Surgical treatment of diabetic macular edema

Relevance Currently, injections of angiogenesis inhibitors are the "gold standard" in the treatment of DME [1, 2]. However, this therapy is accompanied by a number of disadvantages. Most patients require regular administration of anti-VEGF drugs, which in some cases can be difficult due to mobility restrictions or concomitant diseases. Surgical treatment is prescribed when pathology appears on the part of the vitreomacular interface [3]. A number of surgeons consider it appropriate to use vitrectomy with removal of the internal limiting membrane in the early stages of diabetic macular edema [4, 5]. Objective Evaluation of the effectiveness of surgical treatment of resistant diabetic macular edema based on the analysis of morphofunctional parameters of the retina. Material and methods In the ophthalmology center of the N.I. Pirogov National Medical and Surgical Center, 105 patients diagnosed with DME were operated on. They were divided into 3 groups. Group 1 (35 patients, 35 eyes). Patients in the first group continued conservative treatment with angiogenesis inhibitors in combination with laser coagulation of the retina. Group 2 (36 patients, 36 eyes). The second group included patients operated on using standard three-port vitrectomy with membrane peeling. Group 3 (34 patients, 34 eyes). The third group included patients operated on using the proposed technique - three-port vitrectomy with peeling of the internal limiting membrane (ILM) and subretinal administration of balanced salt solution (BSS). All patients underwent standard ophthalmological examination before and after surgery. Statistical processing of the results was carried out using the IBM SPSS Statistics 23 program. Results When analyzing the BCVA in the postoperative period, a reliable excess of functional parameters was revealed in patients of the 2nd and 3rd groups compared to similar parameters of patients of the 1st group at 6 months from the date of surgery. A statistically significant decrease in the retinal thickness in the fovea was revealed in patients of the 3rd group compared to patients of the 1st and 2nd groups, respectively, at 1 week and 1 month. A statistically significant decrease in edema was also noted in patients of the 2nd and 3rd groups compared to patients of the 1st group at 1, 6 and 12 months. When assessing photosensitivity, a reliable excess of this parameter was revealed in patients of the 2nd and 3rd groups compared to preoperative and with similar parameters of patients of the 1st group at 1 week from the date of surgical treatment. Conclusion The results of this study suggest that vitreoretinal surgery may be used in the treatment of diabetic macular edema. Keywords: DME; diabetic macular edema; vitrectomy; membrane peeling; submacular surgery