Scientific Substantiation, Development, Evaluation of the Safety and Clinical Efficacy of Vitrectomy Technology in Patients with Severe Forms of Proliferative Diabetic Retinopathy Who are on Hemodialysis

Abstract

Purpose. Scientific substantiation, development, evaluation of the safety and clinical efficacy of vitrectomy technology in patients with severe forms of proliferative diabetic retinopathy (PDR) who are on hemodialysis (HD).Methods. We observed 100 patients (69 % women; 31 % men, mean age 63.2 ± 2.4 years) with PDR and chronic renal failure (CRF) requiring regular HD sessions (for at least 3 months). Patients were divided into two equal age, gender and number of patients (50 patients, 50 eyes) groups — the main group (MG), who underwent vitrectomy according to the developed technology, and the control group (CG), who underwent surgical intervention according to the traditional method. A comprehensive examination of the vision’s state was performed before and 14 days after surgery according to clinical and subjective indicators.Results. The data obtained indicate a more pronounced dynamics of the studied parameters in the MG compared to the CG, manifested by a significant (by 3–18 %) decrease in the incidence of intra and postoperative complications, a more pronounced (by 16.6 %, p < 0.01) decrease total score according to two developed specific subjective qualitative criteria for the condition of the fundus, a significantly higher (by 20 %) probability of an increase in BCVA, as well as a more significant increase in the level of the patient’s “quality of life” (by 10.4–14.9 %, p < 0.05 depending on the questionnaire used).Conclusion. The developed technology for performing vitrectomy in patients with PDR and end-stage chronic renal failure requiring continuous hemodialysis provides (compared to traditional) a higher level of safety and clinical efficacy due to an integrated approach to surgical intervention based on improving the stages of the operation (the maximum possible removal of the basal vitreum, performing peripheral endolaser coagulation, bimanual vitrectomy technique, and a number of others), as well as the developed medical and anesthetic support, which is confirmed (compared to the traditional technique) by a decrease in the incidence of intra and postoperative complications, as well as a more pronounced positive dynamics of BCVA, the state of the fundus and patient’s quality of life.

Keywords

• proliferative diabetic retinopathy
• vitrectomy
• chronic renal failure
• hemodialysis