retina.

The following, on the other hand, may indicate the more advanced proliferative type:

•    Growth of new, fragile blood vessels.
•    Scars on the retina and other parts of the eye.

The tests can be done through retinal examination by dilating the pupils with eye drops, retinal photography or flourescein angiography.

Surgical Option

A surgical alternative to curing diabetic retinopathy is through vitrectomy. Most people with the disease have bleeding into the vitreous jelly that does not go away and cannot be treated with laser surgery. In vitrectomy, the doctor will remove all the jelly and blood from the eye. The retina can then be treated with laser to prevent more bleeding. Note, however, the following risks that come with this procedure:

•    One of the risks of vitrectomy is retinal detachment.  However, the procedure itself can also be used to treat the detached retina, which is a common complication.  After removing the vitreous jelly, the doctor can cut and remove the scar tissue from the retina before reattaching it.

•    Another risk of vitrectomy is glaucoma. During the procedure, there is a danger of having increased pressure in the eye. While this should only be temporary, it can lead to glaucoma if not controlled properly.

•    The formation of cataracts wherein the lens of the eye becomes cloudy, is yet another risk of vitrectomy. This can be managed easily through doctors who specialize in the treatment of cataracts.

In summary, vitrectomy is not entirely risk-free. However, the complications that may arise after surgery are all easily manageable and can be treated.

About the Author

Dr Jim Kokkinakis (Optometrist) graduated in 1983 from the Optometry School University of NSW. He is currently a Senior Lecturer there and regular speaker to both Optometrists and Ophthalmologists in Australia and Internationally. He has a specialist clinical practice in the Sydney CBD with interests in Eye Strain, Computer Vision problems, Treatment of Eye Diseases and complex Contact lens Fittings.

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