Modern vitreoretinal interventions in the treatment of diabetic maculopathy: delicacy or maximalism?

Abstract

Background. Diabetic retinopathy, one of the major complications of diabetes, is one of the leading causes of low vision and blindness. One of the main causes of decreased central vision in patients with diabetic retinopathy and type 2 diabetes mellitus is diabetic maculopathy (DMP). DMP with possible development of diabetic maculopathy edema can be detected even in patients with initial changes in the fundus. The purpose was to investigate the safety profile and effectiveness of various modern vitreoretinal interventions in the treatment of diabetic maculopathy. Materials and methods. We observed 313 patients with type 2 diabetes mellitus (313 eyes) with DMP and initial (group I; n = 40), moderate-to-severe non-proliferative (group II; n = 92) and proliferative diabetic retinopathy (group III; n = 181). All patients underwent conventional ophthalmological examinations. Three hundred and thirteen patients (313 eyes) who underwent surgical treatment were divided into 4 observation groups: group 1 — 78 people (78 eyes) who underwent pars plana vitrectomy 25G (PPV); group 2 — 85 individuals (85 eyes) who underwent PPV and internal limiting membrane (ILM) peeling; group 3 — 81 patients (81 eyes) who underwent PPV, ILM peeling and panretinal photocoagulation (PPC); group 4 — 69 people (69 eyes) who underwent PPV, ILM peeling, PPC and phacoemulsification. The nature and frequency of surgical, postoperative complications and the effectiveness of different vitreoretinal interventions were studied. Terms of observation were 1, 3, 6 months and 1 year after surgery. Results. The effectiveness of different vitreoretinal interventions was studied 1, 3 and 6 months after surgery. High efficiency of intervention for all types of vitrectomy is established. Modern vitreoretinal interventions in the treatment of DMP and diabetic maculopathy edema is effective after 1 month in 60.7, 82.4, 85.2 and 68.12 % of cases, and after one year — in 76.0, 75.0, 73.1 and 73.5 %, respectively. The recurrence rate of DMP one year after vitreoretinal interventions was 24.0–27.0 % and did not depend on their modification. The effectiveness of DMP treatment depended on the stage of diabetic retinopathy and was 72.5 % in the initial non-proliferative diabetic retinopathy, 77.2 % with moderate-to-severe non-proliferative diabetic retinopathy and 66.3 % with proliferative diabetic retino-pathy. Recurrences of DMP were divided into three types: early transient, early persistent and late. The most frequent were early persistent relapses, which ranged from 16.1 to 25.6 % taking into account different methods of treatment. Conclusions. All stages of surgery must be strictly justified. The risks of each stage of the intervention should always be considered to obtain optimal functional results, especially in the long-term follow-up.