Модифицированная комбинированная лазерная ангиотомия при клапанных разрывах сетчатки в профилактике гемофтальма

Abstract

Purpose. To compare the efficacy and safety between modified laser angiotomy and classical combined angiotomy. Material and methods. Treatment outcomes of 51 patients (51 eyes) with horseshoe retinal tear complicated by the presence of retinal vessels in the area of the tear were analyzed. The patients were divided into two groups: a retrospective group (n= 36) which were treated by classical combined angiotomy and a prospective group (n= 15) treated by modified angiotomy. In addition to standard examination, all patients underwent optical coherence tomography (OCT) to identify vitreoretinal traction fixed to the vessel. Efficacy and safety were compared between technologies, including the rate of vitreous hemorrhages, the laser parameters, and the rate of complications. The follow-up period was 6 months. Results. Analysis of OCT scans revealed vitreoretinal fixation in the area of the retinal tear flap, also associated with a bridge vessel in all patients. During photocoagulation of a retinal vessel, choroidal bleeding was noted in 2 cases in the first group and in 1 case in the second group. During the YAG-laser angiotomy, this complication occurred in 3 cases in the first group and was absent in the second group. There were no vitreous hemorrhages in both groups during follow up period. Conclusion. Retinal vessel coagulation followed by YAG laser angiotomy is a reliable way to prevent vitreous hemorrhages in patients with peripheral retinal tears complicated by the presence of retinal vessels. The proposed modification of laser angiotomy, which consists in coagulation of a segment of the retinal vessel with an intact area of 0.05-1.0 mm in its middle and YAG laser angiotomy in the center of this area, allows the use of fewer pulses with lower pulse energy, which appears to reduces rate of choroidal bleeding. Keywords: horseshoe tear, angiotomy, vitreous hemorrhage, vitreoretinal traction.