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Y. Smirnov, V. Chernykh; Combined Treatment of Diabetic Proliferative Vitreoretinopathy. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5026.
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© ARVO (1962-2015); The Authors (2016-present)
To study the efficacy of lymphotropic lymphostimulating submastoidal blockades in combined treatment of diabetic proliferative vitreoretinopathy (PVR).
Surgical treatment was performed in 80 patients with advanced stages of diabetic PVR. Diabetic PVR was associated with insulin-dependent (type I) diabetes in 61 patient and with insulin-independent (type II) diabetes in 19 patients. Partial or subtotal vitreous hemorrhage presented in all cases. Retinal detachment was revealed in 54 patients. Postoperative pterygopalatine and submastoidal blockades were performed on 1st - 5th days of postoperative period in 30 randomly selected patients (group I). The rest 50 patients were referred as group II. Preoperative mean visual acuity was 0.06±0.03 in both groups. Surgical procedure included 3-port vitrectomy and kenalog-contrasted epiretinal membrane (ERM) peeling (en block or segmentation with maximally possible removal). PFCF was removed on the 7th day after surgery, replaced with saline or silicon oil. A cocktail of enzymes, neuropeptides, retinolamin, and mildronate was injected along I and II trigeminal nerve branches. Levels of interleukin-1ß were detected in lachrymal fluid pre- and post-operatively as a measure of inflammation status.
Retina reattached in 51 cases (94%) out of 54 retinal detachments. Postoperative visual acuity was associated with the preoperative condition of retina and optic nerve in the majority of cases. However, postoperative mean visual acuity in group I at 2-week time point was 0.1±0.04, whereas in group II it was 0.07±0.03. Signs of local inflammation, such as local edema, fibrin formation, pain syndrome, were less pronounced and resolved faster (on 7-8 day) in group I patients as compared to group II patients (on 12-14 day). Levels of interleukin-1ß, measured in lachrymal fluid on 3rd, 7th and 14th days after surgery, were 30%, 50% and 70%, respectfully, lower in group I than in group II (p<0.01).
Regional lymphotropic therapy based on pterygopalatine and submastoidal blockades resulted in improved visual functions and accelerated resolution of inflammatory and hemorrhagic complications in early postoperative period after vitrectomy with ERM peeling in patients with diabetic PVR.
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