Использование аутологичной кондиционированной плазмы (аср) в хирургии тяжелой патологии заднего отрезка глаза. Трехлетний опыт использования технологии

Abstract

Purpose. To evaluate the effectiveness and long-term results of the use of autologous conditioned plasma in the surgery of open eye injury, including perforating eye injuries, surgery of the cicatricial stage of the subretinal neovascular membrane, rhematogenous retinal detachment, including retinal detachment with macular hole in people with high myopia with expressed scleral staphyloma, without the use of an additional laser coagulation of the retina and the almost complete exclusion of silicone tamponade. Material and methods. Since 2018, more than 250 patients with various vitreous pathologies of the posterior eye segment have been operated on perforating eye injuries, cicatricial stage of the subretinal neovascular membrane, idiopathic macular rupture, rhegmatogenous retinal detachment, including those with macular holes, including cases with high myopia and expressed scleral staphyloma. The developed technology of surgical closure of defects of the retina, choroid, sclera of various lengths using autologous conditioned plasma, made it possible to completely eliminate the need for laser coagulation of the retina, which in most cases would be difficult and unsafe, and to practically exclude silicone tamponade. A method of seamless sealing of sclero and conjunctivotomies with the variant of air tamponade using autologous conditioned plasma has been developed and successfully applied. Results. In the early postoperative period the patients in all clinical groups had no complications. Complete adhesion of the retina and sealing of defects in the structures of the eye after using autologous conditioned plasma without additional laser coagulation of the retina on the background of the applied air and silicone tamponade was observed in all patients. In the long-term follow-up period up to 28 months, there were isolated recurrences of retinal detachment after surgery of complex open eye injury, rhematogenous retinal detachment on the background of progression of proliferative vitreoretinopathy. More than 89% of patients had no complications in the long-term period. Complete closure of the sclero and conjunctivotomies without the use of additional suture fixation had been achieved. In all cases, the vascular pattern of the conjunctiva was preserved, in no case was a reactive process detected at the site of application of autologous conditioned plasma. Conclusion. The use of autologous conditioned plasma is an effective and safe method of sealing defects of the retina, choroid, sclera of various lengths in complex open eye injury, of surgery of rhematogenous retinal detachment, including high myopia and the presence of a macular hole, of surgery of the cicatricial stage of the subretinal neovascular membrane, allowing to completely eliminate the need for laser coagulation of the retina, minimize the need for silicone tamponade.