Роль пигментного эпителия сетчатки в лечении субмакулярных кровоизлияний

Abstract

Objective. To evaluate the structural and functional changes in the retina depending on the duration of the morphological structure disorder of the retinal pigment epithelium (RPE) after treatment of patients with submacular hemorrhage (SMH) against the background of age-related macular degeneration (AMD). Material and methods. Depending on the duration of AMD, the patients were divided into two groups: Group 1 (24 patients) – SMH with newly diagnosed AMD; group 2 (19 patients) – SMH with AMD with an established diagnosis for more than 12 months. All patients underwent two-port 27 G surgery with subretinal injection of a fibrinolytic agent with air tamponade of the vitreal cavity. Then all patients were prescribed antivasoproliferative therapy. Results. After 2 weeks, the indices of maximally corrected visual acuity in the 1st group increased to 0.18 ± 0.05 and in the 2nd group to 0.15 ± 0.03. At the end of the 12-month follow-up period, the 1st group demonstrated stable visual acuity at the same levels, and the 2nd group showed a significant decrease in visual functions to 0.1 ± 0.04. The central retinal thickness before therapy was 826.2 ± 168, 9 in the 1st and 778.7 ± 151.9 µm in the 2nd group. One year after the start of treatment, a decrease to 231.3 ± 22.4 and 305.2 ± 57.6 µm was demonstrated in the 1st and 2nd groups, respectively. Before vitreoretinal intervention, the average height of RPE detachment was 167.2 ± 79.9 µm in the 1st group and 184.4 ± 85.1 µm in the 2nd group. and after 12 months – up to 38.8 ± 6.2 and 63.9 ± 11.6 microns in the 1st and 2nd groups, respectively. Conclusion. Vitreoretinal intervention followed by antivasoproliferative therapy in patients with SMH associated with AMD can improve the morphological and functional prognosis of the course of the disease. However, the long-term prospects for the restoration of visual function largely depend on the initial state of RPE and the duration of AMD. Keywords: submacular hemorrhage, tissue plasminogen activator, pneumodislocation