Кондиционированная аутологичная плазма (ACP) в лечении больших макулярных разрывов

Abstract

Background. Macular tear (MR) is a disease that leads to a significant decrease in visual acuity, central scotoma and metamorphopsia, which significantly affects patients' quality of life. For several decades a lot of techniques of MR treatment have been implemented, but modern vitreoretinal surgery is still searching for treatment methods allowing to achieve maximal anatomic and functional results, so the study of application of autologous conditioned plasma (ACP) in MR treatment today is of particular interest. Purpose. Retrospective comparative analysis of surgical treatment of idiopathic MR using ACP. Material and methods. The research was carried out on the basis of Microsurgical ophthalmic center of high-technology medical care of Voronezh Regional Clinical Ophthalmologic Hospital. A total of 82 eyes with idiopathic MR were operated on. Two groups of patients were studied. The first group of patients (41 eyes) underwent surgical treatment: microinvasive three-port 25G-vitreoectomy with membranopilling removal of posterior hyaloid membrane to the extreme periphery and internal border membrane in the central retinal region within the vascular arcades with subsequent tamponade of vitreal cavity with air, intravitreal to macular zone in layers dosed with autologous conditioned plasma until the appearance of visual film. To obtain autologous conditioned plasma, 15 ml of a patient's venous blood was collected immediately before surgery in a patented dual-circuit Arthrex ACP syringe (Germany), which was then centrifuged for 5 minutes at a speed of 1500 rpm. Surgical treatment was performed on the Constellation Vision System using a Topcon Offiss OMS-800 microscope. The second group (41 eyes) underwent microinvasive three-port 25G-vitreoectomy with membranopilling removal of posterior hyaloid membrane to the extreme periphery and inner border membrane in the central retinal region within the vascular arcades followed by vitreal cavity tamponade with air. The results of treatment were assessed on the 7th day. All patients underwent full ophthalmological examination according to the existing standards, which included: visometry, perimetry, biomicroscopy, biomicrophthalmoscopy, B-scanning, optical coherence tomography of the macular area for morphometric evaluation of macular rupture on Optovue RTVue 100. Results. The results of the treatment were assessed on the 7th day. MR closure according to OCT data was observed in 97 % of cases in the first group, in the second group anatomical integrity of the macular area was restored in 90 % of cases. The MRR before and after surgery in the group with ACP was 0.149 ± 0.029 to 0.229 ± 0.025. The MCOZ before and after surgery in the control group was 0.161 ± 0.031 to 0.175 ± 0.027. According to the results of ACP D.G. Arsyutov, in 57 % of cases there was a complete blocking of MR in the early postoperative period, in the distant postoperative period a completely blocked rupture was found in 43 %. Conclusions. The results obtained confirm the effectiveness of ACP for the treatment of large idiopathic macular ruptures. The use of plasma in the treatment of MR allows to achieve high anatomical and functional results in the postoperative period. Keywords: macular rupture, autologous conditioned plasma