[Ozurdex in the treatment of diabetic macular edema. When to prescribe?]

[Viscodissection with staining of epiretinal membranes in surgery of proliferative diabetic retinopathy]

PURPOSE

To develop a method of viscodissection involving staining of epiretinal membranes, and to evaluate its efficacy and safety in surgical treatment of proliferative diabetic retinopathy (PDR).

MATERIAL AND METHODS

The study included 30 patients with type 1 diabetes mellitus and PDR with tractional retinal detachment (TRD). All patients were divided into two groups. In the first (main) group, at the initial stages of the operation, viscodissection with staining of epiretinal structures was performed, followed by segmentation and removal of membranes; in the second (control) group, segmentation and removal of membranes was performed using a vitreotome and endovitreal forceps.

RESULTS

During the follow-up, all patients showed positive trends of morphological and functional indicators. While the number of intraoperative stages was the same in both groups, the total operation time in patients of the main group was significantly lower (p≤0.001) than in patients of the control group (main - 41.3±2.8 min; control - 53.8±6.2 min). With equal number of posterior hyaloid membrane to inner limiting membrane (PHM to ILM) fixation points in both groups, iatrogenic retinal rupture occurred significantly less frequently in patients of the main group (main - 0.6±0.7, control - 3.1±2.9) (p≤0.001). In this regard, among the patients of the control group, in the overwhelming majority of cases, it was necessary to use a silicone oil tamponade (60%) or gas-air mixture (33%), while in the first group the main postoperative media were sterile BSS solution (73%) and gas-air mixture (27%).

[Changes in perfusional and morphological parameters of the macular area after silicone oil tamponade of the vitreous cavity]

PURPOSE

To compare the changes of the macular morphological and functional parameters in the postoperative period in patients with silicone oil tamponade after successful surgery of the macula-on rhegmatogenous retinal detachment (RRD).

MATERIAL AND METHODS

The study included 20 eyes operated on for macula-on RRD, which made up the first group, and the control group (20 eyes) for comparison. All patients of the study group underwent vitrectomy using silicone oil tamponade. Standard ophthalmological examination was performed on the 3rd day (early postoperative period) and the 14th day (late postoperative period), including OCT and OCT-A that were used to assess morphological and functional changes.

RESULTS

A significant decrease in visual acuity was seen on the 3rd day after surgery involving the use of silicone oil tamponade, in comparison with the 14th day (p=0.0237) and the control group (p=0.0001). A decrease in the FD parameter (p=0.045), a decrease in vascular density in the fovea (p=0.020) and parafovea (p=0.024) in SCP were found on the 3rd day in comparison with control. On the 14th day of postoperative observation, a tendency was detected for choroidal perfusion to restore, as well as significant increase in FD (p=0.016), and an increase in vascular density in parafovea (p=0.01) compared with the early postoperative period. No statistically significant changes were seen in the FAZ area and vessel density DCP (p>0.05).