Effectiveness of multistage surgical treatment of advanced proliferative diabetic retinopathy complicated with primary cataract].

K I Konovalova, M M Shishkin, R R Fayzrakhmanov

Vestnik oftalmologii 2020

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Vitreoretinal surgery (VRS) is the «gold standard» for surgical treatment of patients with proliferative diabetic retinopathy (PDR). However, the timing for the removal of primary cataract in this category of patients remains uncertain. To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract. The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS. Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively. The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.

Citation

K I Konovalova, M M Shishkin, R R Fayzrakhmanov. Effectiveness of multistage surgical treatment of advanced proliferative diabetic retinopathy complicated with primary cataract]. Vestnik oftalmologii. 2020;136(6. Vyp. 2):171-176