Интраоперационная периферическая эндолазеркоагуляция сетчатки в профилактике неоваскулярной глаукомы

Abstract

Neovascular glaucoma (NVG) is a severe long-term complication of proliferative diabetic retinopathy (PDR), including that developing in patients after vitreoretinal surgical treatment. Methods of influence aimed at breaking the cascade of biochemical processes leading to neovascularization, thereby preventing the development of NVG, are pathogenetically justified. The use of retinal laser photocoagulation (RLP) of ischemic zones and intravitreal angiogenesis inhibitors (AI) are effective. The problem of choosing a method and developing a strategy for preventing NVG is relevant. Purpose. To comparatively evaluate the effectiveness of peripheral intraoperative endolaser RLP in the prevention of NVG. Material and methods. The study included 182 patients (182 eyes) who received vitreoretinal surgical treatment for PDR complications. At baseline, all patients did not have NVG or other forms of glaucoma. Patients were divided into comparable groups depending on the type of intraoperative intervention. All patients underwent standard three-port 25 Ga vitrectomy with membrane peeling. Patients in 2nd group underwent panretinal endolaser RLP in the area from the arcades to retianl equator. Patients in 3rd group underwent peripheral endolaser RLP in the area from the retinal equator to ora serrata in combination with intravitreal injection of AI. In 1st group, endolaser RLP and AI were not used. Results. At a follow-up period of 1 month after treatment, no statistically significant differences in the incidence of rubeosis iridis were observed, and there were no cases of NVG development. At a follow-up period of 12 months after treatment in 3rd group, the development of rubeosis iridis was noted in one case and the absence of cases of NVG. In 2nd group, rubeosis iridis was detected in five patients, and NVG was detected in four patients. In 1st group, rubeosis iridis was detected in seven patients, and NVG was detected in ten patients, which is statistically significantly higher than in the other groups of the study. Conclusion. It has been established that the use of peripheral endolaser RLP in combination with intravitreal injection of AI is the most effective method for the prevention of postoperative neovascular complications in the anterior segment of the eye. Further study of the method on a representative sample of patients and in a longer postoperative period is promising. Keywords: vitreoretinal surgery, proliferative diabetic retinopathy, retinal laser photocoagulation, neovascular glaucoma, neoangiogenesis