Pharmacological adjuvants for diabetic vitrectomy surgery

Table 1 Summary of pharmacological adjuvants used in patients with advanced diabetic eye disease requiring vitrectomy

Stage of vitrectomy	Objective	Adjuvants used
Before vitrectomy	To differentiate between tractional and non-tractional DME	Intravitreal anti VEGF agents
		Intravitreal TA
During vitrectomy	Facilitation of intraoperative posterior cortical vitreous separation	Use of autologous plasmin enzyme
		Use of intravitreal TA
	Dissection of ERM and ILM	Use of intravitreal pharmacological agents such as TA, Tryphan blue and Brilliant blue G
	Dissection of proliferative membranes	Use of intravitreal pharmacological agents such as TA, Tryphan blue and Brilliant blue G
		Blunt dissection with the use of intravitreal viscoelastic
	Minimizing the intraoperative bleed	Use of pre-operative intravitreal anti VEGF agents
		Use of intraoperative perfluorocarbon liquid or performing fluid air-exchange
		Intraoperative fibrin glue
After vitrectomy	Treatment of recurrent vitreous hemorrhage	Intravitreal anti VEGF agent
		Repeat fluid air exchange and gas endotamponade

DME: Diabetic macular edema; VEGF: Vascular endothelial growth factor; TA: Triamcinolone acetonide; ERM: Epiretinal membrane; ILM: Internal limiting membrane.