Vitrectomy for Proliferative Diabetic Retinopathy with Asteroid Hyalosis: Contemporary Outcomes and Challenges.

PURPOSE: To evaluate the diagnostic and therapeutic outcomes of pars plana vitrectomy (PPV) in eyes with proliferative diabetic retinopathy (PDR) complicated by asteroid hyalosis (AH) in the modern small-gauge era. METHODS: This retrospective series included 12 eyes of 12 patients with AH who underwent PPV for PDR-related complications between July 2023 and August 2025 at a county-based tertiary center. Data collected included systemic comorbidities, surgical indication, preoperative best-corrected visual acuity (BCVA), posterior vitreous detachment (PVD) status, intraoperative events, and postoperative outcomes. RESULTS: Mean age was 60.1 years (median 58.5; interquartile range [IQR] 51.3-66.5). All patients had diabetes; hypertension and hyperlipidemia were present in 91.7% and 66.7%. Surgical indications included vitreous hemorrhage in 9 eyes (75.0%) and tractional retinal detachment in 8 (66.7%). A spontaneous PVD was absent in 4 eyes (33.3%), and retinal breaks occurred in 6 (50.0%). At a mean of 10.7-month follow-up (median 8.5, IQR 5-12.3), 11 eyes (91.7%) remained attached. Final BCVA was 20/200 or better in 7 eyes (58.3%). CONCLUSION: AH increases vitreoretinal adhesion and intraoperative risk during PPV for PDR but does not preclude favorable anatomic outcomes with modern techniques. Fluorescein angiography is a valuable adjunct for detecting occult neovascularization and guiding timely surgical intervention when visualization is limited.