The effectiveness of the combined surgical treatment at advanced stages of proliferative diabetic retinopathy

Session Details

Session Title: Free Paper Session 28: Vitreoretinal Surgery VII

Session Date/Time: Sunday 10/09/2017 | 12:00-13:30

Paper Time: 12:12

Venue: Room 116

First Author: : M.Kalanov RUSSIA

Co Author(s): :    R. Fayzrakhmanov   M. Bikbov   R. Zaynullin   V. Salavatova                    

Abstract Details

Purpose:

To evaluate the effectiveness of combined surgical treatment at advanced stages of proliferative diabetic retinopathy.

Setting:

Ufa Eye Research Institute, Ufa, Russia.

Methods:

We examined 58 patients (58 eyes) with compensated (sub compensated) type 2 diabetes mellitus, with advanced stage of proliferative diabetic retinopathy. The mean age was 59 ± 5.4 years; the average visual acuity – 0.04 ± 0.02; the mean thickness of the retina at the fovea – 358 ± 34 μm; the length of pathologically altered vitreomacular interface was 670 ± 38 μm; the optical density of the macular pigment is 0.096 ± 0.01 du. All patients underwent combined surgical treatment in 2 stages: 1. Intravitreal injection of an anti-VEGF preparation (ranibizumab) in a dose of 0.5 mg - once; 2. The primary vitrectomy including tamponade of vitreous cavity by gas-air mixture - C2F6 (Acreole) was performed 2 weeks after the ranibizumab injection. All patients underwent cataract phacoemulsification before being enrolled in the study. All patients underwent a standard ophthalmic examination. Additional studies included: optical coherence tomography (OCT) (RetinaScan-3000 (NIDEK), analysis of colour images of the ocular fundus with determination of the optical density of the macular pigment - (Visucam 500, Carl Zeiss); The follow-up period was 1 year. Statistical processing of the results was carried out using the Statistica 7.0 program (Statsoft), the differences were considered significant at p <0.05.

Results:

In 48 (82.8%) patients visual acuity after ranibizumab injection slightly improved to 0.06 ± 0.02, in 10 (17.2%) patients it did not change. After vitrectomy, visual acuity averaged 0.15 ± 0.05 (p <0.05), and after a year it decreased to 0.08 ± 0.02 (p <0.05). The retinal thickness at the fovea in the dynamics of combined surgical treatment (M ± σ, μm): after ranibizumab injection - 290 ± 28; after vitrectomy - 180 ± 26; 1 year after vitrectomy - 220 ± 10 (p <0.05). In 40 patients (69.0%) after ranibizumab injection the length of pathologically altered vitreomacular interface increased to 153 ± 25 μm (average), with a decrease in retinal thickness at the fovea, which in 80.0% of cases increased traction on the retina. The regression of neovascularization of fibro-glial tissue occurred in 4-8 days after the injection. Optical density of macular pigment after ranibizumab injection equaled 0.104 ± 0.01 du; after vitrectomy – 0.122 ± 0.01 du; one year after vitrectomy – 0.109 ± 0.01 du (p <0.05).

Conclusions:

1. Intravitreal injection of ranibuzumab as a preoperative preparation promotes regression of neovascularization already on 4-8 days, and reduces the risk of intraoperative haemorrhagic complications; 2. After intravitreal injection of ranibizumab, the distance of the pathologically altered vitreomacular interface increases, which strengthens the traction effect on the retina; 3. After the vitrectomy, the thickness of the retina in the fovea approached to the normal range, which, however, in the long-term follow-up period tended to increase; 4. Combined surgical treatment in the advanced stages of proliferative diabetic retinopathy contributes to the partial restoration of optical density of macular pigment; 5. Combined surgical treatment of advanced stages of proliferative diabetic retinopathy is a safe and effective method of treating this pathology.