Послеоперационный мультимодальный анализ результатов хирургического лечения субмакулярных кровоизлияний

Abstract

Objective. To evaluate the morphological and functional effectiveness of minimally invasive administration of recombinant prourokinase followed by endovitreal gas tamponade without vitrectomy in comparison with antivasoproliferative therapy in patients with submacular hemorrhages. Material and methods. Patients of the 1st group at the 1st stage underwent two-port 27 G surgery with subretinal injection of a solution of recombinant prourokinase 500 IU through a 38 G cannula with the introduction of up to 20% of the volume of the vitreal cavity of C2F6 gas. At stage 2, therapy with anti-vasoproliferative drugs was prescribed according to the treat and extend regimen. Patients of the 2nd group were prescribed intravitreal injections of antivasoproliferative drugs according to the standard scheme with the transition to the treat and extend mode after 3 loading injections. Results. In group 1, there was a pronounced positive trend in maximum corrected visual acuity (BCVA) over the entire observation period: on the 14th day after stage 1 of treatment, it was 0.18 ± 0.05 (p < 0.05 compared to before treatment), after 3 loading injections – 0.3 ± 0.1 and after 6 months – an increase in photosensitivity values up to 4.7 ± 2.2 dB was demonstrated (p < 0.05 in comparison with the values before treatment ) and up to 12.6 ± 4.6 in the 1st group (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 the observation. Conclusion. Combined treatment of patients with SMC on the background of AMD, including subretinal administration of tissue plasminogen activator against the background of antivasoproliferative therapy, improves morphofunctional results with a high frequency of complete dislocation of hemorrhages. The use of a combined technique provides 4-fold depression of the CTS and 2.8-fold elevation of CNV against the background of a 10-fold increase in BCVA. According to the results of microperimetry, there is a decrease in the zone of absolute scotoma by 4.7 times, with an increase in the total photosensitivity of the macular zone by 12.6 times. Postoperative appointment of antivasoproliferative therapy for 14 days ensures the preservation of the morphofunctional results achieved after. Keywords: submacular hemorrhage, tissue plasminogen activator, pneumodislocation