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.
Relevance. Diabetic macular edema (DME) in combination with epimacular fibrosis (EMF) is an indication for vitreoretinal surgical treatment. The necessity of the retinal internal limiting membrane (ILM) peeling is debatable. The question of assessing the anatomy and function of the eyes in the early and late postoperative period is relevant, in particular, the study of the retinal capillary plexuses (RCP) characteristics such that its vascular density. The perpose of the study was to evaluate the presence and nature of the various ILM peeling methods effect on the RCP vascular density in patients with proliferative diabetic retinopathy and DME in combination with EMF in the early and late periods after treatment. Material and methods. A randomized case-control study was conducted on three comparable groups of patients. Surgical treatment was performed – vitrectomy with ILM peeling. The groups differed in the ILM peeling methods. In the early (1 month) and late (1 year) postoperative period, the RCP vascular density CAS was assessed, as well as the development of complications: DME, EMF recurrence, and retinal atrophy. Results. Statistically significant intra- and intergroup differences in the values of indicators of RCP vascular density during the entire period of observation were not revealed. It has been established that the initially higher vascular density in the superficial and deep RCP tends to remain at this level in the early and late postoperative period. Statistically significant relationships between RCP vascular density and the development of postoperative DME, recurrence of EMF or retinal atrophy have not been established. Conclusion. According to the results of our study, ILM peeling does not have a significant effect on the RCP vascular in the early and late postoperative period. The pathogenesis of postoperative complications and their relationship with the state of the RCP require further study. Keywords: vitreoretinal surgery, vitreomacular interface, retinal internal limiting membrane, dosed fovea-sparing ILM peeling, optical coherence tomography, optical coherence tomographyangiography, vascular density, automatic image analysis
Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy
Relevance. Full-thickness macular hole (FTMH) is a vitreomacular interface pathology leading to a significant visual acuity decrease. Traditional surgery of FTMH is not effective enough. With the constant improvement of FTMH surgery, a comparative analysis of various surgical techniques is relevant. Purpose. To compare the early anatomical and functional results of large-diameter FTMH surgery using platelet-rich plasma (PRP) and the technique of hole edges convergence with the intraoperative optical coherence tomography (OCT) control. Material and methods. A randomized study was conducted on two comparable groups of patients. In both groups, surgical treatment of FTMH was performed, the difference was in the direct closure of the FTMH: PRP was used in the first group, the closure of MH was performed with intraoperative OCT control according to the proposed method in the second group. Results. The methods of FTMH closing were comparable in safety. Functional and anatomical results were comparable and did not differ significantly. A difference in the outer retinal layers matching was noted by OCT 1 week after surgery. In group 2, there was a greater number of FTMH closures with the formation of a U-shaped profile of the foveolar zone, which was accompanied by a better inner and outer retinal layers matching. Conclusion. The studied methods of FTMH treatment are comparable in functional results. However, it is necessary to continue studying and analyzing the long-term data. Keywords: macular hole, vitreoretinal surgery, platelet-rich plasma, optical coherence tomography
Purpose. Determination of factors associated with the incidence of hemophthalmos in the early and late postoperative period in patients with proliferative diabetic retinopathy (PDR). Material and мethods. Retrospective analysis of postoperative complications was performed in 124 patients (133 eyes) with PDR, who received treatment at the Research institute of Eye Diseases from 2018 to 2021. The study included patients with PDR with indications for surgical treatment (hemophthalmos, traction retinal detachment (TRD), traction diabetic macular edema). All patients underwent minimally invasive vitrectomy using additional chandelier-type illuminators with bimanual dissection and delamination of the proliferative tissue and careful removal of the vitreous base with sclerocompression. In all cases, the operation was completed without the use of any tamponade. Peripheral retinal photocoagulation (RP) was performed in 98 cases (73.7 %), phacoemulsification with intraocular lens implantation in 66 cases (49.6 %), angiogenesis inhibitors were used perioperatively in 47 cases (35.3 %). Results. Of 133 operated eyes, early postoperative intravitreal hemorrhage (EPH) was observed in 17 cases (12.8 %), of which 6 resorbed spontaneously and 11 required repeated surgical intervention. The development of EPH was significantly associated with the absence of intraoperative RP (p < 0.01), and the frequency of revision of the vitreal cavity to eliminate EPH correlated with the unstable course of arterial hypertension (AH) (p= 0.048) and with the absence of panretinal photocoagulation (PRP) before surgery (p= 0.012). It was found that EPH developed more often in patients operated on for TRD (p= 0.007) and in cases accompanied by severe intraoperative bleeding (p= 0.001) and unintentional intraoperative damage to the retinal vessels of the 2nd-3rd order (p< 0.01). Late postoperative intravitreal hemorrhage (LPH) was observed in 20 cases (19.8 %), of which 11 resorbed spontaneously and 9 required surgical treatment. The development of LPH is significantly associated with the absence of intraoperative RP (p< 0.01 for self-resorbed LPH and p= 0.041 for LPH requiring revision of the vitreal cavity). The frequency of revision of the vitreal cavity for the treatment of LPH is significantly associated with the unstable course of hypertension (p= 0.007) and the presence of EPH requiring surgical intervention (p= 0.003). The use of anti-angiogenic drugs before and during surgery did not show a significant correlation with the occurrence of EPH and LPH. Conclusions. Analysis of complications showed that EPH and LPH occurred in 12.8 % and 19.8 % of cases, respectively. Factors associated with the development of EPH were identified: the absence of PRP before surgery, the absence of intraoperative RP, TRD, intraoperative damage to the retinal vessels of the 2nd-3rd order. Factors associated with the development of LPH were identified: failure to perform RP intraoperatively, unstable course of hypertension, and the presence of EPH that required surgical intervention. Keywords: diabetic retinopathy, vitrectomy, bianual vitrectomy, postoperative hemorrhage, panretinal photocoagulation, peripheral retinal photocoagulation, arterial hypertension.
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