First Author: R.Fayzrakhmanov RUSSIA
Co Author(s): M. Bikbov T. Gilmanshin 0 0 0 0 0 0 0 0 0
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Development of a combined technique of treatment of hidden neovascularization in combination with retinal pigment epithelium detachment.
Ufa Eye Research Institute, Ufa, Russia.
We observed 12 patients (12 eyes) with high detachment of the retinal pigment epithelium (RPE) associated with hidden choroidal neovascularization (CNV). Corrected visual acuity before treatment was 0,2 ± 0,07. On the OCT was determined RPE detachment up to 1200 ± 200 microns with an optically transparent content under it. Indications for surgical treatment were RPE detachment height of over 800 microns and resistance to the previous anti-VEGF therapy. Patients were divided into two equal groups: • Group 1 (6 eyes) underwent only drainage of subretinal fluid without intravitreal injection of medications; • Group 2 (6 eyes) underwent drainage of subretinal fluid with simultaneous intravitreal injection of ranibizumab. Technique of operative treatment consisted in the performance of subtotal vitrectomy 25 G, drainage of RPE detachment by retinal spatula at the bottom edge of the bubble. Intravitreal administration of ranibizumab for patients in group 2 at a dose of 0.5 mg. After draining of RPE to all patients underwent laser coagulation demarcates retinotomy and vitreous cavity tamponade 16% gas mixture (C2F6). Terms of postoperative follow-up was 3 months.
No intra- and postoperative complications were found during the surgical treatment. By the end of the 1 month of observation all the patients reported disappearance of the distortion of objects, visual acuity improved in both groups and was 0,3 ± 0,03. According to OCT retinal layers anatomical contact was observed, but the destruction of the pigment epithelium and photoreceptors remained unchanged. Under PES visualized moderately reflective mass without signs of activity - neovascular membrane. Retinal thickness at the fovea was 176 ± 8 microns. 3 months after surgery, 4 patients (67%) from Group 1 noted deterioration of central vision up to 0,25 ± 0,04. The OCT: RPE detachment relapse with the rise of the dome up to 100 microns was detected in macular area. Absence of complete arresting of pathological process was caused by the activity of CNV. Repeat surgery was not conducted. By the end of 3rd month of follow up in patients from group 2 visual acuity was 0,4±0,05, pathological changes in the macular area were not identified. CNV activity was reduced by anti-VEGF therapy. Retinal thickness in the foveolar area was 184 ± 11 microns.
Formation of hidden neovascular membrane with high detachment of retinal pigment epithelium suggests a comprehensive approach to conducted therapy. Drainage of subretinal fluid with intraoperative administration of ranibizumab at high RPE detachment can improve visual acuity, reach anatomical contact of retinal layers in the macula in the postoperative period.