Abstract
Pars plana vitrectomy (PPV) is integral to the management of late complications in diabetic retinopathy. As a greater understanding of the pathophysiology of diabetic eye disease has developed, so the role of PPV has evolved. This article reviews the current indications for PPV in diabetes (vitreous haemorrhage, tractional retinal detachment and combined rhegmatogenous and tractional retinal detachment) and the evidence for potential future applications, such as in diabetic macular oedema. The role of pharmacological adjuncts, such as antivascular endothelial growth factor (VEGF) agents, to reduce intraocular complications, improve success rates and minimise post-operative complications is examined. Drug-induced vitreolysis as a tool in achieving complete vitreoretinal separation, thus reducing progression of diabetic retinopathy, is discussed. It has already become routine practice for endolaser photocoagulation to be employed during PPV and, in the future, vitreolytic and antiproliferative agents may also be important as adjuncts to achieve good outcomes.
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