Viscodissection for Tractional Fibrotic Proliferative Diabetic Retinopathy

31-year-old man with bilateral PDR in a fibrosis stage. During the preoperative exploration, preretinal fibrosis bands associated with hemovitreous and a tractional retinal detachment near the posterior pole was observed in the left eye (OS). Using a Constellation® system (Alcon, Forth Worth, Texas, USA), a monomanual 25G vitrectomy technique was performed and the release of the vitreoretinal tractions was assisted by the injection of a high molecular weight, pseudoplasticity and surface tension subhyaloid viscoelastic, in a 10mg/ml concentration (Provisc®). Initially, using a Grieshaber® pic, a small opening between the hyaloid fibrotic tissue and the preretinal space was made until the delamination plane was found. Subsequently, Provisc® was injected through the hyaloid opening using a silicone-tipped suction cannula, thus achieving a correct separation of both planes. The same maneuver was repeated in two other peripheral traction zones of the retina. Next, the PVD was induced, isolating the greater vitreoretinal fibrotic areas by cutting and segmenting the better attached tissue. Before a silicone oil tamponade, a complete panphotocoagulation of the untreated areas was performed and an A-VEGF was injected into the vitreous cavity.