Пилинг внутренней пограничной мембраны сетчатки в хирургическом лечении диабетического макулярного отека (2 клинических случая)

Abstract

Relevance. Vitreoretinal surgery (VRS) for diabetic macular edema (DME) is the treatment of choice when combined with vitreomacular interface (VMI) anomalies. Peeling of the inner limiting membrane (ILM) of the retina in such patients is a controversial procedure. Purpose. To clinically approve new method of ILM peeling in patients with DME in combination with VMI. Material and methods. The article presents a comparative analysis of two clinical cases. The patients had similar clinical and anamnestic characteristics. In both cases, patients underwent VRS for DME with a large intraretinal cyst in the fovea in combination with epimacular fibrosis (EMF). The operation was combined with intervention for cataract (phacoemulsification with implantation of an elastic intraocular lens). Only the stages of ILM peeling were different: in the first case, the technology with the preservation of the ILM fragment in the fovea was used, in the second, a complete peeling of the ILM was performed. Results. In the course of dynamic observation for 6 months after the operation, observation, examination and, if necessary, additional treatment were carried out. Based on the results of observation and evaluation of the functional and anatomical parameters of the retina within 6 months, an improvement was noted in 1st patient and stabilization in 2nd patient. In the case of 2nd patient, a lamellar macular rupture formed at a period of 3 months, which can be regarded as a complication of the complete ILM peeling technique. Conclusion. Peeling of the ILM with preservation of the fragment in the fovea showed better functional and anatomical results compared to the complete removal of the ILM. Morphofunctional results of this method are to be investigated on the representative patient sample. Key words: diabetes mellitus, diabetic retinopathy, diabetic macular edema, vitrectomy, ILM-peeling, optical coherence tomography