The second complication of proliferative diabetic retinopathy is the development of a detachment of the retina.

This is because the new vessels grow on to the surface of the vitreous and create a scar tissue scaffold. This scaffolding then contracts and the retina is gently eased away from its normal position. This condition is known as a tractional retinal detachment. Not all tractional retinal detachments need treatment.

Some may be stable but others are considered to be at risk of progressing to involve the macula. The macula is the central part of the retina and provides the finest quality vision; it is the bit with which you read and recognise faces. A tractional retinal detachment which either involves or threatens to involve the macula will require a vitrectomy operation.

The aim of the operation is to relieve the pull on the retina by carefully dissecting the fibrous tissue from its surface thereby allowing the retina to sit back into place. Such operations are quite difficult and a hole may be created in the retina. In such circumstances a gas bubble is inserted in the eye in order to splint the retina in place until such time as laser treatment has welded the retina back into place.

Gas bubbles absorb spontaneously over 2-8 weeks depending on the type which is used. The results of surgery for tractional detachment depend on many factors including whether the macula (the central part of the retina) has been involved in the detachment and if so for how long. Some patients who develop a tractional detachment have also sustained quite marked diabetic damage to the functioning of the retina and accordingly would not be expected to regain entirely normal reading vision afterwards.

The benefits of surgery for a tractional retinal detachment usually, however, outweigh the risks of infection, haemorrhage and retinal detachment. It is also vitally important that individuals undergoing vitrectomy surgery realise that they must not fly until such time as any gas bubble which has been used has been fully absorbed.





Pic : A severe diabetic tractional retinal detachment, the silvery white tissue is pulling on the retina which has been gently pulled out of position. Surgery was able to restore a more normal anatomy and improve vision.