EFFECT OF SURGICAL TREATMENT OF PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY COMPLICATED BY HEMOPHTHALMIA

Purpose: to analyze the effectiveness of endolaser retina photocoagulation and subtotal vitrectomy in patients with proliferative diabetic retinopathy complicated by hemophthalmos using intraoperative fluorescein angiography. Patients and methods. Patients were divided into two groups. In the main group (24 patients, 29 eyes) we performed endolaser photocoagulation of the retina using intraoperative fluorescein angiography data after removal of the altered vitreous body. In control group (31 patients, 32 eyes) we performed endolaser photocoagulation after the altered vitreous body removal in the zones of suspected ischemia without data of fluorescein angiography. Conclusions about the effectiveness of therapy were based on improvement / decrease of visual acuity, intraocular pressure dynamics, electrophysiological studies data and the number of complications (recurrent hemophthalmos, increased intraocular pressure, macular edema and iatrogenic scotomas). Results. The study was conducted on 61 eyes of 55 patients (age 23–80 years, male/female ratio was 0,53). Visual acuity before the operative intervention was 0.001 (median). Visual acuity in the main group was 0.3 (vs 0.1 in the control group) in one month after surgery, 0.35 — after 3 months and 0.3 — after 6 months (vs 0.1 and 0.2 in the control group, respectively). The sensory threshold in the control group (100 μA) was significantly higher than in the main group (90 μA). The incidence of hemophthalmos was significantly lower in the main group compared with the control (6.9% in the main group vs 31.3% in the control group). The incidence of absolute scotomas in the laser photocoagulation zone was significantly higher in the main group (100.0% vs 6.3%), and the incidence of absolute scotomas outside the laser photocoagulation zone was significantly higher in the control group in comparison with the main group (100.0% vs 3.4%). Conclusion. Endolaser photocoagulation in the target non-perfused retinal areas according to intraoperative fluorescein angiography data effectively increases visual acuity at 1, 3 and 6 months after surgery and reduces the number of complications such as hemophthalmos, development of iatrogenic absolute scotomas outside the laser coagulation zone.

endolaser photocoagulation, vitrectomy, proliferative diabetic retinopathy, hemophthalmos, fluorescein angiography

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