Actuality:

Proliferative diabetic retinopathy (PDR) is one of the most common complications of diabetes type I. Proliferative retinal changes lead to a sharp vision reduction and, consequently, loss of life quality in young able-bodied patients. Modern technology of vitreoretinal surgery can be successfully used to eliminate the effects of the proliferative process in an eye and improve vision up to its full recovery. However, in most cases, even after successful vitrectomy in patients repeated hemorrhage has occurred in the vitreal cavity with a sharp visual acuity decrease. In case of frequent hemorrhage patients are tied to permanent treatment and surgery in the clinic, which leads to employment impossibility, independence loss, and social adaptation reduction.

Purpose:

To develop an algorithm of surgical treatment and rehabilitation of patients with proliferative diabetic retinopathy in diabetes type I.

Materials & Methods:

We retrospectively estimated the results of treatment of 10 patients (20 eyes), aged 20 – 30 years, with diabetes type I in anamnesis, operated for PDR with tractional retinal detachment, hemophthalmus and cataract (6 eyes). All patients were evaluated with visual acuity, A-P axis, ultrasound B-scan, OCT of macular zone (with transparency of media) before and after surgical treatment. For the first stage Lucentis was injected intravitreally, and after 5-7 days PDR was operated by 25G vitrectomy method, endolaser coagulation (within the equator) and silicone tamponade in 6 cases, in combination with phacoemulsification with IOL implantation. A month later the second eye was operated by the same method. If necessary, additional panretinal laser photocoagulation was performed. And in a month the silicone was removed. In 15 eyes after silicone removal in the postoperative period up to 10 days repeated hemorrhage occurred in the vitreous cavity with increased IOP to 28 mm Hg in 5 eyes. On this occasion, intravitreal injections of Lucentis were performed and after 7 days the blood was independently reabsorbed and IOP stabilized. Additional intravitreal injections of Lucentis were performed every 2 months with a preventive purpose. The visual acuity and the macular edema thickness results are shown in Table 1. On admission 1 month after the surgery 6 months after the surgery Visual acuity 0.25 0.5 0.8  retinal thickness (microns) 314 305 289

Results:

From the data presented in the Table 1 it follows that after the surgical treatment of tractional retinal detachment in all patients resulted a complete retinal fitting and visual acuity recovery on average to 50%, under panretinal laser coagulation and intravitreal Lucentis injection the height of macular edema decreased to 289 microns. The life quality significantly improved according to patients after a short period, connected with surgery, they were able to go to work, returned to children’s education, gained an opportunity to travel, to drive a car. In 6 months after RD surgery and three injections of Lucentis the best results were noted.

Conclusions:

The optimal algorithm for surgery of young patients with active life style with proliferative diabetic retinopathy and macular edema is combined surgical and laser treatment and intravitreal injections of Lucentis for edema leveling in the macula and hemorrhagic complications after surgery. As a result, visual acuity increases, life quality of patients improves.

Contact Details:

Email: elena_eyedoc@mail.ru
Cell Phone: +79184525233