Гравитационная дислокация субмакулярных кровоизлияний у пациентов с возрастной макулярной дегенерацией

Abstract

Purpose. To study the effectiveness and anatomical results of gravitational dislocation of submacular hemorrhages in patients with age-related macular degeneration. Material and methods. We examined 4 patients (4 eyes) with the diagnosis of submacular hemorrhages. The average age of the subjects was 71.45 ± 5.15 years. The duration of the disease was 7determined from the onset of characteristic symptoms to surgical treatment and averaged 7.5 ± 4 days. The maximum corrected acuity averaged 0.02 ± 0.05. 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. In the presence of lens opacity, surgical treatment was started with phacoemulsification of cataracts. All patients underwent pars plana vitrectomy combined with subretinal tissue plasminogen activator (t-PA) and intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection without any tamponade. The patients were advised to take supine position postoperatively in order t-PA to liquefy the haemorrhage, for 1 h; after which they were positioned upright or lying down on the temporal side of the affected eye, for 3 days. Results. In the early surgical period, there was a tendency to increase the maximum corrected visual acuity (MCI): on the 7th day after the first stage of treatment, it was 0.23 ± 0.06 (p < 0.05 compared with the indicators before treatment). The displacement of the blood clot from the central area of the retina, with the correct positioning of the patient, occurred within 5.87 ± 1.9 days. Lysis of the submacular clot was observed for 14 ± 1.53 days. After 3 loading injections carried out within 1.2 and 3 months after the operation, the MCI increased to 0.4 ± 0.2. Conclusion. Microinvasive subtotal vitrectomy with subretinal injection of Prourokinase, with proper positioning of the patient, help gravitational dislocation of submacular hemorrhages and is an effective treatment method in patients with age-related macular degeneration. Keyword: submacular hemorrhage, age-related macular degeneration, dislocation, optical coherence tomography