THE ROLE OF THE VITREOUS IN DIABETIC-RETI NOPATHY

In recent years it has become evident that the vitreous must play a ro le in various aspects of diabetic retinopathy. The exact role of the v itreous is however in many aspects still ill defined. There are struct ural changes of the vitreous, as for instance vitreous liquefaction an d posterior vitreous detachment, that are associated with the occurren ce and earlier onset of diabetic retinopathy. Further there are angiog enic and angioinhibitory factors in the vitreous which influence neova scularisation by means of endothelial cell proliferation. Photocoagula tion of the retina can cause structual changes (posterior vitreal deta chment) and histological changes (increased hyalocytes activity) which can protect against the progression of proliferative diabetic retinop athy. The role of vitrectomy in protecting against proliferative diabe tic retinopathy is generally concerned to be related to the removal of the vitreal scaffold. But vitrectomy can also induce changes in the o xygenation of the eye. If complete detachment of the posterior vitreou s can be achieved it might be possible to further slow the progression of diabetic retinopathy. Conclusions It is possible that in the futur e manipulation of the vitreous by means of enzymes and lasers can play a role in the treatment and prevention of diabetic retinopathy.