Proliferative diabetic retinopathy: fewer complications with early surgery
Main Article Content
Keywords
Vitrectomy, Diabetic Retinopathy, Diabetes Complications, Blindness, Laser Coagulation
Abstract
Abstract
Legal blindness due to proliferative diabetic retinopathy (PDR) in patients with diabetes mellitus can be preventable if detected and treated in a timely manner. Although vitrectomy has traditionally been reserved for complicated cases, advances in surgical techniques and a better understanding of pathophysiology have driven its evaluation as an early or preventive strategy in selected patients. This article presents a systematic review in PubMed (2020-2025), with an emphasis on classic studies, on the safety and efficacy of vitrectomy as an early intervention in patients with PDR, before the onset of major complications, using the keywords “diabetic vitrectomy,” “proliferative diabetic retinopathy,” “retinal diseases,” and “vitreous hemorrhage”. Most of the specific evidence in Mexican or Latin American populations is limited, which is why general evidence used as a reference in the region was also included. Studies published in English and in open-access were included. The reviewed studies consistently report that early vitrectomy helps maintain or improve visual acuity during follow-up, reduces progression to severe complications, and shows low rates of intraoperative adverse events. It is concluded that early vitrectomy in selected patients with PDR represents a safe and effective strategy with the potential to preserve vision and alter the natural history of the disease. However, prospective multicenter clinical trials are needed to establish standardized selection criteria and validate its long-term impact.
References
1. American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2025. Diabetes Care. 2025;48(1 Suppl 1):S27-49. doi: 10.2337/dc25-S002
2. Dirección General de Epidemiología. Informe Trimestral Sistema de Vigilancia Epidemiológica Hospitalaria de Diabetes Mellitus Tipo 2. México: Secretaría de Salud; 27 de febrero de 2025. Disponible en: https://www.gob.mx/salud/acciones-y-programas/direccion-general-de-epidemiologia
3. Hurley JB. Retina Metabolism and Metabolism in the Pigmented Epithelium: A Busy Intersection. Annu Rev Vis Sci. 2025;7:1-20. doi: 10.1146/annurev-vision-100419
4. Zhang C, Gu L, Xie H, et al. Glucose transport, transporters and metabolism in diabetic retinopathy. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 2024;1870(3):166995. Disponible en: https://www.sciencedirect.com/science/article/pii/S0925443923003617?via%3Dihub
5. Jampol LM, Glassman AR, Sun J. Evaluation and Care of Patients with Diabetic Retinopathy. N Engl J Med. 2020;382(17):1629-37.
6. Alsoudi AF, Wai KM, Koo E, et al. Initial Therapy of Panretinal Photocoagulation vs Anti-VEGF Injection for Proliferative Diabetic Retinopathy. JAMA Ophthalmol. 2024;142(10):972-5.
7. Shaikh N, Kumar V, Ramachandran A, et al. Vitrectomy for cases of diabetic retinopathy. Indian J Ophthalmol. 2024;72(12):1704. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11727963/
8. Tan SZ, Steel DH, Stanzel B V, et al. Safety and effectiveness of pre-emptive diabetic vitrectomy in patients with severe, non-fibrotic retinal neovascularisation despite panretinal photocoagulation. Eye. 2022;37(8):1553. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10219936/
9. Anguita R, Ferro Desideri L, Schwember P, et al. Early Versus Delayed Vitrectomy for Vitreous Hemorrhage Secondary to Proliferative Diabetic Retinopathy. Am J Ophthalmol. 2025;270:237-44. Disponible en: https://www.ajo.com/action/showFullText?pii=S0002939424004884
10. Patel NC, Hsieh YT, Yang CM, et al. Vitrectomy for diabetic retinopathy: A review of indications, techniques, outcomes, and complications. Taiwan J Ophthalmol. 2024;14(4):519. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11717329/
