Прогнозируемая интраоперационная индукция задней отслойки стекловидного тела

Abstract

Purpose. To develop a technique for predictive intraoperative induction of posterior vitreous detachment as the first stage of surgical treatment of various vitreoretinal pathologies based on data of preoperative spectral optical coherence tomography (SOCT) and to evaluate its clinical effectiveness. Material and methods. 30 patients were performed surgery, 15 of them (15 eyes) with epiretinal fibrosis and 15 (15 eyes) with macular hole. Preoperatively, SOCT was used to determine the place of the retina in the parapapillary area, which is the most optimal for induction of posterior vitreous detachment during the operation. For this, a vitreoretinal interface was used on a Solix device (Optovue, USA) with a Full Range Retina protocol with a scan length of 16 mm, according to which the degree of vitreomacular and vitreopapillary adhesion was assessed. In the optimal zone of the posterior hyaloid membrane, microperforations were applied with a parapapillary vitreotom. At maximum vacuum (650 mm Hg), the vitreous body fibers were aspirated into the hole of the vitreotom until a characteristic “wave” or “meniscus” (“crescentic fold”) appeared along the edge of the optic disc. At the final stage, in the “vacuum mode”, movements from the optic nerve head to the periphery by the aspiration method raised the cortical layers of the vitreous body and torn off the posterior hyaloid membrane from the edge of the optic nerve head, separating the vitreous body from the center to the periphery of the retina. Results. In all 30 cases, it was possible to initiate intraoperatively posterior vitreous detachment without the use of dyes. There were no intraoperative complications. Conclusion. The proposed technique makes it possible to perform a predictable intraoperative induction of detachment of the posterior cortical layers of the vitreous from the retina, which is a necessary step for subsequent vitreoretinal surgery. Keywords: intraoperative induction of posterior vitreous detachment, posterior hyaloid membrane, posterior cortical layers.