Evaluation of the results of bimanual vitreoretinal surgery in the treatment of complications of diabetic retinopathy

Relevance The increasing number of patients with diabetic retinopathy requiring surgical intervention actualizes the problem of developing safe and effective treatment methods [1–3]. Of particular importance are the choice of the optimal treatment period and the assessment of remote anatomical and functional results [4, 5]. Objective Evaluation of the results of vitreoretinal surgical treatment using the bimanual technique for DR of various stages of fibrovascular proliferation in the remote postoperative period. Material and methods The study included 135 patients (135 eyes), divided into two groups depending on the type of proliferation: vascular and fibrous. All patients underwent microinvasive vitrectomy with membrane peeling using the bimanual technique, peripheral panretinal endolaser coagulation and tamponade of the vitreous cavity with a balanced salt solution. The observation period was up to 12 months. The functional assessment of the result was carried out by the best-corrected visual acuity (BCVA), and the anatomical assessment was carried out by the change in the central retinal thickness (CRT) using optical coherence tomography (OCT). Results In both groups, during the observation period, statistically significant improvement in BCVA and a decrease in CRT were observed. In patients with initially vascular proliferation, BCVA increased more significantly. Correlation analysis revealed that higher initial BCVA tends to be preserved in the postoperative period, and the presence of type 2 diabetes, severe fibrous proliferation, high CRT and diabetic macular edema is associated with worsening of the final BCVA. The incidence of complications was comparable, with the exception of postoperative DME, which is more often detected in fibrous proliferation. Conclusion Thus, the bimanual technique allows achieving high anatomical and functional results, as well as forming a hypothesis about the advisability of earlier surgical intervention in patients with high initial BCVA indicators. Keywords: diabetes mellitus; diabetic retinopathy; vitrectomy; vitreoretinal surgery; optical coherence tomography; diabetic macular edema; bimanual technique