An Overview on Surgical management of Tractional Retinal Detachment

Abstract

Tractional retinal detachment (TRD) is a serious ophthalmic condition characterized by the separation of the neurosensory retina from the underlying retinal pigment epithelium due to vitreoretinal traction, often caused by fibrovascular proliferations. It is most commonly associated with proliferative diabetic retinopathy (PDR), retinopathy of prematurity, sickle cell retinopathy, and ocular trauma. The primary goal of surgical intervention in TRD is to relieve the pathological traction and reattach the retina to restore or preserve visual function. Pars plana vitrectomy (PPV) is the standard surgical approach for managing TRD. This procedure involves the removal of the vitreous gel and fibrovascular membranes, allowing the retina to relax and reattach. The surgery may also include membranectomy, endolaser photocoagulation, and the use of tamponade agents such as gas (SF6 or C3F8) or silicone oil, depending on the complexity of the detachment and the risk of reproliferation. Advances in microsurgical techniques and instrumentation, such as small-gauge vitrectomy (25- or 27-gauge systems), wide-angle viewing systems, and intraoperative optical coherence tomography (OCT), have significantly improved the safety and anatomical success rates of TRD repair. Despite these advancements, visual outcomes remain variable and are often limited by the chronicity of the detachment, macular involvement, and the presence of ischemia or neovascular complications. Early diagnosis and timely surgical intervention are critical in improving prognostic outcomes, particularly in diabetic patients where TRD is a common and vision-threatening complication.