Diabetic vitrectomy: risks, prognosis, future trends.
OBJECTIVE
We review the current standards, risks, prognosis, and indications for diabetic pars plana vitrectomy and consider recent developments in surgical techniques. We also examine surgery's role as a treatment modality for diabetic eye disease among the other accepted and developing treatment options, such as systemic and intravitreal pharmacotherapy.


RESULTS
Pars plana vitrectomy for diabetic macular edema and for traction retinal detachment is addressed. Techniques to decrease retinal swelling and ischemia are showing promising results. The use of the smaller 25-gauge and 23-gauge vitrectors is gaining acceptance and offers advantages such as less trauma, less postoperative discomfort, and quicker healing. Techniques are being developed and refined to help prevent postoperative vitreous hemorrhage using cryotherapy around sclerotomy sites and/or endolaser in a near-confluent pattern in an effort to quell fibrovascular ingrowth and subsequent hemorrhage. Finally, pharmacological advances include targeting three levels of intervention: achieving the best glycemic control, correcting altered retinal metabolism secondary to increased glucose availability, and employing neuroprotective and vasoprotective agents.


CONCLUSIONS
The combination of therapies and interventions as they improve and evolve offers the potential to revolutionize the approach to the complications of diabetic eye disease and may soon render many current interventions obsolete. Diabetic pars plana vitrectomy continues to advance with better anatomic and visual success.
Mason
John O
JO
Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Callahan Eye Foundation Hospital, Birmingham, Alabama 35233, USA.
Colagross
Cheri T
CT
Vail
Rachel
R
D003930:Diabetic Retinopathy / Q000601:surgery*; D006801:Humans; D008269:Macular Edema / Q000601:surgery; D011379:Prognosis; D012307:Risk Factors; D014821:Vitrectomy / Q000009:adverse effects* / Q000639:trends*