Отдаленные результаты этапного хирургического лечения осложненной начальной катаракты у пациентов с далекозашедшей диабетической ретинопатией

Abstract

Purpose. To evaluate the efficacy of second-stage phacoemulsification (PE) of complicated initial cataract after vitreoretinal surgery (VRS) in patients with advanced proliferative diabetic retinopathy (PDR). Material and methods. 216 patients with PDR and complicated initial cataract who underwent surgery were included. These patients were divided into four groups according to their management. In the group I patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade was performed as the first step, followed by the second step — PE+IOL implantation + silicone oil removal. In the group II PE was performed simultaneously with VRS and silicone oil tamponade. The second step differed in the removal of silicone oil from the vitreous cavity. In the group III patients were subjected to a two-step surgical procedure: VRS with gas tamponade performed as the first step in their treatment; followed by the second step, PE and the IOL implantation. In the group IV PE performed simultaneously with VRS with gas tamponade. Results. Patients in subgroup I and group III had better functional results than those in subgroup II and group IV, respectively (p < 0,001). The subgroup IIa (n = 9; 14.5 %) showed higher incidence of NVG than the subgroup Ia (n = 2; 3.2 %), p = 0.027. There also was a higher rate of NVG in group IV (n = 6; 19,3 %) compared to group III (n = 1; 3,1 %), p = 0,04. Conclusion. Phacoemulsification of initial cataract at the second stage after VRS in patients with advanced PDR provides a sparing approach to surgical treatment in this category of patients and allows to improve anatomical and functional results of VRS. In addition, it contributes to reduction of number and severity of postoperative complications. Keywords: proliferative diabetic retinopathy; vitreoretinal surgery; phacoemulsification