Профилактика эпиретинального фиброзирования в послеоперационном периоде при хирургическом лечении пролиферативной диабетической ретинопатии

Abstract

Purpose. To improve the surgical technique for correcting the retinal central zone to prevent epiretinal fibrosis in the postoperative period in patients with proliferative diabetic retinopathy. Material and methods. The study included 104 patients (104 eyes) with proliferative diabetic retinopathy without signs of epiretinal fibrosis in macular area. All patients were divided into 4 groups: group 1 (n = 27) – vitrectomy with silicone oil tamponade; group 2 (n = 28) – vitrectomy with internal limiting membrane peeling and silicone oil tamponade; in groups 3 (n = 25) and 4 (n = 24) a similar volume of vitreoretinal intervention was performed with gas-air tamponade of the vitreal cavity. 3 months after primary vitrectomy, 61 patients (61 eyes) underwent additional vitreoretinal interventions due to the presence of epiretinal fibrosis with tangential traction syndrome and/or silicone oil tamponade of the vitreal cavity. The observation period was 6 months. Results. At postoperative period, in patients without internal limiting membrane peeling against the background of vitreal cavity tamponade with silicone oil, risk of epiretinal fibrosis increased by 2.7 times (p = 0.036 compared with data before treatment) and by 1.8 times (p = 0.048) against the background of gas-air tamponade. The presence of epiretinal fibrosis with tangential traction syndrome and/or silicone oil tamponade of the vitreal cavity after primary vitrectomy is an absolute indication for additional vitreoretinal interventions. The highest morphological and functional results were due to the absence of epiretinal fibrosis, due to the removed internal limiting membrane, which would serve as a substrate (platform) for cell proliferation on its surface. Conclusion. Optimal surgical technique performed during vitreoretinal intervention for proliferative diabetic retinopathy is internal limiting membrane peeling and use gas-air tamponade of the vitreal cavity, which provides effective prevention of epiretinal fibrosis in retinal central zone and improvement of morphological and functional parameters of patients' eyes. Keywords: proliferative diabetic retinopathy, vitreoretinal intervention, internal limiting membrane peeling, epiretinal fibrosis, tangential traction syndrome, vitreous cavity tamponade