THE INCIDENCE AND VALUE OF DIABETIC MACULAR EDEMA IN THE STRUCTURE OF THE RELAPSES IN THE SURGICAL TREATMENT OF DIABETIC MACULOPATHY IN PATIENTS WITH DIABETES MELLITUS TYPE 2

Panchenko Yu. O., Mogilevskyy S. Yu.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Common diabetes complication is development of diabetic maculopathy (DMP) and macular edema (DME). Surgical treatment of DMP is accompanied by a macula structural improvement, but the functional results depend on the DME formation, the criterion of which is the increase of the central retina thickness (CRT). Aim. To investigate the frequency and significance of diabetic macular edema in the structure of recurrence in the surgical treatment of diabetic maculopathy in patients with type 2 diabetes. Object and methods. The study included 313 cases (313 eye) with DMP and initial (n=40), moderate or severe non-proliferative (n=92) and proliferative diabetic retinopathy (n=181). Patients received four types of treatment: closed subtotal vitrectomy (CSV; n=78); CSV with peeling of the internal limiting membrane (ILM) in the macular region (n=85); CSV, ILM peeling and a stage of panretinal laser coagulation of the retina (n=81) and in addition to all these interventions – a cataract phacoemulsification (n=69). For statistical processing of data was performed using the program Statistica 10 (StatSoft, Inc., USA). Results. The relapses of DMP in the 1 year after the operation amounted to 29.7% (93 eyes). The fate of the DME in the presence of DMP recurrence after 1 month was 37.5%, in 3 months – 80.7%, in 6 months – 84.4% and after 1 year – 88.5%. The frequency of DME of the difference between the applied methods was not (p=0,129). CRT after surgery (CRT0) and the severity of retinopathy on the ETDRS scale substantially influenced the development of DMP relapses (p<0.005). The critical CRT0 level, at which likely development of the DMP relapse after 1 year was more 356.0 µm (p=0.031); critical ETDRS more than 70 points (p=0.005) to predict relapses after 3, 6 months and 1 year follow-up. Conclusion. The incidence of DME in the relapsese of DMP surgical treatment during the 1 year of observation increased; on the relapses development was significantly influenced by the initial CRT and the value of bales of ETDRS

diabetic maculopathy, macular edema, diabetes mellitus type 2, surgical treatment, relapses

1. Balashevich LI, Izmaylov AS. Diabeticheskaya oftal’mopatiya. SPb.: Chelovek; 2012. 396 s. [in Russian].
2. Pasechnikova NV. Diabeticheskaya makulopatiya. Sovremennyye aspekty patogeneza, kliniki, diagnostiki, lecheniya. Kiyev: iz-vo OOO «Karbon LTD»; 2010. 154 s. [in Russian].
3. Mogilevskyy SYu, Panchenko YuA. Osobennosti diabeticheskoy makulopatii u bol’nykh sakharnym diabetom 2 tipa. Arkh oftal’mol Ukr. 2018;6(2(11)):28-32. [in Russian].
4. Amirov AN, Abdulayeva EA, Minkhuzina EL. Diabeticheskiy makulyarnyy otok: epidemiologiya, patogenez, diagnostika, klinicheskaya kartina, lecheniye. Kazanskiy med zh. 2015;96(1):70-6. [in Russian].
5. Umanets NN, Rozanova ZA, Aslanova VS, Brazhnikova YeG. Rezul’taty vitrektomii s udaleniyem vnutrenney pogranichnoy membrany v lechenii bol’nykh s traktsionnym diabeticheskim makulyarnym otekom. Probl yekol ta med genetiki í klín ímunol. 2011;4(106):72-8. [in Russian].
6. Kulikov AN, Sosnovskiy SV, Berezin RD, Oskanov DKh, Remigin AS. Izmeneniya vitreoretinal’nogo interfeysa u patsiyentov s vpervyye vyyavlennym diabeticheskim makulyarnym otekom. Sovr tekhnol v oftal’mol. 2016;1:133-6. [in Russian].
7. Norihito Doi, Taiji Sakamoto. Comparative study of vitrectomy versus intravitreous triamcinolone for diabetic macular edema on randomized paired-eyes. Graefes Arch Clin Exp Ophthalmol. 2012;250:71-8.
8. Hu XY, Liu H, Wang LN, Ding YZ, Luan J. Efficacy and safety of vitrectomy with internal limiting membrane peeling for diabetic macular edema: a Meta-analysis. Int J Ophthalmol. 2018 Nov 18;11(11):1848-55. DOI: 10.18240/ijo.2018.11.18
9. Jackson TL, Nicod E, Angelis A, Grimaccia F, Pringle E, Kanavos P. PARS PLANA VITRECTOMY FOR DIABETIC MACULAR EDEMA: A Systematic Review, Meta-Analysis, and Synthesis of Safety Literature. Retina. 2017 May;37(5):886-95. DOI: 10.1097/IAE.0000000000001280
10. Rinaldi M, dell’Omo R, Morescalchi F, Semeraro F, Gambicorti E, Cacciatore F, et al. ILM peeling in nontractional diabetic macular edema: review and metanalysis. Int Ophthalmol. 2018 Dec;38(6):2709-14. DOI: 10.1007/s10792-017-0761-6
11. Xiao K, Dong YC, Xiao XG, Liang SZ, Wang J, Qian C, et al. Effect of Pars Plana Vitrectomy With or Without Cataract Surgery in Patients with Diabetes: A Systematic Review and Meta-Analysis. Diabetes Ther. 2019 Jul 25. DOI: 10.1007/s13300-019-0672-9 [Epub ahead of print].
12. Rykov SA, Mogilevskiy SYu, Parkhomenko OG, Suk SA. Usovershenstvovannyy algoritm analiza snimkov opticheskoy kogerentnoy tomografii makulyarnoy oblasti setchatki pri diabeticheskom makulyarnom otoke. Arkh oftal’mol Ukr. 2015;3(1(3)):40-7. [in Russian].
13. Schechet SA, DeVience E, Thompson JT. The effect of internal limiting membrane peeling on idiopathic epiretinal membrane surgery, with a review of the literature. Retina. 2017 May;37(5):873-80. DOI: 10.1097/IAE.0000000000001263
14. Pessoa B, Dias DA, Baptista P, Coelho C, Beirão JNM, Meireles A. Vitrectomy outcomes in eyes with tractional diabetic macular edema. Ophthalmic Res. 2019;61(2):94-9. DOI: 10.1159/000489459
15. Early Treatment Diabetic Retinopathy Study Research design and baseline patient characteristics. ETDRS, report number 7. Ophthalmology. 1991;98(5):741-56. DOI: 10.1016/S0161-6420(13)38009-9

«Bulletin of problems biology and medicine» Issue 3 (152), 2019 year, 171-177 pages, index UDK 616.735-005:617.735-0.02:616.379-008.64

10.29254/2077-4214-2019-3-152-171-177