Наш опыт применения обогащенной тромбоцитами плазмы (PRP) в хирургии регматогенных отслоек сетчатки

Abstract

Purpose. To evaluate the effectiveness of using platelet-rich plasma (PRP) as a blocking of retinal rupture without the use of silicone and gas tamponade (SF6, C2F6, C3F8). Material and methods. In the period from September 2020 to February 2021, in the conditions of the BUZ UR "Republican Ophthalmological Clinical Hospital" of the Ministry of Health of the Udmurt Republic, 12 patients aged 48 to 70 years were treated with a diagnosis of rhegmatogenous retinal detachment with the presence of peripheral tears. In 12 patients, breaks of different localization were revealed - in eight, in the upper half, in four in the lower half of the retina. Myopia was identified as a risk factor in 6 patients. Visual acuity before surgery ranged from 0.001 to 0.3. The operations were performed under retrobulbar anesthesia. In all cases, a subtotal 25Ga vitrectomy was performed with the removal of the posterior hyaloid membrane (PCM) to the extreme periphery and careful excision of the vitreous body in the area of retinal ruptures. The next stage is the introduction of PFOS to the level of the retinal defect, replacing it with air and draining the SRF, minimal endolaser coagulation of the retina around the retinal ruptures. At the final stage of the operation, platelet-enriched plasma was sequentially multi-layered on the rupture area until the rupture was blocked with a PRP layer. In all patients, the operation was completed with air endotamponade. Results. On the first day, visualization of the fundus was reduced in all patients due to air tamponade. By the 4th day, plasma enriched with platelets in the form of a gray film was determined on the surface of the retina in the zone of rupture, the resorption of which occurred within 2 weeks. The duration of the air tamponade averaged 7-10 days. Retinal adhesion in the early postoperative period was achieved in all patients. In 6 patients with the introduction of PRP, a picture of mild uveitis was observed, which was stopped within 1-3 days against the background of anti-inflammatory treatment. No other complications were observed. In the late postoperative period (after 2 weeks), complete retinal adhesion was maintained in 12 patients, visual acuity was 0.05-0.2. According to the data of the performed echography, phosphene and the study of the visual fields, no pathological changes were revealed. In the long-term postoperative period, complete retinal adhesion was noted in 10 patients, visual acuity with correction ranged from 0.3 to 0.5. At different times after the operation, a relapse of retinal detachment occurred in two patients. In one patient with multiple degenerative changes in the periphery of the retina, a relapse of detachment was revealed 2 months after surgery. In all likelihood, the relapse was associated with the emergence of new ruptures in the dystrophy zone and the presence of a proliferative process. In another patient, a relapse of retinal detachment was also observed 4 months after surgery due to the progression of PVR (post-traumatic retinal detachment). All patients with a relapse of retinal detachment within 1–2 days after the detection of a relapse underwent a second operation with revision of the vitreous cavity and subsequent silicone tamponade, which led to complete adhesion of the retina. Conclusion. ROS surgery by subtotal vitrectomy with blocking of retinal tears with platelet-rich plasma and air tamponade is an effective one-stage technique that minimizes the traumatic effect of the operation, reduces postoperative inflammatory complications, and also reduces economic losses. Key words: rhegmatogenous retinal detachment, platelet-rich plasma. Key words: rhegmatogenous retinal detachment, platelet-rich plasma