Vitrectomy for Proliferative Diabetic Retinopathy with Asteroid Hyalosis: Contemporary Outcomes and Challenges.

Source: PubMed, NCBI / U.S. National Library of Medicine

To evaluate the diagnostic and therapeutic outcomes of pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR) complicated by asteroid hyalosis (AH) in the modern small-gauge era. This retrospective series included 12 eyes of 12 patients with AH who underwent PPV for PDR-related complications between July 2023 and August 2025 at a county-based tertiary center. Data collected included systemic comorbidities, surgical indication, preoperative best-corrected visual acuity (BCVA), posterior vitreous detachment (PVD) status, intraoperative events, and postoperative outcomes. Mean age was 60.1 years (median 58.5; interquartile range [IQR] 51.3-66.5). All patients had diabetes; hypertension and hyperlipidemia were present in 91.7% and 66.7%. Surgical indications included vitreous hemorrhage in 9 eyes (75.0%) and tractional retinal detachment in 8 (66.7%). A spontaneous PVD was absent in 4 eyes (33.3%), and retinal breaks occurred in 6 (50.0%). At a mean of 10.7-month follow-up (median 8.5, IQR 5-12.3), 11 eyes (91.7%) remained attached. Final BCVA was 20/200 or better in 7 eyes (58.3%). AH increases vitreoretinal adhesion and intraoperative risk during PPV for PDR but does not preclude favorable anatomic outcomes with modern techniques. Fluorescein angiography is a valuable adjunct for detecting occult neovascularization and guiding timely surgical intervention when visualization is limited.