scholarly journals Сomparative Analysis of the Long-Term Results of Diabetic Macular Edema and Epiretinal Membrane Surgical Treatment

2019 ◽  
Vol 16 (1S) ◽  
pp. 33-39
Author(s):  
M. M. Bikbov ◽  
R. M. Zainullin ◽  
T. R. Gilmanshin ◽  
T. A. Khalimov
Keyword(s):  
Comparative Analysis ◽  
Surgical Treatment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Epiretinal Membrane ◽  
Angiogenesis Inhibitor ◽  
Central Zone ◽  
Functional Results ◽  
Long Term Results ◽  
Quantitative Composition

The purpose of the study — to conduct a comparative analysis of structural and functional indicators of the central zone of the retina in patients with diabetic macular edema and epiretinal membrane in the remote period after surgical treatment. Patients and Methods. We examined 97 patients with diabetic macular edema in combination with the epiretinal membrane aged 53 to 68 years (mean age 61 ± 5.4 years). All patients underwent vitrectomy with an internal limiting membrane peeling (ILM). Patients were divided into 3 groups depending on the intravitreal use of an angiogenesis inhibitor. The analysis of the remote anatomical and functional results of patients of different groups during 1 year of observation was carried out. Results. In patients after treatment using the proposed technique, the central retinal thickness was reduced by 16.19 % (p = 0.031) compared with monotherapy and by 11.51 % (p = 0.039) compared with a phased treatment method. Visual acuity significantly increased in the treatment group by the single-step method by 1.53 times (p = 0.024) compared with the group where only vitrectomy was performed, and also 1.44 times (p = 0.029) compared with the delayed administration of angiogenesis inhibitor in avital eye. Patients in all groups have showed an improvement in central photosensitivity 1 month after surgery, followed by a slight decrease in performance. However, by 12 months, the level of central photosensitivity in group 2 was significantly higher than in other groups (p < 0.05). A comparative analysis of the spatial distribution of macular pigment has showed that, along with the development of the pathological process, macular pigments were dispersed in the retinal tissue. On the background of treatment, their concentration was normalized in the central zone of the retina, without increasing the quantitative composition. Conclusion Analysis of the morphofunctional parameters of the retina central section in patients with diabetic macular edema and epiretinal membrane in the dynamics of treatment with various techniques led to the creation of an algorithm for managing patients. It allows to achieve high clinical and functional results in an overwhelming percentage of cases and, thereby, significantly improve medical and social rehabilitation, and also the quality of life of this contingent. 

Structural and functional features of the central retina and improvement of surgical treatment of patients with diabetic macular edema and epiretinal membrane

2021 ◽  
pp. 27-32
Author(s):  
R.M. Zainullin ◽  
Keyword(s):  
Surgical Treatment ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Epiretinal Membrane ◽  
Angiogenesis Inhibitor ◽  
Long Term Results ◽  
Central Retina ◽  
Group A ◽  
Functional Features ◽  
Group B

Purpose. Improving the efficiency of surgical treatment of patients with diabetic macular edema and epiretinal membrane. Material and methods. Clinical studies were based on the analysis of morphological and functional parameters of the central retina. Patients with diffuse diabetic macular edema (DME) and epiretinal membrane (ERM) made up group A (main) of 96 people (96 eyes). Group B (control) included 22 patients (44 eyes) without ophthalmological diseases. Depending on the chosen method of surgical treatment, patients in group A were divided into three subgroups. Results. According to the data of optical coherence tomography, it was revealed that the average index of retinal thickness as a result of edema increased by 1.35 times (p=0.011) compared with group B. When conducting microperimetry in the macular zone in patients of group A, the total light sensitivity was reduced in 1.88 times compared with group B (p=0.028). Comparative analysis of long-term results of surgical treatment of patients with DMO and ERM showed that complex simultaneous vitrectomy and administration of an angiogenesis inhibitor is preferable compared to delayed administration of drugs, which is confirmed by a decrease in the total thickness of the retina in 78.3% of cases, preservation of the total photosensitivity of the central part of the retina on average, up to 15.3±3.24 dB, visual acuity - up to 0.51±0.22, no recurrence of edema in 63.4% of patients and the development of ERM - in 100% of cases. Conclusion. If the central thickness of the retina at the preoperative stage is less than 400 microns, it is possible to use a step-by-step method (vitrectomy + intravitreal administration of an angiogenesis inhibitor after 1 month). The use of the proposed one-step operation technique is preferable when the retina thickness is more than 400 microns. Vitrectomy with peeling of the internal limiting membrane in patients with cysts in the retinal edema zone with a diameter of more than 200 µm does not lead to a positive anatomical and functional result. Key words: diabetic macular edema, angiogenesis inhibitor, vitrectomy, microperimetry, epiretinal membrane.

Surgical treatment for diabetic macular edema

2016 ◽  
Vol 11 (3) ◽  
pp. 173-179 ◽  
Author(s):  
Elad Moisseiev ◽  
Joseph Moisseiev ◽  
Anat Loewenstein
Keyword(s):  
Surgical Treatment ◽  
Macular Edema ◽  
Diabetic Macular Edema

scholarly journals Comparative characteristics of the outcomes of the use of multidirectional intravitreal pharmacotherapy in the treatment of diabetic macular edema

2021 ◽  
pp. 39-45
Author(s):  
М.М. Bikbov ◽  
◽  
K.I. Kudoyarova ◽  
R.M. Zainullin ◽  
T.R. Gilmanshin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Intravitreal Injection ◽  
Diabetic Macular Edema ◽  
Angiogenesis Inhibitor ◽  
Standard Technique ◽  
Macular Area ◽  
Dexamethasone Implant ◽  
Biodegradable Implant ◽  
Inflammatory Reactions

Purpose. To conduct a comparative analysis of the effectiveness of intravitreal injection of dexamethasone-containing implant and aflibercept in macular edema in patients with diabetes mellitus. Material and methods. The study involved 80 patients (80 eyes) with macular edema. The group 1 included 38 patients (38 eyes) who underwent a single intravitreal injection of dexamethasone-containing biodegradable implant «Ozurdex» in a dose of 0.7 mg according to the standard technique. In the group 2, 42 patients (42 eyes) received 5 loading doses of aflibercept with an interval of one month. All patients underwent monthly spectral optical coherence tomography (OCT) of the macular area, as well as visometry and tonometry during the observation period. Results. One month after intravitreal injection of the studied drugs in both groups, no inflammatory reactions were detected in any case. According to OCT data, cystic edema of the macular area with a tendency to decrease the thickness in the fovea was preserved. After treatment with aflibercept, the average retinal thickness in the macula was 186.4±15.1 µm, and visual acuity averaged 0.48±0.05 in 85.7% of patients. During therapy with intravitreal injection of Ozurdex, an increase in visual acuity was noted in 89.4% of patients. Conclusion. This study found that intravitreal pharmacotherapy with an angiogenesis blocker and a dexamethasone implant in patients with diabetic macular edema are comparable in its effectiveness – 85.7 and 89.4% respectively. If systematic anti-angiogenesis therapy is not possible for a number of reasons, it is advisable to use a prolonged dexamethasone implant. Key words: macular edema, intravitreal pharmacotherapy, angiogenesis inhibitor, implant with dexamethasone.

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