ABSTRACT
A firm grasp of the underlying pathophysiology and pathoanatomy of proliferative diabetic retinopathy (PDR) is crucial in understanding the surgical approach for diabetic vitrectomy. Significant advances in technique, in instrumentation, and in knowledge of the disease process have allowed the repair of more complex diabetic ocular complications, and consequently have expanded the vitrectomy indications for intervention in PDR. The creation of retinal breaks is one of the major complications related to surgical intervention for PDR. The more common subtype of broad vitreoretinal adhesion, which is associated with underlying retinal folds, develops as a consequence of a fibrotic posterior hyaloid between multiple focal adhesions that coalesce and contract. Vitrectomy surgery may lead to breakdown of the blood–retinal barrier, which can subsequently result in intraocular fibrin deposition and pupillary block. Treatment with panretinal photocoagulation and reattachment of rhegmatogenous retinal detachments will reduce the frequency of postoperative rubeosis, as well as cause its regression.
