pirogovestnikВестник Национального медико-хирургического центра им. Н.И. ПироговаBulletin of Pirogov National Medical & Surgical Center2072-82552782-3628Национальный медико-хирургический Центр им. Н.И. Пирогова10.25881/20728255_2024_19_4_S1_53pirogovestnik-194Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESДИНАМИКА МОРФОФУНКЦИОНАЛЬНЫХ ПАРАМЕТРОВ РЕЗИСТЕНТНОГО ДИАБЕТИЧЕСКОГО МАКУЛЯРНОГО ОТЕКА ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯDYNAMICS OF MORPHOFUNCTIONAL PARAMETERS OF RESISTANT DIABETIC MACULAR EDEMA AFTER SURGICAL TREATMENTМартыновА. О.MartynovA. O.

Москва

Moscow 

aandrey_099098@mail.ruФайзрахмановР. Р.FaizrakhmanovR. R.

Москва

Moscow

ПавловскийО. А.PavlovskiiO. A.

Москва

Moscow

ДалогланянА. А.DaloglanyanA. A.

Москва

Moscow

ЛукиныхМ. А.LukinykhM. A.

Москва

Moscow

ФГБУ Национальный медико-хирургический Центр им. Н.И. ПироговаРоссияPirogov National Medical and Surgical CenterRussian FederationКафедра глазных болезней института усовершенствования врачей «НМХЦ им. Н.И. Пирогова» Минздрава России; ФГБУ Национальный медико-хирургический Центр им. Н.И. ПироговаРоссияInstitute of Advanced Training of Physicians N.I. Pirogov National Medical Surgical Center; Pirogov National Medical and Surgical CenterRussian FederationКафедра глазных болезней института усовершенствования врачей «НМХЦ им. Н.И. Пирогова» Минздрава России; ФГБУ Национальный медико-хирургический Центр им. Н.И. ироговаРоссияInstitute of Advanced Training of Physicians N.I. Pirogov National Medical Surgical Center; Pirogov National Medical and Surgical CenterRussian FederationКафедра глазных болезней института усовершенствования врачей «НМХЦ им. Н.И. Пирогова» Минздрава РоссииРоссияInstitute of Advanced Training of Physicians N.I. Pirogov National Medical Surgical CenterRussian FederationОфтальмологический центр «Визион»РоссияOphthalmological center «Vision»Russian Federation202413112024194приложение 15356Copyright © Мартынов А.О., Файзрахманов Р.Р., Павловский О.А., Далогланян А.А., Лукиных М.А., 20242024Мартынов А.О., Файзрахманов Р.Р., Павловский О.А., Далогланян А.А., Лукиных М.А.Martynov A.O., Faizrakhmanov R.R., Pavlovskii O.A., Daloglanyan A.A., Lukinykh M.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://submit.pirogov-vestnik.ru/jour/article/view/194

Инъекции ингибиторов ангиогенеза на сегодняшний день являются установленным «золотым стандартом» в лечении диабетического макулярного отека (ДМО). Витреоретинальная хирургия назначается при наличии эпиретинальной мембраны или витреоретинального тракционного синдрома. Ряд врачей считают возможным выполнение витрэктомии с удалением внутренней пограничной мембраны у пациентов с данным заболеванием.

Целью данного исследования является оценка изменений морфофункциональных параметров сетчатки у пациентов с резистентной формой ДМО, подвергшихся хирургическому вмешательству.

В НМХЦ имени Н.И. Пирогова было прооперировано 75 пациентов с диагнозом ДМО, не поддающимся консервативной терапии (антивазопролиферативная терапия, лазеркоагуляция сетчатки). Все пациенты были распределены на три группы в зависимости от типа вмешательства.

Оценка максимально корригированной остроты зрения после оперативного вмешательства показала статистически значимое улучшение данного параметра у пациентов второй и третьей группы по сравнению с пациентами первой группы через шесть месяцев после операции. У пациентов третьей группы наблюдалось заметное снижение толщины сетчатки в области фовеа через месяц после вмешательства. Отмечено значимое уменьшение отека у пациентов второй и третьей группы по сравнению с пациентами первой группы в срок с месяца до года. При оценке светочувствительности выявлено достоверное улучшение параметров у пациентов второй и третьей группы по сравнению с данными пациентов первой группы через 1 неделю после операции.

Полученные данные показывают высокую эффективность витреоретинального хирургического вмешательства у пациентов с резистентным диабетическим макулярным отеком, подтверждая возможность выбора хирургического подхода.

Anti-angiogenic injections are currently established as the «gold standard» for treating diabetic macular edema (DME). Vitreoretinal surgery is indicated in cases involving an epiretinal membrane or vitreoretinal traction syndrome. Some physicians consider it feasible to perform vitrectomy with the removal of the internal limiting membrane in patients with this condition.

The objective of this study is to assess changes in the morphofunctional parameters of the retina in patients with resistant forms of DME who have undergone surgical intervention. At the N.I. Pirogov National Medical and Surgical Center, 75 patients diagnosed with DME unresponsive to conservative therapy (anti-vascular proliferation therapy, retinal laser coagulation) were operated on. All patients were divided into three groups based on the type of intervention.

Evaluation of best-corrected visual acuity after surgery revealed a statistically significant improvement in this parameter among patients in the second and third groups compared to those in the first group six months post-operation. Patients in the third group showed a notable reduction in retinal thickness in the foveal area one month after the intervention. A significant decrease in edema was observed in patients from the second and third groups compared to those in the first group over the period from one month to one year. When assessing light sensitivity, a significant improvement in parameters was noted in patients from the second and third groups compared to the data from the first group one week after the surgery.

The results confirm the high effectiveness of vitreoretinal surgical intervention in patients with resistant diabetic macular edema, affirming the possibility of selecting a surgical approach.

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The authors declare that there are no conflicts of interest present.