Vladislav Dzinic
University Eye Clinic, Serbia
Title: Proliferative diabetic retinopathy - where are we now
Biography
Biography: Vladislav Dzinic
Abstract
Diabetic retinopathy is the fifth most common cause of blindness according to new researches. The number of people with moderate to severe visual loss due to the DR is constantly growing. Treatment modalities are improving moving the shift from laser photocoagulation to intravitreal injections (anti-VEGF, corticosteroids). Advances in technology of modern vitreoretinal surgical systems, usage of vitreal dyes and smaller gauges (MIVS) allow us to intervene earlier in the course of the disease. Our study presents the results of laser photocoagulation and anti-VEGF treatment approach as well as combined bimanual 4 port pars plana phaco-vitrectomy for advanced proliferative stages and epimacular membranes with or without ILM removal in the first surgery course. 53 eyes (50 patients) were followed. Visual acuity (VA) ranges from light perception to 0,3. In 18 eyes silicon oil as a tamponade agent was used and removed after 3-6 months after the surgery and in 35 eyes tamponade agent was air. In 29 eyes ILM was peeled primary. In 24 eyes in which ILM was not peeled in the first surgery after 9-12 months epi-macular membrane with significant macular traction was observed in 7 (29,2%) eyes in which additional surgery with ILM peeling was performed. Mean VA at the end of the follow-up period was 0.3 (0,03 - 0,6). According to our results combined phaco-vitrectomy procedure presents the treatment of choice for patients with severe visual loss, vitreous haemorrhages combined with epimacular membrane and retinal proliferations. Primary peeling of internal limiting membrane ILM has beneficial effect in preventing reoccurrence of epi-macular membrane in diabetic patients. Further investigations are needed in order to confirm safety and potential damage to the nerve fibre layer in order to establish ILM peeling as primary procedure.