Vitreoretinal surgery for advanced proliferative diabetic retinopathy of the only seeing eye

Objective. To demonstrate modern approaches to surgical treatment of advanced proliferative diabetic retinopathy in a patient with type 1 diabetes mellitus. Methods. Patient A., 20 years old, came to the ophthalmology center of the N.I. Pirogov National Medical and Surgical Center with complaints of low vision in both eyes. History: type 1 diabetes mellitus, glycated hemoglobin level below 7.0 mmol/l, diabetic polyneuropathy. The following were performed: visometry, pneumotonometry, autorefractometry, biomicroscopy, ultrasound examination, optical coherence tomography. Based on the results of examination and instrumental diagnostics, it is known: Vis OD pr. l. incerta n/c (not corrected), intraocular pressure (IOP) OD=35 mm Hg. Biomicroscopy of the OD shows rubeosis iris, the pupil is fixed to the anterior surface of the lens capsule, the fundus is not ophthalmoscoped. Vis OS 0.01 n/c, IOP OS=17 mm Hg. Biomicroscopy of the OS shows aggressive fibrovascular tissue from the optic nerve head (ONH) along the vascular arcades with tractional retinal detachment involving the macular zone, multiple subretinal cords, and anterior segment without features. Ultrasound examination showed the outcome of advanced proliferative diabetic retinopathy, funnel-shaped retinal detachment in the right eye. Tractional retinal detachment involving the macula, multiple subretinal proliferations, and severe vitreopapillary traction syndrome are determined in the left eye. Surgical treatment of the left eye was recommended to eliminate the traction component and achieve straightening and adhesion of the retina. An intravitreal injection of an angiogenesis inhibitor was performed 10 days before surgery. During the surgery, microinvasive vitrectomy was performed followed by gentle removal of the posterior hyaloid membrane complex with fibroglial proliferation with the formation of residual islands of fibroglial tissue in the areas of the most pronounced adhesion in order to minimize iatrogenic ruptures and vascular damage. A perfluororganic compound (PFOC) was introduced into the vitreous cavity, preretinal structures were stained with trypan blue in order to eliminate planar synechiae using a cannula with a silicone tip. Removal of PFOC followed by tamponade of the vitreous cavity with silicone oil through sterile air. Results. In the postoperative period, significant improvement of visual functions is noted, Vis OS=0.05 sph+6.0=0.1, straightening and adhesion of the retina of the left eye is achieved. The patient underwent a session of panretinal laser coagulation of the retina (PRLCS), it was recommended to achieve control of intraocular pressure, drug therapy was prescribed, subsequent series of PRLCS of the left eye is indicated. Conclusions. Advanced proliferative diabetic retinopathy is characterized by a wide range of clinical manifestations and complications leading to significant irreversible deterioration of visual functions and an unfavorable outcome. Along with this, the successful use of gentle techniques of vitreoretinal surgery, the use of complex and individualized approaches at all stages of patient management allows achieving high and stable treatment results even in complex clinical cases. Key words: proliferative diabetic retinopathy, vitrectomy, type 1 diabetes mellitus, sparing technique, traction retinal detachment, subretinal proliferation