Anterior Hyaloid Fibrovascular Proliferation

A 64-year-old diabetic lady underwent pars plana vitrectomy in her left eye for a taut posterior hyaloid face due to proliferative diabetic retinopathy (PDR). Visual acuity (VA) at baseline had been 20/120. She had previously received panretinal laser photocoagulation (PRP) and the retinopathy had been stable, but there was localized extrafoveal tractional retinal detachment in the inferonasal quadrant. After vitrectomy, she was discharged in good condition, VA of 20/400 and mild vitreous hemorrhage (VH). One month postoperatively, the density of the VH increased and VA decreased to counting fingers (CF) (Fig. 1). The VH was non-clearing for three months but on echography, the retina was attached (Fig. 2). VH density decreased one month later and the patient received additional peripheral laser therapy. Six months postoperatively, she underwent uncomplicated phacoemulsification with intraocular lens (IOL) implantation due to severe lens opacity. One month after cataract surgery, VA was 20/400, intraocular pressure (IOP) was 3 mmHg and there was fibrin deposition over the IOL. Fundus examination revealed regressed PDR. She received steroid and cycloplegic drops and the condition remained stable three months after cataract surgery. On final examination, about 10 months after cataract surgery, VA deteriorated to hand motions, IOP was 5 mmHg, the IOL was partially captured by iris with fibrovasular tissue behind the IOL (Fig. 3); the fundus was not visible. The echography is shown in Figure 4. Based on this presentation, what is your diagnosis, what treatment modality would you