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Vol. 25, Art. 10 (pp. 160-169)    |    2024       

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Surgical treatment of resistant forms of diabetic macular edema.

Fayzrakhmanov R.R. , Pavlovskiy O.А., Lukinykh M.A.

1Federal state budgetary institution «National Medical and Surgical Center named after N.I. Pirogov» of the Ministry of Healthcare of the Russian Federation. 105203 Moscow, Nizhnyaya Pervomayskaya st., 70, center of ophthalmology.
2Institute of Advanced Training of Physicians N.I. Pirogov National Medical Surgical Center 105203 Moscow, Nizhnyaya Pervomayskaya st., 65.
3Ophthalmological center «Vision», 121099 Moscow, Smolenskaya square, 3.

Brief summary

Relevance. Diabetic retinopathy is a serious complication of diabetes mellitus. Today, injections of angiogenesis inhibitors are the gold standard for the treatment of diabetic macular edema. Currently, vitrectomy is used when epiretinal membrane or vitreoretinal traction syndrome develops. Some surgeons believe that vitrectomy with internal limiting membrane peeling in patients with DME can be used. Target. To evaluate the morphofunctional parameters of the retina of patients after surgical treatment of resistant diabetic macular edema. Materials and methods. 44 patients diagnosed with DME with no response to previous conservative treatment (laser coagulation, angiogenesis inhibitors) underwent surgery on the basis of the ophthalmology center of the National Medical Research Center named after N.I. Pirogov. Results. When analyzing BCVA in the postoperative period, a significant increase in functional parameters was revealed in patients of group 2 compared with similar parameters in patients of group 1 within 6 months from the date of surgery (p = 0.027). In the postoperative period, a statistically significant decrease in this parameter was revealed in patients of group 2 compared with patients of group 1, respectively, within 1 month (p = 0.035). When assessing photosensitivity, a significant increase in parameters was revealed in patients of group 2 compared with preoperative parameters and with similar parameters in patients of group 1 within 1 week from the moment of surgery (p = 0.023). Conclusion. Our results showed that vitrectomy with peeling of the internal limiting membrane provides a higher functional outcome compared to the group where only angiogenesis inhibitors and retinal laser coagulation were used from 6 to 12 months of follow-up. By the 1st week of observation, in patients of group 2, in comparison with the results of patients in group 2, there was a more pronounced positive dynamics of photosensitivity, which persisted for 12 months. A higher rate of edema resorption was also observed in the vitreoretinal surgery group. Thus, these data confirm that the use of vitreoretinal surgery is possible in the treatment of diabetic macular edema. Further study of this issue is required. This study was conducted on a small sample of patients. It is possible to study angio-OCT data as an additional research method. In the future, to confirm the statistical reliability of the results, it is necessary to study the data when examining a larger sample in groups.


Key words

DME; diabetic macular edema; vitrectomy; membrane peeling

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