Changing indications and techniques for vitrectomy in management of complications of diabetic retinopathy.

During the past two decades, the number of diabetic patients requiring vitrectomy for nonresolving vitreous hemorrhage has decreased four-fold, whereas there has been a substantial increase in diabetic patients with traction and combined traction/rhegmatogenous retinal detachment (RD) requiring surgery. Additional contemporary surgical indications are progressive fulminant neovascular proliferation, massive preretinal hemorrhage, massive fibrin response, and progressive retrolental fibrovascular proliferation. Surgical techniques for management of tractional detachments have evolved from circumscription of tractional epicenters to en bloc removal of all proliferative tissue.