Устранение витреомакулярного тракционного синдрома на глазах, ранее оперированных по поводу отслойки сетчатки

Abstract

Aims. Evaluate the efficiency of ILM peeling in the treatment of VMTS on eyes previously treated for retinal detachment. Materials and methods. 4 participants diagnosed with VMTS were enrolled in this study. There were 2 male and 2 female patients aged 30-64 y.o. who were previously surgically treated for their retinal detachment. 3 patients had rhegmatogenous and 1 patient had traumatic tractional retinal detachment with the mean duration of 5.75 years. 3 eyes undergone scleral buckling following subretinal fluid drainage, 1 eye underwent cataract phacoemulsification with an implantation of IOL + closed vitrectomy + pneumatic retinopexy + endolaser retinal photocoagulation + silicone oil, insertion following silicone oil removal from the vitreous cavity. All patients had some degree of myopia as well as peripheral retinal degenerations. 2 patients were diagnosed with epiretinal fibrosis and 2 other with stage 2 small full-thickness macular hole. Mean BCVA before surgery was 0.078, mean central retinal thickness was 390,25 um, small full-thickness macular hole diameter was about 320 um. Before the surgery, all patients undergone cycloscopy, where there were no indications for the additional laser photocoagulation. 3 patients underwent posterior vitrectomy 25G and 1 patient had 25G ports placed on his eye with the peeling of ILM and usage of pneumatic retinopexy, 2 eyes underwent cataract phacoemulsification with IOL implantation. Results and discussion. All surgical interventions were done without any complications. Since there were conjunctival scars left after the previous surgeries, conjunctiva did not show any displacement during the sclerotomy procedures, which led to the formation of post-sclerotomy holes. This fact forced us to make knot sutures, which resulted in foreign body sensations in our patients during the post-op period. Intraoperatively, all patients had their ILM removed, which was proved by OCT in the post-op period. Mean BCVA after operations was 0.3. Mean Central retinal thickness was 314 um based on OCT data in the post-op period. Patients were recommended to undergo cycloscopy 1 month after the surgery and then twice every year. There were no retinal detachment relapse observed in the post-op period. Conclusion: 1. Removal of ILM in patients, that were previously operated due to retinal detachment, is considered as an effective method in the treatment of VMTS. It is clinically manifested as visual acuity improvement, retinal thickness reduction, lamellar hole closure and the absence of full thickness macular hole formation risk in the early and late post-op periods. No retinal detachment relapses were observed. 2. Presence of conjunctival scars following previous retinal detachment surgical interventions leads to the hole formation following sclerotomy procedures, which causes foreign body sensations in patients during the post-op period. 3. Endovitreal surgical intervention for the retinal detachment should include ILM peeling to prevent formation of VMTS in the post-op period. Key words: vitreomacular traction syndrome (VMTS), Internal limiting membrane (ILM), rhegmatogenous retinal detachment ( RRD), optic coherence tomography (OCT).