In the early stage of glycogen retinopathy there are no symptoms, the eyes are not red or painful, and the vision is normal, so it is often ignored by patients until the neovascularization ruptures and bleeds or causes a traction retinal detachment, and the vision suddenly and severely decreases, and patients only think of coming to the ophthalmology department. At this time, most patients miss the retinal laser timing, or do not have timely supplemental laser treatment (after total retinal photocoagulation to regularly review the fundus and timely supplemental laser) progression occurs to vitreous hemorrhage, retinal detachment, neovascular glaucoma, which can lead to blindness without timely treatment. The prognosis of advanced diabetic retinopathy cannot be generalized. Patients should undergo a detailed examination at the earliest possible time at a qualified hospital in order to fully assess the extent of the lesion and the functional status of the retina, weigh the pros and cons, and decide whether to operate. Patients are recommended to undergo fundus fluorescence angiography, the results of which are important for doctors to determine the severity of the lesion and guide the next step of treatment. Timely laser and surgical treatment is able to save most diabetic patients from blindness. Retinal laser photocoagulation can be performed on an outpatient basis based on strict glycemic control. Surgical treatment includes vitrectomy, intraocular injection, laser, etc. The surgeon must be specially trained and have very skilled clinical experience in ocular microsurgery and laser treatment. Modern vitrectomy has now made it possible to cure many “incurable” diseases and has enabled thousands of blind people to see again. After surgery, patients can usually see very well and walk freely on their own. Sometimes, the operated eye regains enough vision to allow the patient to read or drive again. Vitrectomy The vitrectomy procedure originated in the early 1970s, using a special trocar needle to puncture directly into the white eye, creating the required access to the vitreous cavity through three pinholes to perform the procedure. From 17G to 20G, 23G, 25G, the era of minimally invasive surgery, the incision is getting smaller and smaller, there is higher cutting frequency and suction force, the incision is able to close by itself, avoiding sutures, the postoperative inflammatory reaction is light, and the bosch cutter head enters the vitreous cavity to remove intravitreal blood clots, hyperplastic fibrous membrane, and reduce retinal pulling and peeling to facilitate retinal repositioning. If the retinal wrinkles are too severe to be repositioned, retinopexy may be performed. Inert gas or silicone oil may be used to fill the vitreous cavity instead, and then retinal laser photocoagulation may be performed to strengthen the fibrous adhesion between the retina and adjacent tissues, inhibit the vascular deterioration of the lesion area, stop the development of retinal lesions, and save the visual function of most patients. If the patient has severe cataract, cataract ultrasonic emulsion resection combined with trans-flat vitrectomy can be performed in combination. Vitrectomy is indicated for severe vitreous hemorrhage, retinal detachment, dense preretinal hemorrhage and pre-macular fibrous membrane, and neovascularization into the vitreous cavity that should be operated as early as possible; cataract combined with vitreous hemorrhage, hemolytic glaucoma, etc. Pre-operative examination: 1. Systemic examination: Before surgery, ask endocrinology or internal medicine doctor to help control blood sugar, and give corresponding treatment for combined hypertension and cardiovascular disease. Patients who have been on hemodialysis should seek the advice of a nephrologist for the schedule of surgery. Young patients often need to use insulin to prevent ketosis. Those with blood glucose above 300 or combined with ketosis are not able to undergo surgery. 2. Eye examination:A detailed eye examination should be performed before surgery, including visual acuity, intraocular pressure, atrial angle, lens, iris, vitreous and retina. Fluorescein fundus angiography can understand the extent of retinal neovascularization. If the vitreous is cloudy and the fundus cannot be seen clearly, ultrasound and electrophysiological examination should be performed to assist in determining retinal function and morphology. Post-operative precautions: For simple removal of vitreous hemorrhage, post-operative prone position is not required and the patient can be discharged in a few days. However, immediate exercise and physical work should be avoided to avoid rebleeding. Patients injected with inert gas or silicone oil should be placed on their stomachs after surgery to allow the gas or silicone oil to float and hold the retina to facilitate its repositioning, which can be unbearable for the patient, who has to lie on his stomach for 24 hours a day, without great endurance and perseverance. All patients should follow the doctor’s orders for regular post-operative review and, if necessary, laser supplemental photocoagulation. Sometimes after 1 to 2 months of gas absorption, the retina may hemorrhage or peel again, and the ophthalmologist may recommend reoperation, including simpler blood-gas replacement, intravitreal injection of anti-vascular endothelial growth factor, or more complex vitrectomy.