Дифференцированный подход к лечению пациентов с субретинальным кровоизлиянием на фоне возрастной макулодистрофии

Abstract

Purpose. To determine the directions of a differentiated approach to the treatment of patients with subretinal hemorrhage (SRH) by of age-related macular degeneration (AMD). Material and methods. A total of 24 patients (25 eyes) with SRH by of AMD were treated. The mean duration of a hemorrhage from its onset to the start of treatment was 23.0 ± 17.9 days (range from 5 to 72 days). The size of the SRH varied from 1 DD to subtotal hemorrhagic retinal detachment. Prior to the onset of SRH, anti-VEGF therapy was performed in 11 (44 %) cases. Patients underwent the following treatment options for SRH: 1) anti-VEGF intravitreal injection (IVI) – 6 (24 %); 2) IVI anti-VEGF + IVI prourokinase + IVI ophthalmic gas (SF6, C2F6) – 4 (16 %); 3) vitrectomy (VE) + subretinal administration of prourokinase + IVI antiVEGF + IVI ophthalmic gas (C2F6, C3F8) – 13 (52 %); 4) VE + transplantation of PES – 2 (8 %). The average follow-up period for patients after treatment was 9.4 ± 5.4 months. Results and discussion. With the maximum follow-up period after the treatment, regardless of the method, it was possible to achieve hemorrhage displacement: partial – in 6 (24 %) patients, complete – in 19 (76 %) patients. At the maximum follow-up period, an improvement in BCVA in comparison with the preoperative one was observed in 15 (60 %) cases, no dynamics – in 7 (28 %) cases, and negative dynamics – in 3 (12 %) cases. In 2 (8 %) cases, after treatment for 3 and 6 months, a recurrence of SRH was observed, moreover, a larger size than the initial one. All patients underwent anti-VEGF therapy after the start of SRH treatment. Conclusions. A differentiated approach in the treatment of patients with SRH by of AMD has positive results in improving BCVA and shifting hemorrhage from the macular zone, and the choice of treatment method is determined by the size and duration of the existence of the SRH. Keywords: submacular hemorrhage, age-related macular degeneration, pneumodislocation, vitrectomy, anti-VEGF inhibitors, tissue plasminogen activator, retinal pigment transplantation