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
To evaluate the effectiveness of combined surgical treatment at advanced stages of proliferative diabetic retinopathy.
Ufa Eye Research Institute, Ufa, Russia.
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.
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).
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.