Сравнение ранних результатов и безопасности различных способов пилинга внутренней пограничной мембраны сетчатки в хирургическом лечении диабетической ретинопатии

Abstract

Relevance. Surgical treatment (VRS) of diabetic retinopathy (DR) is the method of choice in the development of its complications and in combination of DR with other vitreoretinal diseases. The procedure of the retinal inner limiting membrane (ILM) peeling is a debatable stage of the VRS, there is no single concept for its application, and the analysis of its results provides conflicting data. The purpose of the study was a comparative analysis of various methods of retinal ILM peeling in terms of safety, functional and anatomical results in the early postoperative period (up to 3 months). Material and methods. A randomized study was conducted on three comparable groups of patients with proliferative DR (PDR). All patients underwent comparable VRS treatment, the groups differed only in the stage of ILM peeling: in group 1, ILM peeling was not performed, in group 2, it was performed within the inter-arcade space, in group 3, dosed center-sparing ILM peeling was performed. Results. ILM peeling methods were comparable in terms of safety. However, in group 2, a lamellar macular hole (LMH) formation was noted in two cases. Also intraoperatively among patients of group 2, five cases of transient retinal neuroepithelial detachment (tNED) associated with ILM peeling were detected. Functional and anatomical results in the groups were comparable and did not differ significantly. A possible predictive role of the central macular volume in the prognosis of postoperative diabetic macular edema (DME) was revealed. A relationship between tNED and the risks of developing DME and LMH after surgery has been established. Conclusion. In the early postoperative period, the results of treatment using different methods of ILM peeling are comparable. Their further study and analysis of long-term results are required. Keywords: diabetic retinopathy, diabetic macular edema, vitreoretinal surgery, ILM peeling, dosed center-sparing ILM peeling, optical coherence tomography, lamellar macular hole.