Результаты применения усовершенствованного витреоретинального вмешательства при пролиферативной диабетической ретинопатии

Abstract

Purpose. To improve the technology of combined vitreoretinal intervention, including preliminary intravitreal injection of angiogenesis inhibitors followed by vitrectomy and a differentiated approach to internal limiting membrane peeling in patients with proliferative diabetic retinopathy (PDR). Material and methods. The research based on analysis of morpho-functional parameters 134 patient's eyes with PDR during type II diabetes mellitus. The patients were divided into 2 groups. The first group consisted of 30 patients (30 eyes), who were determined optimal period for vitrectomy. That patients underwent fundus photography and optical coherence tomography during 1 month after intravitreal injection of ranibizumab. Vitrectomy was performed within 1-3 months (38.4 ± 5.6 days). The second group consisted of 104 patients (104 eyes) who underwent vitrectomy with a differentiated approach to internal limiting membrane peeling and tamponade of the vitreous cavity. Results. The optimal period for vitrectomy in patients with PDR is 10-14 days after preliminary ranibizumab injection, which is due to the maximal regression of neovascularization and minimal traction on the retina (the risk of developing local traction retinal detachment decreases by 36.6%). Carrying out vitrectomy in optimal period helped to reduce the risk of intraoperative hemorrhagic complications by 4.2 times, the frequency of using perfluorocarbons by 3.7 times. At postoperative period, in patients without internal limiting membrane peeling on the silicone oil tamponade, the risk of epiretinal fibrosis increased 2.7 times compared with the data before treatment, and 1.8 times on air-gas mixture tamponade. Conclusion. The optimal surgical tactic for patients with PDR is preliminary intravitreal injection of angiogenesis inhibitors before vitrectomy, internal limiting membrane peeling at silicone oil tamponade (frequency of epiretinal fibrosis 96%) and individual approach to surgical correction of macular area at gas-air mixture tamponade (frequency of epiretinal fibrosis 36%), which allows to achieve a progressive improvement in morphological and functional results. Key words: proliferative diabetic retinopathy, preliminary anti-VEGF therapy, vitrectomy, internal limiting membrane peeling.