Careful planning needed to perform diabetic vitrectomy
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WAIKOLOA, Hawaii — Rishi P. Singh, MD, provided management tips on diabetic vitrectomy at Retina 2022.
“We have evolved greatly our techniques in the past few years,” Singh said. “Preoperative anti-VEGF makes a huge difference in the surgical time.”
According to Singh, when performing these surgeries, “You really have to have a good surgical plan prior to entry. You have to know when to intervene at the right time, and less is always more in these cases.”
Singh said he thinks surgeons may spend a lot of time filling nasal hyaloid and nasal fibrotic areas, which does not make a difference to the ultimate outcome.
In terms of preoperative evaluation, Singh said it is important for the surgeon to realize what he or she is getting into. A medical assessment of comorbidities, blood pressure and medications is recommended.
“We find a lot of patients on these newer [antiplatelet] drugs that have severe bleeding episodes after surgery, and therefore they should maybe be held, if possible,” Singh said.
The patient’s potassium level should be evaluated on the day of surgery because that could lead to cardiac arrhythmias. Scheduling dialysis is also important, he said. Dialysis should be done at least 1 day before or 1 day after surgery.
Singh said that surgeons should not feel bad about leaving tissue behind.
“You don’t want to leave macular tissue behind, but certainly, you can leave nasal, temporal, inferior tissue behind, so long as you can laser in and around it,” he said. “I think people forget that, and they tend to be a little bit aggressive in these cases. There’s really not a nice way of doing these elegantly.”
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Singh RS. Diabetic tractional detachments: Surgical management tips. Presented at: Retina 2022; Jan. 15-21, 2022; Waikoloa, Hawaii.
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