THE ROLE OF THE VITREOUS IN DIABETIC-RETINOPATHY

In recent years it has become evident that the vitreous must play a role in various aspects of diabetic retinopathy. The exact role of the vitreous is however in many aspects still ill defined. There are structural changes of the vitreous, as for instance vitreous liquefaction and posterior vitreous detachment, that are associated with the occurrence and earlier onset of diabetic retinopathy. Further there are angiogenic and angioinhibitory factors in the vitreous which influence neovascularisation by means of endothelial cell proliferation. Photocoagulation of the retina can cause structual changes (posterior vitreal detachment) and histological changes (increased hyalocytes activity) which can protect against the progression of proliferative diabetic retinopathy. The role of vitrectomy in protecting against proliferative diabetic retinopathy is generally concerned to be related to the removal of the vitreal scaffold. But vitrectomy can also induce changes in the oxygenation of the eye. If complete detachment of the posterior vitreous can be achieved it might be possible to further slow the progression of diabetic retinopathy. Conclusions It is possible that in the future manipulation of the vitreous by means of enzymes and lasers can play a role in the treatment and prevention of diabetic retinopathy.