Влияние хирургического лечения субмакулярных кровоизлияний на морфофункциональные результаты

Abstract

Aim. To evaluate the morphological and functional parameters of the retina after subretinal administration of recombinant prourokinase followed by endovitreal tamponade with an air-gas mixture without vitrectomy in comparison with antivasoproliferative therapy in patients with subfoveal hemorrhages. Methods. Patients of the first group at the 1st stage underwent two-port 27 G surgery with controlled subretinal injection of recombinant prourokinase solution (500 IU) through a 38 G cannula with tamponade of 1/5 of the vitreous cavity volume with air-gas mixture. At stage 2, therapy with antivasoproliferative drugs was prescribed according to the treat and extend regimen. Patients in the control group received antivasoproliferative therapy as the main treatment. Results. In group 1, there was a trend towards an increase in best corrected visual acuity (BCVA) throughout the entire observation period: on the 14th day after the 1st stage of treatment it was 0.18±0.05 (p < 0.05 compared to before treatment), after 3 loading injections 0.3±0.1, while there was an increase in photosensitivity values up to 4.7±2.2 dB (p < 0.05 in comparison with the values before treatment) and up to 12.6±4.6 dB (p < 0.05 in comparison with the indicators before treatment, the indicators of the 2nd group, respectively). An inverse correlation of functional parameters was noted against the background of depression of the central retinal thickness up to 222.0±60.7 µm and the height of the neovascular membrane up to 72.0±23.0 at the end of observation. Conclusion. Use of subretinal administration of recombinant prourokinase followed by endovitreal tamponade with an air-gas mixture without vitrectomy demonstrates an increase in BCVA with a decrease in the area of absolute scotoma with an increase in the overall photosensitivity of the macular zone against the background of improved anatomical parameters. Timely appointment of antivasoproliferative therapy in the postoperative period ensures preservation of morphofunctional results achieved after surgery. Key words: submacular hemorrhage; tissue plasminogen activator; pneumodislocation; age-related macular degeneration.