Пилинг-ассоциированные тракции в хирургическом лечении диабетического макулярного отека

Abstract

Vitreoretinal surgical treatment is indicated for diabetic macular edema (DME) in combination with vitreomacular interface abnormalities. Peeling of the retinal internal limiting membrane (ILM) is often used as part of the treatment. Tight adhesion of the posterior hyaloid membrane and the ILM may be the cause of the intraoperative retinal tractions development. Purpose. To assess the prevalence and impact of transient peeling-associated traction (tPAT) on the results and incidence of complications of surgical treatment of DME using ILM-peeling. Material and methods. As part of the study, a group of 40 patients was divided into 2 comparable subgroups according to the presence of tPAT (1st group — with tPAT, 2nd group — without tPAT). Patients in both groups received surgical treatment — three-port 27 Ga vitrectomy with ILM-peeling in a rounded area with a diameter of up to 2 DD centered on the fovea. ILM-peeling was performed using intraoperative tomographic control (optical coherence tomography). Results. In both groups, anatomical improvement was noted in the form of a decrease in foveal retinal thickness. At the same time, in 1st group there was no improvement in visual acuity, while in 2nd group its statistically significant increase was revealed. The presence of tPAT is associated with a higher incidence of postoperative neurodegenerative changes development of long-term follow-up period — disorganization of retinal inner layers and the formation of lamellar breaks in the fovea. According to correlation analysis, tPAT negatively affects the final value of visual acuity. Conclusion. It has been established that tPAT is a predictor of lower postoperative visual acuity, and is also a risk factor for retinal neurodegenerative changes in the long-term follow-up period. It is promising to evaluate the prevalence of tPAT in larger studies, reveal predictors of tPAT development and measures for their intraoperative prevention. Keywords: vitreoretinal surgery, ILM peeling, dosed fovea-sparing ILM peeling, optical coherence tomography, lamellar macular hole, disorganisation of retinal inner layers, peelingassociated tractions photocoagulation of the retina; long-term results