Current Management of Combined Traction/Rhegmatogenous Retinal Detachments

Due to proliferative diabetic retinopathy (PDR) and related complications, 25% of diabetic patients experience significant visual impairment. Panretinal argon laser photocoagulation (PRP) and the use of vascular endothelial growth factors (VEGF) in recent years have reduced the frequency of visual loss and tractional retinal detachment (TRD) and combined tractional/rhegmatogenous retinal detachment (CTRD). TRD and CTRD are the primary indications for vitreoretinal surgery related to PDR. TRD and CTRD which elevate macula less than 6 months, rapidly progressive and threatening macula are the other important indications to vitreoretinal surgery in diabetic retinopathy. CTRD, which was almost inoperable in previous years, now it takes place in the indications to vitreoretinal surgery by the development of new surgical equipment (vertical and horizontal scissors, light systems, diamond knives, trocar systems, etc.) and new surgical techniques (segmentation, visco-dissection, en-block dissection). Small calibered (23, 25, 27 Gauge) vitrectomy probes shortened the duration of vitreoretinal surgery in TRD and CTRD cases. Preoperative anti-VEGF treatment inhibits the fibrovascular tissue activation in this way facilitates and enables a safe surgery. As long as the vitreoretinal surgery equipment and technics improved, the functional and anatomical success in CTRD and TRD will increase.