Video Presentation

Diabetic tractional retinal detachment repair under challenging conditions

Video Details

First Author: F.March de Ribot SPAIN

Co Author(s):    P. Lopez Lizarraga   A. March de Ribot                          

Abstract Details



Purpose:

To share the experience and the challenge it represents for a surgeon the treatment of complex diabetic manifestations in the eye involving the anterior and posterior segment.

Setting:

University hospital, ophthalmology department

Methods:

Clinical and surgical case: A 57 years old patient with poorly controlled diabetes presented a neovascular glaucoma that was treated with glaucoma surgery. Once the intraocular pressure was stabilized the approach was reevaluated. The patient presented a superior temporal ahmed valve with the tube in the anterior chamber, prominent iris neovessels, bad dilation, retraction of the pupillary margin and a dense cataract. The echography detected vitreous opacities and a tractional retinal detachment. A combined surgery with phacoemulsification and vitrectomy were planned.

Results:

Cataract surgery was realized using trypan blue dye to stain the anterior capsule. The capsulorrhexis was difficult because of poor iris dilation. The cataract could be removed using a divide and conquer technique. An intraocular lens was placed in the bag. The posterior vitrectomy identified a vitreous hemorrhage and a tractional retinal detachment. Segmentation and delamination were realized. Endolaser was applied once the retina was flattened.

Conclusions:

Neovascular glaucoma and tractional retinal detachment represent an advanced diabetic damage in the eye. Dealing with these cases is a medical and a surgical challenge. Each case has to be evaluated individually to determine the best management. Medical treatment and a close follow up are very important to get the best result.

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