Diabetic Retinopathy Requiring Vitrectomy: Epidemiology and Pathology
DOI:
https://doi.org/10.48047/t1qjte98Keywords:
Diabetic Retinopathy, Vitrectomy, PDR.Abstract
Diabetic retinopathy (DR) is a chronic microvascular complication of diabetes mellitus and remains one of the leading causes of preventable blindness worldwide, particularly among individuals of working age. As global diabetes prevalence rises, the burden of DR is also increasing, with estimates indicating that over one-third of diabetic patients develop some form of retinopathy, and nearly 7% progress to the proliferative stage (PDR). Proliferative diabetic retinopathy is characterized by retinal ischemia-induced neovascularization, where fragile new blood vessels form on the retinal surface or optic disc. These vessels often extend along the posterior hyaloid, accompanied by fibrovascular tissue that may contract and exert traction on the retina, leading to tractional retinal detachment (TRD). Persistent or recurrent vitreous hemorrhage and macula-threatening TRD are the most common indications for pars plana vitrectomy (PPV) in diabetic patients. The pathological mechanisms leading to the need for surgical intervention involve a cascade of metabolic and vascular changes triggered by chronic hyperglycemia. These include capillary basement membrane thickening, pericyte loss, increased VEGF expression, and breakdown of the inner blood-retinal barrier, all of which contribute to neovascular complications and vision loss. Surgical management, particularly vitrectomy, plays a critical role in preventing irreversible blindness in advanced DR. However, surgical outcomes depend on multiple factors such as the extent of macular involvement, duration of detachment, systemic glycemic control, and presence of other ocular comorbidities.
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