THE SURGICAL TREATMENT OF DIABETIC MACULOTHE SURGICAL TREATMENT OF DIABETIC MACULOPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2: EFFECTIVENESS, COMPLICATIONS, RELAPSEPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2: EFFECTIVENESS, COMPLICATIONS, RELAPSES

Abstract

Relevance. It’s known a number of surgical treatment methods of diabetic maculopathy (DMP) in diabetes mellitus (DM) type 2: closed subtotal vitrectomy (CSV), which according to the testimony combined with peeling of the inner limiting membrane of the retina (ILM), panretinal laser coagulation of the retina (PRLC) and phacoemulsification of cataract (PEC).
 Objective. To study the effectiveness of different variants of vitreoretinal interventions, complications and frequency of DMP relapses in patients with type 2 diabetes.
 To study the effectiveness of different options for vitreoretinal interventions by the number of relapses of the DMP for patients with type 2 DM.
 Materials and methods. Observed 313 patients with type 2 DM (313 eyes) with DMP and primary (group 1; n=40), moderate or severe non-proliferative diabetic retinopathy (NPDR; group 2; n=92) and proliferative diabetic retinopathy (PDR; group 3; n=181). The severity of retinopathy and DMP was established under the International clinical scale of the American Academy of Ophthalmology (2002). 78 patients underwent CSV; 85 patients in addition to performing the vitrectomy was further held peeling of ILM in the macular region; 81 patient in addition to the CSV and peeling of the ILM was performed PRLC of the retina and in 69 patients additionally to all these interventions were made PEK. For statistical processing of obtained data was performed using the program Statistica 10 (StatSoft, Inc., USA).
 Results. The effectiveness of surgical treatment DMP was 70.3%; in 1st month follow-up, recurrence was observed in 23.0%; 3 months – 18.2%; 6 months – from 10.2% a year monitoring – 24.9% of patients. Efficiency of used methods was as follows: CSV – 67.9%; CSV + ILM peeling – 72.9%; CSV + ILM peeling + PRLC – 71.6%; CSV + ILM peeling + PLC + PEK – 68.1%. These differences had no statistical significance (p=0.87). Methods of treatment the recurrence rate at different periods of observation did not differ significantly; only after 1 month was more frequent relapses in patients who fulfilled the maximum number of types of operations (CSV, ILM peeling, PRLC and PEK) were 31.9% (p=0.025). When using only the CSV, and in complex use of all surgeries (CSV, ILM peeling, PRLC & FEK) all recurrences were early, of which the majority (77.3 and 80.0%, respectively) had persistent. In other types of surgery, most recurrences (91-96%) were in the early persistent and late. The effectiveness of DMP surgical treatment decreased with worsening of retinopathy and was 72.5% at the primary NPDR; 77.2% at moderate or severe NPDR and 66.3% in the DPR. DPR patients had a greater frequency (33.7%) and greater severity of relapses (the number of late relapses in patients of the 3rd group was higher than that in patients of the 1st and 2nd groups in 2.3 times; p=0.001).
 Conclusion. The study showed the high effectiveness of all techniques that increasingly depended on the severity of retinopathy was the worst with PDR.