Combined Laser Surgical Treatment of Proliferative Diabetic Retinopathy in Combination with Diabetic Macular Edema

Purpose. To evaluate the clinical, functional and anatomical results of combined laser surgical treatment, including antiangiogenic therapy, panretinal laser coagulation (PRС) and precise YAG laser dissection in patients with proliferative diabetic retinopathy (DR) complicated by the development of epiretinal gliosis and diabetic macular edema (DME). Patients and methods. A total of 18 patients (18 eyes) with PDR in combination with epiretinal gliosis and DME were included in the study, who underwent step-by–step combined laser surgical treatment: 1 — antiangiogenic therapy, 2 — PRC, 2 — YAG-laser dissection of epiretinal gliosis. In the general cohort of patients, the average age was 60.7 ± 4.9 years. Before the treatment, as well as within 1, 3, 6, and 12 months after the intervention, all patients underwent uncorrected and best corrected visual acuity (UCVA and BCVA), computer microperimetry, optical coherence tomography, and digital photoregistration of the fundus on a wide-field fundus camera. YAG laser dissection of epiretinal gliosis was performed using an Ultra-Q Reflex Nd:YAG (Ellex) device. Results. The average value of the UCVA before surgery was 0.23 ± 0.14, and the best BCVA was 0.38 ± 0.13. In all cases, after the combined treatment, after 12 months of follow-up, there was a significant improvement in both UCVA (p < 0.05) and BCVA (p < 0.05). After 12 months of follow-up, the average UCVA value was 0.35 ± 0.11, and the BCVA was 0.47 ± 0.14. Before surgery, all patients underwent the CRT measurements, the average value was 529 ± 97 microns, which indicated the presence of macular edema. After 12 months of follow-up, the CRT significantly decreased (p < 0.05), averaging 344 ± 23 microns. According to the results of computer perimetry, retinal photosensitivity before treatment averaged 17.7 ± 2.7 dB, gradually increasing with treatment. After 12 months of observation, the photosensitivity was 19.6 ± 2.4 dB. During the indicated follow-up period, stabilization of anatomical and functional parameters was achieved. Conclusion. The obtained clinical and functional results indicate sufficient efficacy and safety of the proposed combined phased laser surgical treatment, including intravitreal antiangiogenic therapy, panretinal laser coagulation and YAG laser dissection, in patients with DR in combination with epiretinal gliosis and DME.

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