MANAGEMENT OF PROLIFERATIVE DIABETIC RETINOPATHY WITH COMBINED USE OF "SALT SOLUTION MEDIUM" AND "PERFLUOROCARBON LIQUIDS MEDIUM"

Khristo Takhchidi, O. A. Kostin, V. N. Kazaikin (Ekaterinburg)

Background: Since the development of vitreous surgery (Machemer, 1970) there have been many changes in the techniques of vitrectomy in proliferative diabetic retinopathy (PDR).

Aim: to develop a modern surgical method of PDR treatment with combined employment of "salt solution medium" and "perfluorocarbon liquids medium".

Patients and methods: 181 eyes with PDR, including 127 eyes with traction retinal detachment, have been operated in our clinic from 1995 till 2001. In 108 eyes hemophthalmia was present. Age of patients varied from 14 to 68 years (mean, 40 years).

Surgical technique: A standard 3-port vitrectomy was performed in "salt solution medium" (BSS), the vitreous was removed up to the epiretinal membranes. Fibrovascular tissue loosely adherent to the disk and the retina was removed in the "salt solution medium". After that "salt solution medium" was exchanged for "perfluorocarbon liquid (PFCL) medium" and fibrovascular tissue firmly adherent to the disk and the retina was removed in the "PFCL medium". Presence of PFCL in the vitreous cavity ensured efficacy and low traumaticity of these manipulations. Besides, PFCL provided additional haemostasis. After final separation of epiretinal membranes they were cut with vitreotome or removed with forceps through scleral incisions. Endolaser coagulation was performed. At the end of operation PFCL (Vitreopress) was left in the vitreous cavity for 7 days (137 eye) or exchanged for silicone oil (30 eyes), or for BSS (14 eyes). Postoperative PFCL tamponade provided haemostasis, transparency of optic media, adaptation and temporary fixation of retina, helped to unfold the retina and decreased retinal edema. Besides, PFCL tamponade provided favourable conditions for additional transpupillary lasercoagulation of retina. PFCL tamponade was finished by PFCL exchange for BSS (130 eyes) or silicon oil (7 eyes).

Results: During follow-up the status of the retina was stable in 159 eyes. In 22 eyes retinal detachment occurred, most of them in the early stage of this study. In 6 eyes hemophthalmia was seen. Visual acuity improved in 146 cases, was unchanged in 14, decreased in 21.

Conclusions:

1. Vitreoretinal surgery for PDR is most effective on condition of consecutive use of "salt solution medium" and "PFCL medium": the first - for vitrectomy and the last - for separation and removal of the fibrovascular tissue.
2. "PFCL medium" facilitates removal of the fibrovascular tissue, decreases risk of intraoperative complications and reduces time of the operation.
3. Postoperative PFCL tamponade provides additional unfolding of the retina, its fixation to the choroidea, reduces the retinal edema, permits effective monitoring of the retina and perform the transpupillary laser-coagulation.