Surgical Management of Tractional Retinal Detachments in Proliferative Diabetic Retinopathy

There have been significant recent advances in the management of diabetic tractional retinal detachments. Pre-operative intravitreal bevacizumab causes regression of active vessels and less intraoperative hemorrhage, small-gauge vitrectomy has dramatically changed how segmentation and delamination are performed, and bimanual surgery and viscodissection offer additional options. Intraoperative bevacizumab may decrease the incidence of postoperative vitreous hemorrhage. Single surgery success rates are generally >85 % with final anatomic success rates approaching 100 %. Useful vision (VA ≥ 20/100) is attained in <40 % of patients in most series while ambulatory vision (VA ≥ 5/200) is attained in <80 % patients in most series. No light perception/light perception only vision occurs in <10 % patients while recurrent hemorrhage occurs in approximately one-third of patients.