Анализ геморрагических осложнений в хирургии пролиферативной диабетической ретинопатии

Abstract

Purpose. Determination of factors associated with the incidence of hemophthalmos in the early and late postoperative period in patients with proliferative diabetic retinopathy (PDR). Material and мethods. Retrospective analysis of postoperative complications was performed in 124 patients (133 eyes) with PDR, who received treatment at the Research institute of Eye Diseases from 2018 to 2021. The study included patients with PDR with indications for surgical treatment (hemophthalmos, traction retinal detachment (TRD), traction diabetic macular edema). All patients underwent minimally invasive vitrectomy using additional chandelier-type illuminators with bimanual dissection and delamination of the proliferative tissue and careful removal of the vitreous base with sclerocompression. In all cases, the operation was completed without the use of any tamponade. Peripheral retinal photocoagulation (RP) was performed in 98 cases (73.7 %), phacoemulsification with intraocular lens implantation in 66 cases (49.6 %), angiogenesis inhibitors were used perioperatively in 47 cases (35.3 %). Results. Of 133 operated eyes, early postoperative intravitreal hemorrhage (EPH) was observed in 17 cases (12.8 %), of which 6 resorbed spontaneously and 11 required repeated surgical intervention. The development of EPH was significantly associated with the absence of intraoperative RP (p < 0.01), and the frequency of revision of the vitreal cavity to eliminate EPH correlated with the unstable course of arterial hypertension (AH) (p= 0.048) and with the absence of panretinal photocoagulation (PRP) before surgery (p= 0.012). It was found that EPH developed more often in patients operated on for TRD (p= 0.007) and in cases accompanied by severe intraoperative bleeding (p= 0.001) and unintentional intraoperative damage to the retinal vessels of the 2nd-3rd order (p< 0.01). Late postoperative intravitreal hemorrhage (LPH) was observed in 20 cases (19.8 %), of which 11 resorbed spontaneously and 9 required surgical treatment. The development of LPH is significantly associated with the absence of intraoperative RP (p< 0.01 for self-resorbed LPH and p= 0.041 for LPH requiring revision of the vitreal cavity). The frequency of revision of the vitreal cavity for the treatment of LPH is significantly associated with the unstable course of hypertension (p= 0.007) and the presence of EPH requiring surgical intervention (p= 0.003). The use of anti-angiogenic drugs before and during surgery did not show a significant correlation with the occurrence of EPH and LPH. Conclusions. Analysis of complications showed that EPH and LPH occurred in 12.8 % and 19.8 % of cases, respectively. Factors associated with the development of EPH were identified: the absence of PRP before surgery, the absence of intraoperative RP, TRD, intraoperative damage to the retinal vessels of the 2nd-3rd order. Factors associated with the development of LPH were identified: failure to perform RP intraoperatively, unstable course of hypertension, and the presence of EPH that required surgical intervention. Keywords: diabetic retinopathy, vitrectomy, bianual vitrectomy, postoperative hemorrhage, panretinal photocoagulation, peripheral retinal photocoagulation, arterial hypertension.