Офтальмохирургия. 2016; : 84-89
ИНТРАОПЕРАЦИОННАЯ ФЛУОРЕСЦЕИНОВАЯ АНГИОГРАФИЯ В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ПРОЛИФЕРАТИВНОЙ ДИАБЕТИЧЕСКОЙ РЕТИНОПАТИИ, ОСЛОЖНЕННОЙ ГЕМОФТАЛЬМОМ
https://doi.org/undefinedАннотация
Пролиферативная диабетическая ретинопатия (ПДР) представляет собой одну из наиболее распространенных причин слепоты среди лиц трудоспособного возраста. Среди пациентов с сахарным диабетом (СД) распространенность диабетической ретинопатии (ДР) составляет более 40%, и в настоящее время отмечается тенденция к увеличению частоты ее встречаемости. Основным методом лечения данного заболевания является субтотальная витрэктомия (ВЭ) и лазеркоагуляция сетчатки (ЛКС). Медикаментозное лечение применяется лишь в сочетании с хирургическим вмешательством. Одним из наиболее распространенных осложнений ПДР является кровоизлияние в стекловидное тело. При использовании современных методов первичная ВЭ сопровождается низким системным риском хирургического вмешательства, вызывает улучшение зрительных и анатомических результатов. Однако при ПДР, осложненной гемофтальмом, возможны трудности предоперационной диагностики. До удаления стекловидного тела затруднены визуализация поражения сетчатки и планирование объема эндолазеркоагуляции сетчатки (ЭЛКС). Основными диагностическими процедурами, используемыми при ПДР, являются прямая офтальмоскопия, флуоресцеиновая ангиография (ФАГ) и оптическая когерентная томография (ОКТ). При ПДР их проведение затруднено вследствие нарушения прозрачности стекловидного тела. Проведение интраоперационной ФАГ может служить решением проблемы. Данный метод прост в исполнении. Он позволяет непосредственно в ходе хирургического вмешательства осуществлять диагностику сосудистых патологий сетчатки, изучение которых было невозможно в предоперационном периоде. Итраоперационная ФАГ позволяет диагностировать макулярный отек и ишемию, определять расположение аваскулярных областей сетчатки и зон неоваскуляризации. Возможной становится идентификация областей кровотечения. Результатом является более точное проведение ЭЛКС и, таким образом, улучшение результатов лечения, и снижение количества осложнений.
Список литературы
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33. Lim J.I., Blair N.P., Liu S.J. Retinal pigment epithelium tear in a diabetic patient with exudative retinal detachment following panretinal photocoagulation and filtration surgery // Arch. Ophthalmol. – 1990. – Vol. 108. – P. 173-174.
34. Maiman T. Stimulated optical radiation in ruby // Nature. – 1960. – Vol. 187. – P. 493-494.
35. Matsumoto M., Yoshimura N., Honda Y. Increased production of transforming growth factor-beta 2 from cultured human retinal pigment epithelial cells by photocoagulation // Invest. Ophthalmol. Vis. Sci. – 1994. – Vol. 35. – P. 4245-4252.
36. Meyer-Schwickerath G. Photocoagulation of the ocular fundus and the retina // Ann. Ocul (Paris). – 1956. – Vol. 189. – P. 533-548.
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Fyodorov Journal of Ophthalmic Surgery. 2016; : 84-89
INTRA-OPERATIVE FLUORESCEIN ANGIOGRAPHY IN THE DIAGNOSIS AND TREATMENT OF PROLIFERATIVE DIABETIC RETINOPATHY COMPLICATED BY HEMOPHTHALMOS
https://doi.org/undefinedAbstract
Proliferative diabetic retinopathy (PDR) is one of the most common reasons of blindness among working age people. Among patients with diabetes mellitus (DM) the prevalence of diabetic retinopathy is more than 40%, and at present there is a tendency to an increase of its incidence. The main methods of treatment of this disease are a pars plana vitrectomy and retinal laser photocoagulation (RLP). Medication used only in combination with surgery. One of the most common PDR complications is a vitreous hemorrhage. The use of modern methods of primary VE is accompanied by a low surgical risk and causes an improvement of visual and anatomical results. However, in the PDR complicated by vitreous hemorrhage, there can be possible difficulties of preoperative diagnosis. Prior to the removal of the vitreous body a visualization of retinal lesions is hampered as well as planning volume of the retinal endolaser coagulation (RELC). The main diagnostic procedures used in the PRD are direct ophthalmoscopy, fluorescein angiography (FAG) and optical coherence tomography (OCT). In the PDR their implementation is difficult because of a violation of the vitreous transparency. The intra-operative FAG can serve as a solution to the problem. This method is simple to perform. It allows to diagnose retinal vascular abnormalities directly during the surgical intervention, the study of which was impossible in the preoperative period. The intra-operative FAG allows to diagnose macular edema and ischemia, to determine the location of the retinal avascular regions and areas of neovascularization. The identification of areas of bleeding becomes possible. As a result there is a more precise RELC procedure, and, therefore, an improvement of treatment outcomes as well as an reduction in the quantity of complications.
