Saratov JOURNAL of Medical and Scientific Research

proliferative diabetic retinopathy

Long-term results of the combined treatment of severe forms of proliferative diabetic retinopathy

Year: 2019, volume 15 Issue: №2 Pages: 550-555
Heading: Ophtalmology Article type: Original article
Authors: Tereshhenko. A.V., Sidorova Yu.A., Zhukova O.M., Firsova V.V.
Organization: S. Fedorov Eye Microsurgery Federal State Institution, Kaluga Branch
Summary:

Purpose: to evaluate the results of fve-year follow-up of patients with proliferative diabetic retinopathy after combined treatment using intravitreal administration of angiogenesis inhibitors and subtotal panretinal laser coagulation of the retina. Material and Methods. The study included 42 patients (42 eyes) with severe forms of proliferative diabetic retinopathy. In all cases, the frst step was intravitreal administration of an angiogenesis inhibitor (IVV AI) of-label. The second stage was carried out sessions of panretinal laser coagulation (PRLK), with the frst session — no later than two weeks after the IVV AI. Subsequent sessions of laser treatment were carried out with an interval of 1.5–2 months before the completion of subtotal PRLK (3 sessions). In the course of further follow-up, additional treatment was performed as necessary. The observation period was 5 years. Results. By the end of the observation period, complete regression of retinovitreal neovascularization and neovascularization of the optic nerve head was observed on 39 and 32 eyes (92.8 and 76.2 % respectively). During the observation period, all patients underwent subtotal PRLK, additional sessions of laser treatment were required in 19 cases (45.2 %), of which in 12 cases 1 additional session was performed, in 7 cases — 2 sessions of PRLP each. IVV AI was performed once in all cases, in 11 cases (26.2 %) additional injections were required, with the largest number of injections performed during the frst 2 years. Conclusion. The proposed algorithm for the management and treatment of severe forms of proliferative diabetic retinopathy has demonstrated its efectiveness, as evidenced by fve-year observation data.

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Combined approach to the surgical treatment of patients with prolifera-tive stage of diabetic retinopathy

Year: 2017, volume 13 Issue: №2 Pages: 338-345
Heading: Ophtalmology Article type: Original article
Authors: Bikbov M.M., Fayzrakhmanov R.R., Kalanov M.R.
Organization: State Budgetary Institution "Ufa eye research institute of the Academy of Sciences of the Republic of Bashkortostan"
Summary:

Purpose: to evaluate the effectiveness of combined surgical treatment in patients with proliferative stage of diabetic retinopathy. Material and Methods. 52 patients with advanced stage of proliferative diabetic retinopathy who were divided into 2 groups were examined. Group 1 consisted of 30 patients with a preliminary intravitreal injection of ranibi-zumab, followed by vitrectomy In group 2, 22 patients underwent vitrectomy without anti-VEGF therapy. Visual acuity in the 1st group before treatment was 0.04±0.02, in the second 0.05±0.03. The thickness of the retina in the foveolar zone of the 1st group was 358±34 urn, in the second 378±44 urn. Height of the complex "PHM with fibro-glial proliferation — retina" 670±38 and 710±30, respectively. Results. The visual acuity after treatment increased 4.2 times (group 1), in comparison with the results of the second group by 2.5 times. In patients of the 1st group intraoperative hemor-rhagic manifestations were observed in 36.6% of cases, in the 2nd group in all patients. An increase in the height of the complex "PHM with fibro-glial proliferation — retina" was noted in 83.3% in patients of the 1st group one month after the injection. The height of the complex increased on average to 153±25 urn, which in 76.6% increased the traction effect on the retina. The neovascularization regression occurred 4-8 days after ranibizumab injection in group 1 patients. The retinal thickness of the central zone 10 months after vitrectomy decreased to 220±10 urn in the 1st group and to 273±14 urn in the 2nd group, respectively. Conclusion. The use of inhibitors of angiogenesis, in particular ranibizumab, as a preoperative preparation of patients with proliferative stage of diabetic retinopathy reduces the risk of intra- and postoperative hemorrhagic complications, which facilitates the implementation of vitrectomy, avoids additional vitreo-retinal interventions, in connection with which a positive functional result remains.

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