Дифференцированный подход в хирургическом лечении кистозного макулярного отека

Abstract

Cystoid macular edema (CME) is the accumulation of fluid in the retina between the outer plexiform layer and the inner nuclear layer, which leads to the formation of cysts. Treatment of CME depends on the cause, for example, with AMD – anti-VGEF, with thrombosis – a combination with a laser, with uveitis, unfortunately, often – corticosteroids. Significant vision loss in patients with intraocular inflammation is most often a consequence of cystoid macular edema. CME with epiretinal fibrosis was observed in 33% of all patients with uveitis. Material and methods. We examined 12 patients diagnosed with CME with a diagnosis of uveitis of various genesis. Of these, 8 patients underwent treatment courses in different institutions in the past, using traditional methods (eye drops, anti-VGEF and ozurdex implants) with little success. Results. Out of 12 patients, all had identified sources of endogenous infection. All patients underwent OCT-angio and it is noteworthy that in 11 out of 12 patients (91.66 %), CME was detected with the presence of epiretinal fibrosis with macular traction syndrome. Within the background of the preparation, a vitrectomy was performed with the removal of the fibrosis. Subsequently, additional therapy was prescribed according to the scheme. According to OCT data, edema regression was observed in 10 out of 11 patients without the need for repeated intravitreal intervention. Conclusions. With CME of uveal genesis, there is a high risk of detecting epiretinal fibrosis with a traction component in the macular zone. The best result of surgical treatment in CME of uveal genesis is achieved by vitrectomy with removal of membranes in combination with efferent therapy. Keywords: CME, uveitis, epiretinal fibrosis, vitrectomy.