The use of viscodissection with contrasting epiretinal membranes in the surgery of proliferative diabetic retinopathy

Relevance In surgical treatment of proliferative diabetic retinopathy, the risk of iatrogenic retinal breaks and massive hemorrhages remains high due to the presence of dense adhesion between the altered posterior halogen membrane (PHM) and the retina [1–3]. Modern methods require improvement to increase safety, minimize the risk of intraoperative complications and reduce the time of surgery [4]. Objective To develop and evaluate the effectiveness of the method of viscodissection with contrasting of epiretinal membranes to optimize PDR surgery. Material and methods The study included 30 patients with type 1 diabetes with severe proliferative diabetic retinopathy and traction retinal detachment. Patients were randomized into two groups: the main group underwent viscodissection using a mixture of viscoelastic and retinal dye to contrast epiretinal structures, and the control group underwent standard segmentation using a vitreotome and endovitreal forceps. The total operative time, the number of intraoperative stages, the frequency of iatrogenic ruptures, and the need to use tamponade were assessed. Results The method of viscodissection with contrast significantly reduced the operative time (mean time 41.3 ± 2.8 min versus 53.8 ± 6.2 min in the control group) and reduced the frequency of iatrogenic retinal breaks (0.6 ± 0.7 versus 3.1 ± 2.9). In addition, the main group used silicone oil less often as a tamponade for the vitreous cavity. Conclusion The obtained data indicate that the proposed method increases the safety and effectiveness of surgical intervention in PDR. Keywords: diabetes mellitus; proliferative diabetic retinopathy; vitreoretinal surgery; viscodissection; epiretinal membrane