THE INFLUENCE OF RELAXING RETINECTOMY ON THE DYNAMICS OF INTRAOCULAR PRESSURE AFTER VITREORETINAL OPERATIONS IN PATIENTS WITH PROLIFERATIVE DIABETIC RETINOPATHY

Abstract

The development of secondary glaucoma is one of the main factors limiting the use of silicone oil in vitreoretinal surgery. In the surgery of traction detachments, in addition to vitrectomy and membranectomy, it is often necessary to resort to retinectomy. After vitrectomy performed with retinectomy, the risk of developing secondary glaucoma is lower. The purpose of the study was to study changes in intraocular pressure after relaxation retinectomy in order to achieve retinal reattachment in patients with proliferative diabetic retinopathy. Materials and methods: a prospective clinical single-center study. The main group included 16 eyes of 16 patients with proliferative diabetic retinopathy, who underwent relaxing retinectomy during vitrectomy. The control group consisted of 19 eyes of 17 patients with proliferative diabetic retinopathy. They were a sample of operated patients without relaxing retinectomy, formed according to the “experience-control” principle. The minimum follow-up period was 24, the maximum was 34 months, the average duration in the main group was 30.6±2.2, in the control group – 29.7±3.0. Visual acuity was measured using tables in the decimal system, followed by recalculation of the indicators in the LogMAR system. Intraocular pressure in the eyes was measured by pneumotonometry. Statistical methods: Student's t-test; Mann-Whitney u-test; Pearson's χ2 test; Kaplan-Meier actuarial method. Research results. It should be noted that there are no significant differences between the groups both in the frequency of the need for repeated interventions and in visual acuity after surgery (1.2 ± 0.5 and 1.2 ± 0.6 in the main and control groups). When comparing the average intraocular pressure values of patients in the main and control groups, a statistically significant difference in IOP values in the postoperative period after 1 month was revealed (by 74.4%, p=0.048), 3 months (by 57.1%, p=0.043), 6 months (58.7%, p=0.029), 12 months (63.2%, p=0.048) and 24 months (58.0%, p=0.046) in favor of the main group. When analyzed using the actuarial method in the main group, the proportion of patients with normal IOP one month after surgery was 0.9; in the sixth month of observation – 0.72; on the twelfth – 0.65; and finally, on the 18th – 0.43. In the control group, the curve of the frequency of maintaining normal IOP was significantly different and was steeper: one month after surgery, the proportion of patients with normal IOP was 0.8; after 3 months – 0.32, after 10 months – 0.24; after 12-0.18; and after 18 months – 0.11. Conclusion. Based on the study, it can be assumed that retinectomy performed during vitrectomy for proliferative diabetic retinopathy complicated by tractional retinal detachment can lead to the prevention of the development of neovascular or silicone oil tamponade-induced glaucoma.