Выбор тампонады при хирургическом лечении субмакулярных кровоизлияний при влажной форме возрастной макулярной дегенерации

Abstract

Purpose. To evaluate the efficacy and anatomical results of surgical treatment of submacular hemorrhages in the exudative age-related macular degeneration with tamponade with air or gas-air mixture. Material and methods. We examined 6 patients (6 eyes) with the diagnosis of submacular hemorrhages. The average age of the subjects was 69.47 ± 3.12 years. The maximum corrected acuity averaged 0.03 ± 0.04. According to the data of optical coherence tomography, a high central detachment of the neuro- and pigment epithelium with hemorrhagic contents was determined in patients. All patients had previously received a course of intravitreal injections of an angiogenesis inhibitor (Aflibercept) in the range from 1 to 5. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. In the main group, after microinvasive subtotal vitrectomy and subretinal administration of tissue plasminogen activator (Prourokinase)® 500, irrigation fluid was replaced with sterile air; in the control group, the operation was completed with a gas-air mixture tamponade. In the early postoperative period, patients of both groups were recommended a forced head position «face down» two days. The follow-up period for patients was 3 months. Results. The compared groups did not differ in terms of age and gender. The duration of existence of submacular hemorrhages was 6.27 ± 2.67 days. In the early operational period, low visual acuity was explained by tamponade with air or a gas-air mixture. In the main group, air resorption occurred for 10 ± 1.53 days with an increase in visual acuity to 0.25 ± 0.06 and lysis of the submacular clot. The displacement of the blood clot from the central area of the retina by air or gas-air mixture, with the correct positioning of the patient, occurred at the same time (6.87 = 2.13 days). In the control group, an increase in visual acuity to 0.23 ± 0.04 was observed for a longer period – 22 ± 3.12 days due to a longer period of resorption of the gas-air mixture. During the observation period of 3 months, stable results were achieved in all cases in patients of both groups. Conclusion. Microinvasive subtotal vitrectomy and subretinal injection of Prourokinase with air tamponade can achieve a significant improvement in the functional results of treatment in a shorter period. Keyword: submacular hemorrhage, age-related macular degeneration, air tamponade, optical coherence tomography.