References
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32. L’Esperance F. A., Jr. An opthalmic argon laser photocoagulation system: Design, construction, and laboratory investigations // Trans. Am. Ophthalmol. Soc. – 1968. – Vol. 66. – P. 827-904.
33. Lim J.I., Blair N.P., Liu S.J. Retinal pigment epithelium tear in a diabetic patient with exudative retinal detachment following panretinal photocoagulation and filtration surgery // Arch. Ophthalmol. – 1990. – Vol. 108. – P. 173-174.
34. Maiman T. Stimulated optical radiation in ruby // Nature. – 1960. – Vol. 187. – P. 493-494.
35. Matsumoto M., Yoshimura N., Honda Y. Increased production of transforming growth factor-beta 2 from cultured human retinal pigment epithelial cells by photocoagulation // Invest. Ophthalmol. Vis. Sci. – 1994. – Vol. 35. – P. 4245-4252.
36. Meyer-Schwickerath G. Photocoagulation of the ocular fundus and the retina // Ann. Ocul (Paris). – 1956. – Vol. 189. – P. 533-548.
37. Peyman G.A., Grisolano J.M., Palacio M.N. Intraocular photocoagulation with the argon krypton laser // Arch Ophthalmol. – 1980. – Vol. 98. – P. 2062-2064.
38. Photocoagulation treatment of proliferative diabetic retinopathy: The second report of diabetic retinopathy study findings // Ophthalmology. – 1978. – Vol. 85. – P. 82-106.
39. Raman R., Ananth V., Pal S.S., Gupta A. Internal ophthalmoplegia after retinal laser photocoagulation // Cutan. Ocul. Toxicol. – 2010. – Vol. 29. – P. 203-208.
40. Schawlow A., Townes C. Infrared and optical masers // Phys Rev. – 1958. – Vol. 112. – P. 1940-1949.
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43. Sramek C., Mackanos M., Spitler R. et al. Non-damaging retinal phototherapy: Dynamic range of heat shock protein expression // Invest. Ophthalmol. Vis. Sci. – 2011. – Vol. 52. – P. 1780-1787.
44. Sramek C., Paulus Y., Nomoto H. et al. Dynamics of retinal photocoagulation and rupture // J. Biomed. Opt. – 2009. – Vol. 14. – P. 034007.
45. The Diabetic Retinopathy Vitrectomy Study Research Group. Early vitrectomy for severe vitreous hemorrhage in diabetic retinopathy. Four-year results of a randomized trial: Diabetic Retinopathy Vitrectomy Study Report 5 // Arch. Ophthalmol. – 1990. – Vol. 108. – P. 958-964.
46. Usuelli V., La Rocca E. Novel therapeutic approaches for diabetic nephropathy and retinopathy // Pharmacol. Res. – 2015. – Vol. 98. – P. 39-44.
47. West S.K., Klein R., Rodriguez J. et al. Diabetes and diabetic retinopathy in a Mexican-American population: Proyecto VER // Diabetes Care. – 2001. – Vol. 24. – P. 1204-1209.
48. Yanyali A., Celik E., Horozoglu F. et al. 25-Gauge transconjunctival sutureless pars plana vitrectomy // Eur. J. Ophthalmol. – 2006. – Vol. 16. – P. 141-147.
49. Zweng H.C., Little H.L., Peabody R.R. Argon laser photocoagulation of diabetic retinopathy // Arch. Ophthalmol. – 1971. – Vol. 86. – P. 395-400.
