Показания к первичной витрэктомии в лечении 3-й активной стадии ретинопатии недоношенных

Abstract

Purpose is to determine the indications and evaluate the results of primary vitrectomy at 3rd stage of active ROP with an unfavorable type. Material and methods. A retrospective analysis of multimodal diagnostics was carried out in 16 premature infants from 2016 to 2019 who were treated with a diagnosis of 3rd active stage ROP, in which, due to the progression of the pathological process after transpupillary laser coagulation of the retina, vitreoretinal surgery was required during the period. In 2021, 3 patients (5 eyes) with an unfavorable type of 3rd active stages of ROP and confirmed extraretinal retinovitreal neovascularization underwent primary vitrectomy. Results. According to the results of a retrospective analysis, it was revealed that extraretinal retinovitreal neovascularization is a predictor of the development of retinal detachment. It is this clinical sign that indicates that transpupillary laser coagulation of the retina will be ineffective and will not lead to stabilization of the process, therefore, primary vitrectomy will be a pathogenetically justified treatment in such cases. Based on the data obtained in the type of a retrospective study in 2021, 3 patients with an unfavorable type of 3rd active stage ROP and confirmed extraretinal retinovitreal neovascularization underwent primary vitrectomy. After 3–6 months after the operation, the pathological process stabilized, the retina was completely attached, continued growth of vessels into the previously avascular zone of the retina was observed. Conclusion. To date, the search for a clear correspondence between a pathogenetically substantiated method of treatment and the timing of its implementation of the stage of the pathological process of ROP remains relevant. Extraretinal retinovitreal neovascularization according to multimodal preoperative diagnostics indicates the need for vitreretinal surgery as a pathogenetically substantiated method of treatment for 3rd active stage ROP. Keywords: retinopathy of prematurity, active stage, primary vitrectomy, transpupillary laser coagulation of the retina, early vitreous surgery.