Vitrectomy for Combined Rhegmatogenous and Tractional Retinal Detachment

A 38-year-old patient with poorly controlled diabetes presented with bilateral retinal detachments. Surgery was performed the better-seeing right eye that had a visual acuity of 20/200 and a rhegmatogenous component. Her proliferative diabetic retinopathy (PDR) was highly vascular with large islands of active neovascularization elsewhere (NVE), therefore pre-operative bevacizumab was administered 2 days prior to surgery to decrease intra- and post-operative hemorrhage. Combined rhegmatogenous/tractional retinal detachment (RRD/TRD) cases can be more challenging due to a mobile retina and less counter traction for membrane peeling. However, the vitrector probe can be used for the majority of the surgery to segment and delaminate the broad plaques of fibrotic NVE with minimal need for intraocular forceps or peeling. Newer vitrectomy probes with beveled tips allow closer approximation to the retina and access to the dissection plane beneath the fibrotic NV. The causative break for the RRD was used as the primary drainage retinotomy to flatten the bullously detached retina. Short-acting SF6 gas with 1 week facedown positioning was utilized. The patient's visual acuity improved to 20/50 at 1-month post-op.

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