Combined treatment of severe forms of diabetic retinopathy

2021 ◽  
pp. 168-170
Author(s):  
A.V. Tereshchenko ◽  
◽  
I.G. Trifanenkova ◽  
Y.A. Sidorova ◽  
N.N. Yudina ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Silicone Oil ◽  
Combined Treatment ◽  
Vitreous Cavity ◽  
Fundus Photography ◽  
Laser Coagulation ◽  
Ophthalmological Examination ◽  
Initial Examination ◽  
Primary Vitrectomy

Purpose. To evaluate the efficacy and safety of combined treatment of proliferative diabetic retinopathy (PDR), including primary vitrectomy and delayed single-stage patterned panretinal retinal laser coagulation (PLC). Material and methods. The study included 28 patients (28 eyes) with newly diagnosed PDD complicated by hemophthalmos and / or local traction retinal detachment with or without 1-2 stage gliosis, against the background of sub- or decompensation of the course of diabetes mellitus (DM). At the initial examination, a standard ophthalmological examination was performed, as well as fundus photography (Visucam 500, Carl Zeiss, Germany), optical coherence tomography (OCT) (STRATUS OCT Carl Zeiss, Germany). The best corrected visual acuity (BCVA) at admission ranged from light projection to 0.4. All patients were undergone combined treatment. Results. 1-1.5 months after pattern PLC, patients showed regression of neovascularization, ischemic zones were completely blocked, in cases of iris neovascularization, its regression was noted. According to OCT data, the height of edema in the macular zone did not increase. In all cases, the removal of silicone oil was completed within 1-2 months. The indices of BCVA increased and varied from 0.1 to 0.7 after the removal of the silicone oil. According to OCT data, 17 patients showed a decrease in the height of retinal edema in the macular zone from 73 to 150 µm. Conclusion. In the postoperative period after vitreoretinated surgery in patients with PDR, one-stage patterned PLC allows to stabilize the course of the disease in a shorter time and shorten the time of silicone tamponade of the vitreous cavity. Key words: proliferative diabetic retinopathy, vitrectomy, silicone tamponade of the vitreous cavity, patterned panretinal laser coagulation of the retina.

scholarly journals EXPERIENCE OF SURGICAL TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY

2016 ◽  
Vol 1 (6) ◽  
pp. 118-121
Author(s):  
Казеннов ◽  
Aleksey Kazennov ◽  
Канюков ◽  
Vladimir Kanyukov ◽  
Трубина ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Visual Function ◽  
Silicone Oil ◽  
Antihypertensive Drugs ◽  
Direct Action ◽  
Blood Clot ◽  
Vitreous Cavity ◽  
Transscleral Cyclophotocoagulation

The study included 48vitreoretinal surgeries performed during 2014-2015 in 39patients with advanced fibrovascular stage of proliferative diabetic retinopathy. Visual acuity before the surgery averaged from pr. l. certae to 0.01. In 7cases patients underwent intravitreal injection of Lucentis 2–3weeks before the surgery. The surgery was performed according to the standard 3-port 25G vitrectomy. In some cases, short-term tamponade of vitreous cavity by fluid perfluororganic compounds (PFOS) was performed for 2–3days. This was due to prolonged bleeding during the surgery. In these cases, fibrinolytic of direct action (hemasa) was injected directly to the blood clot. In 4 cases circular retinotomy was needed. In 35cases tamponade was made by silicone oil 5700cSt, in 13 – by air-gas mixture. In cases of air-gas tamponade 3 patients had a relapse. After vitreous cavity revision it was plugged with silicone oil 5700cSt. In 17cases visual function remained unchanged, in 18 cases the changes were imperceptible, in 9cases visual acuity improved to 0.2, in 3cases – visual function increased to 0.4 and in 1patient – to 0.7. In postoperative period IOP increased in 7 cases. In 5 of these cases compensation was achieved with antihypertensive drugs. In one case the patient was implanted leukosapphire drainage, and in one more case transscleral cyclophotocoagulation about terminal aching glaucoma was performed. The silicone oil was removed in 6patients at the period of 6 months up to 2years.

