PROLİFERATİV DİABETİK RETİNOPATİYANIN FƏSADLARI ZAMANI KOMBİNƏ OLUNMUŞ FAKOEMULSİFİKASİYA VƏ 23 GAUGE PARS PLANA VİTREKTOMİYANIN NƏTİCƏLƏRİ

Xülasə

SUMMARY

Aim – to study the results of combined mini-invasive surgery (cataract phacoemulsifcation and 23 gauge pars plana vitrectomy) in patients with complications of proliferative diabetic retinopathy.

Material and methods
Retrospective analysis of results of 430 phakic eyes operated for complications of proliferative diabetic retinopathy (379 patients) in a period between August 2009 and August 2015 in the Department of Diabetic Eye Disease, Zarifa Aliyeva National Ophthalmology Centre, Baku. 219 eyes of 197 patients underwent clear corneal phacoemulsifcation, foldable IOL implantation and 23 gauge pars plana vitrectomy, 211 eyes (193 patients) underwent 23 gauge pars plana vitrectomy only.

Results
Total number of surgeries during follow-up period was 286 in combined surgery group (1,31 average per eye, in 163 eyes only one surgery) and 343 in vitrectomy only group (1,62 average, 109 eyes with only one surgery). (Pearson χ2 = 23,62, P<0,001). Intraoperative miosis was observed in the combined surgery group (pupil size decreased from 6,82±1,82 to 5,21±1,12 mm at the end of cataract surgery). In the “vitrectomy only” group pupil size was signifcantly larger (7,23±0,99 mm, P<0,001) at the beginning of vitrectomy procedure. Other intraoperative complications in combined group were posterior capsule rupture in 4 cases (1,8%), signifcant corneal epithelial edema reguiring debridement in 6 eyes (2,7%) versus 2 eyes (1,0%) in vitrectomy only group. Early postoperative complications in the combined group included marked corneal edema in 10 eyes (4,6%), and intraocular hypertension in 12 eyes (5,5%), fbrinous anterior chamber reaction in 12 (5,5%) eyes (5,5%), bacterial endophthalmitis in 1 eye (0,5%). In the control group, 2 eyes had corneal edema (0,9%), 18 eyes (8,5%) – intraocular hypertension, 1 eye (0,5%) – fbrinous reaction in anterior chamber. In the control (phakic) group 96 eyes out of 211 (45,5%) underwent cataract surgery later in the follow-up period. Mean cataract surgery time was 17,85±1,19 months, median - 13,00±2,74 months. Final BCVA were 0,66±0,46 (in LogMAR units) in the combined group, and 0,70±0,62 in the control (vitrectomy only) group (P>0,05). In both combined and control groups fnal BCVA was signifcantly better in vitreous hemorrhage cases (0,72±0,36 and 0,74±0,55, correspondingly) than in tractional retinal detachment cases (1,38±0,79 and 1,28±0,89).

Conclusion
Both combined phacovitrectomy and vitrectomy are the safe and effective method of treatment and allow to obtain comparable functional results in patients with different complications of proliferative diabetic retinopathy. Patients with combined surgery should be monitored more carefully in the early postoperative period due to the higher rates of anterior segment related complications.