Addressing blood pressure key before diabetic tractional retinal detachment surgery
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WAILEA, Hawaii — Addressing blood pressure and other underlying health concerns is critical to get the best outcomes in diabetic tractional retinal detachment surgery, according to a speaker at Retina 2024.
Sunil K. Srivastava, MD, said the most important part of successful surgery has little to do with the retinal surgeon.
Image: Adobe Stock
“It has absolutely everything to do with the primary care doctor, the cardiologist and the kidney specialist,” he said. “In these incredibly sick eyes, these are incredibly sick patients. You need to take the time and make sure that they’re ready for surgery.”
Blood pressure control is vital, Srivastava said, and is a common reason for surgery cancellation or negative postoperative events.
Surgeries for about 12% of patients scheduled for pars plana vitrectomy for proliferative diabetic retinopathy are canceled on the same day, with more than half secondary to blood pressure elevation. Elevated blood pressure is also a risk factor for postoperative rebleed and perioperative cardiovascular death.
Preparing these patients for surgery means setting up cardiac and renal assessments, getting them on anticoagulation medication and counseling them on the importance of adhering to their blood pressure management.
Many of these patients have not had access to the care they need, but rushing them to surgery can cause even more harm. In almost every case, surgeons have time to pause and address issues before continuing to the operating room.
“For a lot of these patients, I ask them to buy in,” Srivastava said. “You’ve got to give me some time to get ready for surgery so you can have, ultimately, the best outcomes.”
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Srivastava SK. How I manage diabetic tractional retinal detachments. Presented at: Retina 2024; Jan. 13-19, 2024; Wailea, Hawaii.
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