I was diagnosed, apparently early, with proliferative retinopathy last summer, and had four laser treatments on both eyes. A few months later, I woke up with a floater in my right eye and had a couple of bleeds in that eye. I had more laser done but in the front half of the eye, and my eye doctor said I could have a vitrectomy. The blood has been absorbed, but he is saying that I may want to remove the gel to prevent a detachment. The decision is up to me. I’m not an eye doctor, so I don’t know what to do. I also may have to move to another city in a few weeks for a new job, and I’m wondering if I should get this vitrectomy before I start my new job? I had this bleed three months ago, and have not had a problem since. My blood sugars are great and I am now on an ace inhibitor and have low to normal blood pressure. I also have had some small flashes on the right side of my right eye. I rushed to the hospital and they said nothing had happened.

I’m pretty confused and scared. I also don’t know if I should accept this job, especially if I’m going to have to deal with bleeds and different problems like this for the rest of my life? Does this ever stabilize?

The largest study of vitrectomy in proliferative diabetic retinopathy (PDR) was completed in 1983, called the “diabetic retinopathy vitrectomy study” (DRVS). This study was designed to ascertain which patients benefit most from vitrectomy, and the conclusions were that the following types of patients benefited: (1) patients with a recent and severe vitreous hemorrhage obstructing vision in one eye, particularly when there was already poor vision in the other eye (vitrectomy sped up the rate of visual recovery and allowed these patients to function sooner); (2) patients with “severe” (high risk) fibrovascular scar tissue due to PDR, even with good vision in the affected eye. In both these instances, vitrectomy resulted in better vision on the eye chart at two and four years follow-up.

Based on your self-description, it sounds as if you are not in the first category, and you may or may not be in the second category. You need to ask your specialist this question directly. If scar tissue is tugging on your retina sufficiently (“traction”), it could cause a retinal detachment, and blindness, now, or at a later date; although this often can be surgically repaired, the surgery is technically difficult and outcomes are not always good. I would ask your doctor point blank what he/she would do if he/she were in your shoes, or if you were his sister. If you are not comfortable with the answer, I would seek a second opinion. In my opinion, it is best to be followed after vitrectomy surgery by the person doing the surgery, so if you elect to proceed you would be better off getting established in your new city.

It is important to know that many patients without vitrectomy do have a degree of retinal traction and never develop a detachment (myself included, 20 years after having laser treatment for PDR), and that vitrectomy surgery itself does have risks, including loss of vision. The decision to have a vitrectomy procedure for proliferative diabetic retinopathy is complicated, and I am sorry your retinal specialist was not able to give you more personalized guidance. I hope my explanation arms you with some information upon which you can ask the necessary, tough questions.

PC