Abstract
Ischaemic diabetic retinopathy maybecomplicated bymultiple outgrowths offibrovascular tissue onto theretinal surface within themostcortical part ofthe vitreous gel,typically alongthemajorvascular arcades andnasal totheoptic disc. Tangential traction, exerted bycontraction ofthecoalescent epiretinal membranes, results indistortion, folding, and detachment oftheunderlying retina. Thisprocess is frequently exacerbated by traction alongthe detached posterior hyaloid interface between the vitreous baseanteriorly and theepiretinal membranes intowhichthegelisincarcerated posteriorly (anteroposterior traction) orbetween individual sitesof fibrovascular proliferation (bridging traction). A retinal break, usually sited immediately peripheral totheavulsed edgeofa posterior fibrovascular membrane,may also contribute toretinal separation byallowing exchange offluid between theretrohyaloid andsubretinal spaces. Thefovea, which isusually free ofoverlying vasoproliferation, mayeventually become detached, with consequent serious impairment ofvision. Closed microsurgical techniques canbeusedtoeliminate eachoftheelements ofvitreoretinal traction described aboveandtosealretinal breaks, thus allowing themacular retina toreattach withsome restoration ofcentral visual function. Wepresent the results ofclosed microsurgery performed fordiabetic traction macular detachment intheSurgical Vitreoretinal UnitatMoorfields EyeHospital. Thesurgical prognosis iscorrelated withtheextent ofpreoperative epiretinal fibrovascular proliferation.
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