PROLİFERATİV DİABETİK RETİNOPATİYANIN FƏSADLARI ZAMANI APARILMIŞ MİKROİNVAZİV VİTREKTOMİYANIN UZAQ NƏTİCƏLƏRİ

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SUMMARY

Aim - to study stability of anatomical and functional results and incidence of complications in late postoperative period (5 years and more) after small-incision vitrectomy in patients with complications of proliferative diabetic retinopathy.

Material and methods
Results of 5 years and more observations of 53 eyes (44 patients, 29 females and 15 males) after 23 gauge pars plana vitrectomy in the department of diabetic eye diseease of National Centre of Opthalmology named after acad. Z. Aliyeva in 2009-2012 were analysed. Mean age of patients was 54,84±7,25 years, mean duration of diabetes 13,26±8,57 years. Mean HbA1c level was 7,2±0,3%.

Results
Indications for vitrectomy were: in 18 eyes (34,0%) – non-resolving vitreous hemorrhage, in 25 eyes (47,1%) – tractional retinal detachment, in 7 eyes (13,2%) – various diabetic maculopathies (tractional macular edema in 5 eyes, macular hole with local detachment in 1 eye and lamellar macular hole in 1 eye), in 2 eyes (3,8%) – dense premacular hemorrhage and in 1 eye (1,9%) progressive fbrovascular proliferation. 11 eyes were (20,8%) only functional eyes. 48 eyes were phakic, of which 35 (72,3%) underwent combined surgery – phacoemulsifcation with iOL and 23 gauge vitrectomy. Vitreal cavity was substituted with gas in 22 eyes (41,6%), silicone oil in 14 eyes (26,4%), air in 12 eyes (22,6%) and BSS in 5 eyes (9,4%). Mean follow-up period was 77,7±14,9 months (range, 60-114 months). At fnal visit complete retinal attachment was observed in all eyes (in 6 eyes under silicone oil), visual acuity improved in comparison to baseline in 48 eyes (90,6%), was unchanged in 4 eyes (7,5%), and deteriorated in 1 eye (1,9%). Mean visual acuity (in LogMAR units) improved from baseline 1,66±0,76 to fnal 0,84±0,68 (p<0,001). 10 eyes out of remaining phakic 13 eyes (76,9%) had cataract surgery in postoperative period. At fnal visit glaucoma was diagnosed in 11 eyes (20,8%). in 7 cases glaucoma was related to silicone oil, and in 4 cases to anterior segment neovascularisation. intraocular pressure was under contriol with hypotensive drugs in all cases. Ealy recurrent vitreous cavity hemorrhage was observed in 2 cases and late hemorrhage in 9 eyes (17,0%). Rhegmatogenous retinal detachment was observed in 2 eyes after vitrectomy and retina was reattached after repeeat surgery with silicone oil infusion.

Conclusion
23 gauge pars plana vitrectomy is an effective treatment method for complications of proliferative diabetic retinopathy, which allows to obtain long-term stable anatomical and functional results. Postoperative glaucoma (20,8%) and recurrent vitreous cavity hemorrhage (17,0%) are two most frequent complications in late postoperative period.