[Proliferative diabetic retinopathy: vitreo-retinal complications are often related to insufficient retinal photocoagulation].
BACKGROUND
Panretinal photocoagulation proved to be effective in preventing complications related to vasoproliferative diabetic retinopathy. Surgery is most often a last resort in cases of recurrent or persistent vitreous hemorrhage or retinal detachment. The aim of our study is to point out that eyes requiring surgery for complications related to vasoproliferative diabetic retinopathy are often insufficiently photocoagulated.


METHODS
Retrospective analysis of operating protocols and surgical results for a series of 39 eyes of 36 patients with complications of vasoproliferative diabetic retinopathy.


RESULTS
The mean age at the intervention was 57 years. Eighty-five percent of the eyes had a vitreous hemorrhage, 17% a retinal detachment. Eighty-five percent of the eyes had undergone a partial retinal photocoagulation before surgery. All eyes underwent a vitrectomy with segmentation of fibrovascular membranes. In 85% of the eyes studied, endolaser photocoagulation was necessary, sometimes even in the mid-periphery. After 39+/-26 months of postoperative follow-up, 97% of eyes showed improvement of the anatomical state of the retina and improvement or stabilization of visual acuity.


CONCLUSIONS
Our results confirm the benefit of vitreoretinal surgery in complications related to vasoproliferative diabetic retinopathy. Moreover, it should be emphasized that complications requiring surgery often result from incomplete preoperative photocoagulation. To be effective, photocoagulation has to destroy more than 35% and up to 50% of photoreceptors. An intraoperative laser extension can reduce the risk of regrowth of fibrovascular membranes.
Hôpitaux Universitaires Genevois, Clinique d'Ophtalmologie, 22 rue Alcide-Jentzer, 1211 Genèva 14, Switzerland.
M
M
Zaninetti
I K
IK
Petropoulos
C J
CJ
Pournaras
D003930:Diabetic Retinopathy / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D008028:Light Coagulation / Q000592:standards; D008297:Male; D008875:Middle Aged; D015861:Retinal Neovascularization / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies