All patients with diabetes should have their retina examined once a year to look for signs of retinopathy. Early laser treatment can prevent progression of retinopathy and prevent loss of vision.
Vitrectomy Eye Surgery for Diabetes
Unfortunately, many patients with diabetes are unaware of this and only seek help when the have lost their eye sight. I have come across many young patients with severe diabetic retinopathy in both eyes that cannot be treated with laser.
This is because there is blood in the eye that prevents the laser beam from entering the eye or there is retinal detachment present. The only option left to try to save the eye sight is to carry out vitrectomy surgery.
Surgery for diabetic retinopathy is very challenging. This is because the retina of these patients are already damaged and have poor potential for vision. I often give an injection of Avastin (an anti-VEGF drug) into the eyeball of the patients 1 week before their operation.
This wonder drug causes rapid shrinking of any new blood vessels in the eye and reduces the chance of bleeding during surgery.
Advantages of Small Gauge Vitrectomy Surgery
I feel that the best approach for diabetic vitrectomy is to use the latest modern sutureless small gauge vitrectomy machines. Although the cost is slightly more expensive, it really makes my life as a surgeon easier.
It is also more comfortable for the patient post op as there are no sutures in the eye and recovery is quicker. Surgery aims to remove all blood in the eye and any scar tissue. This is easier said than done!
Very often, the scar tissue is very tightly stuck to the retina and you can easily cause damage to the retina. It is like trying to peel away two wet pieces of tissue paper that are stuck together. Surgery can often take more than 1 hour.
Surgery to Prevent or Repair Retinal Detachment
Once all scar tissue is removed, I often try to flatten the retina by putting air into the eye ball. I then perform extensive laser treatment to try to stick the retina down.
Sometimes, despite all my best efforts and the retina is reattached, the patient fails to see any improvement in vision. This is probably due to the fact that the eye has been deprived of oxygen and nutrients for too long.
It is of course much better to prevent severe diabetic retinopathy from occurring in the first place. A well organized local screening program for all diabetics is key to this as well as good control of the diabetes, lipids and blood pressure.