Pathogenesis, Epidemiology, and Natural Course of Retinal Detachment

2009 ◽  
Author(s):  
Daniel A. Brinton ◽  
Charles P. Wilkinson
Keyword(s):  
Diabetic Retinopathy ◽  
Retinal Detachment ◽  
Proliferative Diabetic Retinopathy ◽  
Posterior Vitreous Detachment ◽  
Subretinal Fluid ◽  
Vitreous Cavity ◽  
Subretinal Space ◽  
Retinal Break ◽  
Vitreous Detachment ◽  
Pass Through

Retinal detachment does not result from a single, specific disease; rather, numerous disease processes can result in the presence of subretinal fluid. The three general categories of retinal detachments are termed rhegmatogenous, exudative, and tractional. Rhegmatogenous detachments are sometimes referred to as primary detachments, while both exudative and tractional detachments are called secondary or nonrhegmatogenous detachments. The three types of retinal detachments are not mutually exclusive. For example, detachments associated with proliferative vitreoretinopathy or proliferative diabetic retinopathy may exhibit both rhegmatogenous and tractional features. However, excluding the section on differential diagnosis in Chapter 5, the scope of this book is limited to rhegmatogenous retinal detachments. Accordingly, throughout the book, the term retinal detachment refers to the rhegmatogenous type, unless another type is specifically mentioned. Rhegmatogenous detachments (from the Greek rhegma, meaning rent, rupture, or fissure) are the most common form of retinal detachment. They are caused by a break in the retina through which fluid passes from the vitreous cavity into the subretinal space. The responsible break(s) can be identified preoperatively in more than 90% of cases, but occasionally the presence of a minute, unseen break must be assumed. Exudative detachments, also called serous detachments, are due to an associated problem that produces subretinal fluid without a retinal break. This underlying problem usually involves the choroid as a tumor or an inflammatory disorder. Tractional detachments occur when pathologic vitreoretinal adhesions or membranes mechanically pull the retina away from the pigment epithelium without a retinal break. The most common causes include proliferative diabetic retinopathy, cicatricial retinopathy of prematurity, proliferative sickle retinopathy, and penetrating trauma. Retinal breaks may subsequently develop, resulting in a combined tractional and rhegmatogenous detachment. The essential requirements for a rhegmatogenous retinal detachment include a retinal break and low-viscosity vitreous liquids capable of passing through the break into the subretinal space. Vitreous changes usually precede development of important defects in the retina. The usual pathologic sequence causing retinal detachment is vitreous liquefaction followed by a posterior vitreous detachment (PVD) that causes traction at the site of significant vitreoretinal adhesion with a subsequent retinal tear. Fluids from the vitreous cavity then pass through the tear into the subretinal space (Figure 2–1), augmented by currents within the vitreous cavity caused by rotary eye movements. Although a total PVD is usually seen, many detachments occur with partial vitreous detachment, and evidence of posterior vitreous detachment may not be seen.

scholarly journals Efficacy and Safety of Intravitreal Conbercept, Ranibizumab, and Triamcinolone on 23-Gauge Vitrectomy for Patients with Proliferative Diabetic Retinopathy

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Jinglin Cui ◽  
Hong Chen ◽  
Hang Lu ◽  
Fangtian Dong ◽  
Dongmei Wei ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Silicone Oil ◽  
Operation Time ◽  
Intravitreal Ranibizumab ◽  
Intravitreal Triamcinolone ◽  
Retinal Breaks ◽  
Pars Plana ◽  
Silicone Oil Tamponade ◽  
23 Gauge

Introduction. To compare the effect and safety of intravitreal conbercept (IVC), intravitreal ranibizumab (IVR), or intravitreal triamcinolone acetonide (IVTA) injection on 23-gauge (23-G) pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). Methods. Fifty patients (60 eyes) of varying degrees of PDR were randomly grouped into 3 groups (1 : 1 : 1) (n=20 in each group). The 23-G PPV was performed with intravitreal conbercept or ranibizumab injection 3–7 days before surgery or intravitreal TA injection during surgery. The experiment was randomized controlled, with a noninferiority limit of five letters. Main outcome measures included BCVA, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, and silicone oil tamponade. Results. At 6 months after surgery, there were no significant differences of BCVA improvements, operation time, incidence of iatrogenic retinal breaks, endodiathermy rate, silicone oil tamponade, vitreous clear-up time, and the incidence of intraoperative bleeding between the IVC and IVR groups (all P values ≥ 0.05), but they were significantly different from the IVTA group (all P values < 0.05). IOP increases did not show significant differences between the IVC and IVR groups, but both were significantly different with the IVTA group. More patients had higher postoperative IOP in the IVTA group. Conclusions. The intravitreal injection of conbercept, ranibizumab, or TA for PDR had a significant different effect on outcomes of 23-G PPV surgery. Conbercept and ranibizumab can reduce difficulty of the operation, improve the success rate of PPV surgery, and decrease the incidence of postoperative complications.

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