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.
Macular hole (MH) is one of the most common pathologies of the macular area of the retina which leads to a significant decrease in visual acuity. The article presents early comparative morphofunctional results of surgical treatment of 60 patients (22 men and 38 women) with MH of the III–IV stages according to Gass and the minimum diameter (MinD) MH 404–696 microns. All patients included in the study had pseudophakia and have not previously undergone endovitreal interventions. Patients with MH with a diameter of 404–696 μm were randomized and divided into 3 equal groups: after three-port 25G pars plana posterior vitrectomy the patients of the first group underwent peeling of the inner limited membrane (ILM) with the convergence of the edges of MH and vitreous cavity tamponade with 16 % gas-air mixture of perfluoropropane (C2F6). In the area of the macular defect, patients of the second group underwent application of autologous conditioned plasma (ACP) in the PFСs environment and the convergence of the edges of MH. In patients of the third group, MH was closed using the technique of an inverted ILM flap. In patients of groups 2 and 3 the operation was completed by tamponade of the vitreous cavity with sterile air. Standard and special research methods, such as optical coherence tomography of the macular zone, were performed before surgery, 5 days and 1 month after surgery in all patients from groups 2 and 3. Patients from group 1 were examined before surgery and 1 month after surgical treatment, due to the long-lasting gas-air mixture in the vitreous cavity. Restoration of the correct structure of the fovea with the formation of U- and V-shaped profile during OCT after 1 month was noted in all cases. The data obtained demonstrate the peculiarities of using the inverted ILM flap and ACP methods in comparison with the traditional method of MH closure with a gas-air mixture.
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
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