Combined approach to the surgical treatment of patients with prolifera-tive stage of diabetic retinopathy

Purpose: to evaluate the effectiveness of combined surgical treatment in patients with proliferative stage of diabetic retinopathy. Material and Methods. 52 patients with advanced stage of proliferative diabetic retinopathy who were divided into 2 groups were examined. Group 1 consisted of 30 patients with a preliminary intravitreal injection of ranibi-zumab, followed by vitrectomy In group 2, 22 patients underwent vitrectomy without anti-VEGF therapy. Visual acuity in the 1st group before treatment was 0.04±0.02, in the second 0.05±0.03. The thickness of the retina in the foveolar zone of the 1st group was 358±34 urn, in the second 378±44 urn. Height of the complex "PHM with fibro-glial proliferation — retina" 670±38 and 710±30, respectively. Results. The visual acuity after treatment increased 4.2 times (group 1), in comparison with the results of the second group by 2.5 times. In patients of the 1st group intraoperative hemor-rhagic manifestations were observed in 36.6% of cases, in the 2nd group in all patients. An increase in the height of the complex "PHM with fibro-glial proliferation — retina" was noted in 83.3% in patients of the 1st group one month after the injection. The height of the complex increased on average to 153±25 urn, which in 76.6% increased the traction effect on the retina. The neovascularization regression occurred 4-8 days after ranibizumab injection in group 1 patients. The retinal thickness of the central zone 10 months after vitrectomy decreased to 220±10 urn in the 1st group and to 273±14 urn in the 2nd group, respectively. Conclusion. The use of inhibitors of angiogenesis, in particular ranibizumab, as a preoperative preparation of patients with proliferative stage of diabetic retinopathy reduces the risk of intra- and postoperative hemorrhagic complications, which facilitates the implementation of vitrectomy, avoids additional vitreo-retinal interventions, in connection with which a positive functional result remains.