Силикониндуцированная офтальмогипертензия

PURPOSE: To demonstrate the results of conservative treatment for secondary ocular hypertension associated with silicone oil (SO) 5000-s tamponade of the vitreal cavity (VC).METHODS: We conducted a retrospective analysis of conservative treatment for ocular hypertension associated with SO 5000-s tamponade of the VC in 45 eyes (45 patients). Patients’ age ranged from 28 to 75 years: 22 males (49% of 45 patients), 23 females (51% of 45 patients). Among them 16 patients had high myopia (35% of 45 patients), 17 patients (38% of 45 patients) had moderate myopia, 8 patients (18 % of 45 patients) had mild myopia, 4 patients (9% of 45 patients) had emmetropia. All patients had previously underwent an operation for rhegmatogenous retinal detachment (primary and recurrent) with VC tamponade by means of silicone oil 5000-s. The tamponade duration was 3 months or more.RESULTS. In 33% of cases (15/45) we noted an intraocular pressure (IOP) increase during the first 48 hours after the insertion of SO 5000-s into the vitreal cavity, in 27% (12/45) — within the 1-4 months timeframe, in 24% (11/45) — 4-6 months, in 16% (7/45) — 6-12 months. IOP fluctuation range was 19-32 mm Hg. The first hypotensive regimen (1) included instillations of fixed combination brinzolamide/ timolol twice daily and sufficiently decreased IOP level in 27 patients (60% of 45 patients; IOP range 14-19 mm Hg). The second regimen (2) included additional instillations of brimonidine 0,15% 3 times per day and lead to IOP normalization in 11 more patients (24% of 45 patients; IOP range 15-20 mm Hg). Patients with persisting IOP decompensation had a further regimen enhancement. The third regimen (3) also included latanoprost 0.005% solution instillation once daily in the evening. IOP level normalization was achieved in 6 patients (14% of 45 patients; IOP range 17-19 mm Hg). One patient (2%) had to undergo a glaucoma operation. Out of 16 high myopia patients, 4 patients reached IOP compensation due to the first regiment, 7 patients — the second regimen; 4 patients — the third regimen, 1 patient — to the glaucoma operation.CONCLUSION: IOP compensation by means of conservative treatment was effective in most cases (98% of 45 patients). In one case (2% of 45 patients) of persisting IOP decompensation glaucoma surgery had to be performed. The highest IOP level was noted in high myopia patients; they needed a more intensive hypotensive regimen than patients with other kinds of refraction.ЦЕЛЬ. Представить собственные результаты консервативного лечения пациентов с вторичной гипертензией, возникшей на фоне тампонады витреальной полости (ВП) силиконовым маслом (СМ) 5000-S.МЕТОДЫ. Проведен ретроспективный анализ историй болезни 45 пациентов (22 (49%) мужчин, 23 (51%) женщин в возрасте от 28 до 75 лет; 45 глаз), у которых возникла вторичная гипертензия на фоне пролонгированной тампонады витреальной полости силиконовым маслом вязкостью 5000-S. В группу вошли как пациенты после витрэктомии при первичной ОС, так и пациенты после ревизии ВП по поводу рецидивов ОС. Всем пациентам хирургическое вмешательство проводилось по стандартной методике, включавшей временную тампонаду ПФОС, круговую эндолазеркоагуляцию и тампонаду ВП СМ вязкостью 5000-S. Срок тампонады составлял от 3 мес. и более. Миопия высокой степени наблюдали у 35% (16/45), средней степени — у 38% (17/45), слабой степени — у 18% (8/45), эмметропию — у 9% (4/45).РЕЗУЛЬТАТЫ. У 33% (15/45) пациентов повышение внутриглазного давления (ВГД) отмечали в первые 48 часов, у 27% (12/45) — в срок от 1 до 4 месяцев, у 24% (11/45) — в срок от 4 до 6 месяцев, у 16% (7/45) — в срок от 6 до 12 месяцев. Уровень ВГД в оперированных глазах колебался от 19 до 32 мм рт.ст. (пневмотонометрия). После использования фиксированной комбинации бринзоламид/тимолол (гипотензивный режим 1) в ежедневной двукратной инстилляции снижение ВГД было зафиксировано у 60% пациентов (27/45; ВГД составляло от 14 до 19 мм рт.ст.). После дополнительного назначения препарата бримонидина 0,15% в ежедневной трёхкратной инстилляции (гипотензивный режим № 2) ВГД снизилось у 24% пациентов (11/45; ВГД составляло от 15 до 20 мм рт.ст.). Пациентам, у которых ВГД компенсировать не удалось, дополнительно был назначен препарат латанопроста 0,005% в ежедневной однократной инстилляции в вечернее время (гипотензивный режим № 3). У 13% пациентов (6 из 45 пациентов) ВГД составило от 17 до 19 мм рт.ст. В одном случае (2% из 45 пациентов) была произведена антиглаукоматозная операция, так как компенсировать ВГД на максимальном гипотензивном режиме не удалось. Из 16 пациентов с миопией высокой степени (35% из 45 пациентов) 4 пациента использовали гипотензивный режим № 1, 7 пациентов — гипотензивный режим № 2, 4 пациента — гипотензивный режим № 3, 1 пациенту была проведена антиглаукоматозная операция.ЗАКЛЮЧЕНИЕ. В большинстве случаев (98% из 45 пациентов) компенсация ВГД была достигнута консервативным гипотензивным режимом, в 2% случаев (1/45) была произведена антиглаукоматозная операция. Наиболее высокие цифры ВГД и интенсивность гипотензивного режима были у пациентов с миопией высокой степени