11. Berrocal MH. The benefits of early surgical intervention for diabetic retinopathy: modern tools and techniques make vitrectomy an important early treatment option. Retina Today. 2021;16(6). Disponible en: https://retinatoday.com/articles/2021-sept/the-benefits-of-early-surgical-intervention-for-diabetic-retinopathy
12. Berrocal MH, Acaba-Berrocal L, Acaba AM. Long-Term Outcomes of Same Patient Eyes Treated with Pars Plana Vitrectomy in One Eye and Conventional Treatment in the Other for Complications of Proliferative Diabetic Retinopathy. J Clin Med. 2022;11(18):5399. doi: 10.3390/jcm11185399
13. Confalonieri F, Barone G, Ferraro V, et al. Early versus Late Pars Plana Vitrectomy in Vitreous Hemorrhage: A Systematic Review. J Clin Med. 2023;12(20):6652. doi: 10.3390/jcm12206652
14. Chen SN, Chen SJ, Wu TT, et al. Refining vitrectomy for proliferative diabetic retinopathy. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2023 Dec 1;261(12):3659. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10667443/
15. Papavasileiou E, Vasalaki M, Garnavou-Xirou C, et al. Vitrectomy with fibrovascular membrane delamination for proliferative diabetic retinopathy with or without preoperative Avastin. Hell J Nucl Med. 2017;20(Suppl):161. doi: 10.1111/j.1755-3768.2017.02313
16. Tan Y, Fukutomi A, Sun MT, et al. Anti-VEGF crunch syndrome in proliferative diabetic retinopathy: A review. Surv Ophthalmol. 2021;66:926-32. doi: 10.1016/j.survophthal.2021.03.001
17. Dervenis P, Dervenis N, Smith JM, et al. Anti-vascular endothelial growth factors in combination with vitrectomy for complications of proliferative diabetic retinopathy. Cochrane Database Syst Rev. 2023;5(5):CD008214. doi: 10.1002/14651858.CD008214.pub4
18. Chatziralli I, Loewenstein A. Intravitreal Anti-Vascular Endothelial Growth Factor Agents for the Treatment of Diabetic Retinopathy: A Review of the Literature. Pharmaceutics. 2021;13(8):1137. doi: 10.3390/pharmaceutics13081137
19. Bahr TA, Bakri SJ. Update on the Management of Diabetic Retinopathy: Anti-VEGF Agents for the Prevention of Complications and Progression of Nonproliferative and Proliferative Retinopathy. Life (Basel). 2023;13(5):1098. doi: 10.3390/life13051098
20. Trujillo-Sanchez GP, Gonzalez-De La Rosa A, Navarro-Partida J, et al. Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian J Ophthalmol. 2018;66(8):1136-40. doi: 10.4103/ijo.IJO_289_18
21. Verma S, Shiny H, Azad SV, et al. Evaluation of twenty-seven-gauge vitrectomy for complex proliferative diabetic retinopathy. Oman J Ophthalmol. 2023;16(1):18-22. doi: 10.4103/ojo.ojo_348_21
22. Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology. 2010;117:93-102.e2. doi: 10.1016/j.ophtha.2009.06.043
23. Trujillo-Sanchez GP, Gonzalez-De La Rosa A, Navarro-Partida J, et al. Response to comment on: Feasibility and safety of vitrectomy under topical anesthesia in an office-based setting. Indian Journal of Ophthalmology. 2019;67(1):182-3. doi: 10.4103/ijo.IJO_1516_18
24. Nishigushi R, Usui-Ouchi A, Sakanishi Y, et al. Outcomes, efficacy and risk factors of 27-Gauge vitrectomy for diabetic tractional retinal detachment in Japanese patients. Jpn J Ophthalmol. 2025;69(1):59-65. doi: 10.1007/s10384-024-01135-6
25. Ohara H, Torikai T, Takeuchi J, et al. Comparison of 27-Gauge to 25-Gauge Vitrectomy in Patients with Tractional Retinal Detachment Associated with Proliferative Diabetic Retinopathy. J Clin Med. 2025;14(7):2533. doi: 10.3390/jcm14072533
26. Xiang W, Fang D, Jiang X, et al. 27 Gauge vitrectomy vs. 25 gauge vitrectomy in the management of proliferative diabetic retinopathy with preoperative intravitreal injection of conbercept. Exp Ther Med. 2023;26(4):472. doi: 10.3892/etm.2023.12171
27. Béjar-Cornejo F, Robredo-Torres V. Electrorretinograma estandarizado en pacientes sometidos a vitrectomía por retinopatía diabética proliferativa avanzada. Revista Mexicana de Oftalmología. 2014;88(1):16-9. doi: 10.1016/j.mexoft.2014.04.002
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.