The Role of Vitrectomy in Threatment of Epimacular Fibrosis

Purpose: а comparison of the results of epimacular fibrosis surgical treatment with vitrectomy and without it.Patients and methods. Two groups of patients with epimacular  fibrosis have been compared. The first group — 20 patients (20  eyes), epiretinal membrane was removed without vitrectomy. The  second group (30 patients — 30 eyes), epiretinal membrane was  removed after subtotal vitrectomy. Control of visual acuity was  monitored, as well as intraocular pressure, the retinal thickness in  the Central zone, and the thickness of the nerve fiber layer of the  retina in different sectors. Sensitivity of the retina macular zone was  determined by using microperimetry Maia, and peripheral zones  were determined with the help of computer perimeter, Humpfrey.  The patients were examined before surgery and at 1, 3, 6 and 12 months after it.Results. The average duration of surgery was 8 minutes in a group without vitrectomy and 32 minutes in a group of subtotal vitrectomy. 6 patients from 20 in the group of ERM removal without vitrectomy  had a relapse of fibrosis found in terms of 3 to 6 months. The groups showed a comparable improvement in visual acuity and  photosensitivity of the central retina, as well as a decrease of retina  thickness. There was a significant increase in IOP by 1.6 mmHg in  the group of subtotal vitrectomy. Statistically significant changes in  the retinal nerve fiber layer thickness were recorded only in temporal sector, and they were significantly more pronounced in subtotal  vitrectomy group (–15.95 and –22.47 microns respectively). In  absolute terms, the decrease in the sensitivity of the peripheral zone of retina was more pronounced in the group of subtotal vitrectomy,  intergroup differences were reliable.Conclusion. Direct comparison of the two methods demonstrated their comparable effectiveness in terms of influencing the visual  acuity and light sensitivity of the macula. Remove the ERM without  vitrectomy does not affect the peripheral visual field and intraocular  pressure, in contrast to the removal of the ERM after Subtotal  vitrectomy. ERM removal without vitrectomy entails a high risk of  recurrence, which indicates significant limitations of intervention and the impossibility of widespread use of this method

Efficacy and safety of various methods in surgical treatment of epimacular fibrosis

Purpose. To evaluate the efficiency and safety of three different techniques in the surgical treatment of epimacular fibrosis. Material and methods. A comparative evaluation of surgical treatment results was carried out in three groups of patients with epimacular fibrosis. In the first group – 20 patients (20 eyes), epiretinal membrane (ERM) was removed without vitrectomy. In the second group 30 patients (30 eyes), epiretinal membrane was removed after subtotal vitrectomy. In the third group – 30 patients (30 eyes), epiretinal membrane was removed after local vitrectomy. Local vitrectomy was performed by the following procedure: installing three 25G ports, induction of posterior hyaloids detachment in the macular area, local vitrectomy within the zone of vascular arcades (approximately 20% of the total vitreous volume), except for the area over the optic nerve head, layer-by-layer staining with MembraneBlueDual, removal of ERM, and then ILM. In all the groups a control of visual acuity was monitored, as well as intraocular pressure, the retinal thickness in the central zone, and the thickness of the retinal nerve fiber layer (RNFL) in different sectors. The OCT was used for a control the optic nerve head. The control of fusion of flickering frequency was made. The control of the optic nerve head was made using OCT and the control of fusion of flickering frequency (CFFF). Sensitivity of the macular zone of the retina was determined using the Maia microperimeter, and peripheral zones (Peripheral 60-4) were detected by means of the Humpfrey computer perimeter. The patients were examined before the surgery and 1, 3, 6 and 12 months after the sur gery. Results. The average duration of surgery was 8 minutes in the group without vitrectomy, 32 minutes in the group of subtotal vitrectomy and 18 minutes in the group of local vitrectomy. In the group of ERM removal without vitrectomy 6 patients out of 20 had a relapse of fibrosis found in follow-up period of 3 to 6 months. The groups showed a comparable improvement in visual acuity and photosensitivity of the central retina, as well as a decrease in the thickness of the r etina.  In the group of subtotal vitrectomy, a significant IOP increase 1.6mmHg was recorded, as well as an increase in optic disc excavation, a more significant effect on the thickness of RNFL, indicators of the CFFF (drop from 38.4Hz to 34.3Hz), and a decrease in the light sensitivity of the retina periphery. In the local vitrectomy group, the IOP decreased significantly (from 16.5mmHg initially to 14.6mmHg). In addition, there was no decrease in the light sensitivity of the peripheral regions of the retina, and the changes in excavation of optic disc and RNFL were significantly smaller compared to the group of subtotal vitrectomy. Surgical cataract treatment was required in 47% of cases (14 patients) in the group of subtotal vitrectomy, and only 15% (5 patients) in the group of local vitrectomy. Patients of the first group did not require any cataract treatment.Conclusion. Subtotal vitrectomy with epiretinal membrane peeling is effective (30% increase in visual acuity), however, this intervention increases a risk of cataract development (47% of patients were operated on for cataract), negatively affects the optic nerve (CFFF decreased by 4Hz, increase of excavation of optic disk) and intraocular pressure (a 2mmHg persistent IOP increase 12 months later), and also, probably, reduces the sensitivity of the peripheral zone of the retina (-17dB in the upper-temporal quadrant). An alternative method of treatment is a removal of the membrane without vitrectomy. It allows to avoids the above-mentioned complications, but this method is associated with a high relapse rate (6 out of 20 patients had a relapse with a preservation complaints), due to the complexity of implementation and it significantly lim its the use of this method. Local vitrectomy demonstrated the most optimal balance between efficacy, safety, risk of recurrence and difficulty of implementation (no elevation of IOP, less pronounced negative impact on the optic disc and RNFL, no relapse, a low percentage of cataract development – 15%)