RU2724009C1 - Method for prediction of developing macular edema following microinvasive vitrectomy for retinal detachment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, in particular to ophthalmology. Preoperative examination is performed, within which a kinetic perimetry is carried out and a total value of 8 meridians of the visual field is calculated. Further, using the biomicroscopy method and the B-scan data, determining the number of detached retina quadrants. Thereafter, the probability of developing macular edema is determined by formula: A=1/(1+2.72^{-(-12.637+0.017*B+2.978*C)}), where A – probability of developing macular edema; B is the total value of 8 meridians of the field of vision from kinetic perimetry data; C is the number of detached quadrants.

EFFECT: method enables providing accurate prediction of macular edema development in treating retinal detachment by microinvasive vitrectomy.

1 cl, 2 ex, 1 dwg

Description

The invention relates to medicine, in particular to ophthalmology, and in particular to a method for predicting the development of macular edema after microinvasive vitrectomy for retinal detachment.

Currently, most surgeons prefer vitrectomy as a method of treating exfoliated retina, especially in cases complicated by severe proliferative vitreoretinopathy. Modern technologies make it possible to quickly and less traumatically remove the altered vitreous body and create conditions for its expansion and the formation of the chorioretinal adhesion. In surgery for complicated retinal detachment, silicone oil is most commonly used as a temporary substitute for the vitreous body.

V., 2012; D. Н. Steel, 2017; Akiyama К., 2016; Лыскин П.В, 2017; и др.).However, despite these achievements, a certain proportion of complications of the postoperative period remains, one of which is the formation of epiretinal membranes and the occurrence of macular edema on the background of tamponade with silicone oil. According to some authors, the likelihood of this complication varies from 4.4 to 31% in those cases when vitrectomy was the method of treatment of retinal detachment (Mohamed G., 2017;

V., 2012; D. N. Steel, 2017; Akiyama K., 2016; Lyskin P.V., 2017; and etc.).

Removal of the inner border membrane (VPM) during vitrectomy for regmatogenous retinal detachment reduces the likelihood of the formation of epiretinal membranes and macular edema (Akiyama K., 2016; Blanco-Teijeiro MJ, 2018; Foveau P., 2018; Shkvorchenko D.V., 2018 , and etc.).

Since VPM is part of the Muller cell structure, its removal becomes a rather traumatic procedure for the retina and can cause a decrease in visual acuity and sensitivity in the central parts of the retina according to microperimetry. (Gupta R.R., 2018; Steel D.N., 2017; Hisatomi T., 2017; Forlini M, 2017; Deltour J.B., 2017, etc.)

Thus, predicting the development of macular edema will allow the removal of VPM only in cases where the risks of developing fibrosis of the latter are quite high.

A known method of determining the indications for performing posterior vitrectomy in patients with vitreomacular traction syndrome (The method for determining the indications for performing posterior vitrectomy in patients with vitreomacular traction syndrome: patent No. 2684204, Russian Federation, application No. RU 2017138170; application. 01.11.2017; publ. 04.04.2017; .2019). To determine the indication for posterior vitrectomy in patients with vitreomacular traction syndrome (hereinafter referred to as “BMTC”), visual acuity (hereinafter referred to as “OZ”) and retinal visual acuity (hereinafter referred to as “ROSE”) in the eye with Naval Forces, after which these indicators are compared. If the ROS is higher than OZ by 0.08 or more, conclude that the performance of posterior vitrectomy is indicated; if ROS does not differ from OZ, then performing posterior vitrectomy in the eye with BMI is not shown. The method allows to predict visual acuity after performing posterior vitrectomy in patients with VMTC.

The disadvantage of this method is the impossibility of predicting the development of macular edema in the treatment of retinal detachment by microinvasive vitrectomy. This is due to the focus of the above method solely on determining the indications for posterior vitrectomy in patients with BMD.

The technical problem is the need to develop a method for predicting the development of macular edema in the treatment of retinal detachment by microinvasive vitrectomy, devoid of the above disadvantages.

The technical result consists in providing an accurate prediction of the development of macular edema in the treatment of retinal detachment by microinvasive vitrectomy.

The technical result is achieved by the fact that in the method for predicting the development of macular edema in the treatment of retinal detachment by microinvasive vitrectomy, including preoperative examination, according to the invention, kinetic perimetry is performed as part of the preoperative examination and the total value is calculated from 8 meridians of the visual field, then using the biomicroscopy method and according to the B-scan data determine the number of detached quadrants of the retina, after which the likelihood of developing macular edema is determined by the formula:

A = 1 / (1 + 2.72 ^{- (- 12.637 + 0.017 * B + 2.978 * C)} ), where

A is the likelihood of developing macular edema;

In - the total value of 8 meridians of the field of view according to the kinetic perimetry;

C is the number of exfoliated quadrants;

This formula is the result of a regression analysis. A significant model was selected (p = 0.006), which had the highest sensitivity, specificity and accuracy, which included two of the variables listed above: the total value of 8 meridians of the visual field (p = 0.015), the number of detached retinal quadrants (p = 0.021), as well as a constant (p = 0.018).

After substituting the patient's data in the proposed formula, it is possible to determine the likelihood of developing macular edema in the patient. Thus, using the method of binary logistic regression, a mathematical model was obtained to assess the likelihood of patient edema and, consequently, the severity of his condition based on data that can be obtained before surgery. This model has a sensitivity of 84.6%, specificity of 81.8%, test accuracy of 83.3%, which indicates a fairly high reliability of the model.

Also, to assess the prognostic value of the proposed model of logistic regression, a ROC analysis was performed. The forecast quality is determined by the area under the characteristic curve, in our case the area under the graph was 0.86, which allows us to evaluate the model as “very good” (with values from 0.8 to 0.9, the quality of the model is defined as “very good” (Trukhacheva N.V., 2012)). The ROC curve of the proposed model is presented in the figure.

The claimed invention is illustrated by examples.

Example 1

Patient P., 66 years old. Right eye: Regmatogenous retinal detachment. PVR Wed type 2., Artifakia, Macular region is involved in retinal detachment. Corrected visual acuity before treatment was 0.02. After a diagnostic examination, a decision was made on endovitreal treatment of retinal detachment. In addition, during the diagnosis, kinetic perimetry was performed, according to the results of which a total value of 8 meridians of the field of view was determined equal to 262 degrees, as well as biomicroscopy and B-scan, with which it was determined the number of detached retinal quadrants equal to 3. Then the probability of developing macular edema was determined by the formula 1 / (1 + 2.72 ^{- (- 12.637 + 0.017 * B + 2.978 * C)} ) and amounted to 0.68 (68%). The obtained value corresponded to the conclusion: the likelihood of developing macular edema is present.

After endovitreal treatment of retinal detachment, the visual acuity of the patient was 0.4. During the rehabilitation period (1 month after surgery), the patient revealed macular edema (465 μm in the center of the macula).

Example 2

Patient T., 34 years old. Left eye: Regmatogenous retinal detachment. PVR CP type 1. The macular region is involved in retinal detachment. Corrected visual acuity before treatment was 0.2. After a diagnostic examination, a decision was made on endovitreal treatment of retinal detachment. In addition, during the diagnosis, kinetic perimetry was carried out, according to the results of which a total value was determined from the 8 meridians of the visual field, equal to 270 degrees, as well as biomicroscopy and B-scanning, with which the number of detached retinal quadrants was determined, equal to 1. Then the probability of developing macular edema was determined by the formula 1 / (1 + 2.72 ^{- (- 12.637 + 0.017 * B + 2.978 * C)} ) and amounted to 0.033 (3.3%). The obtained value corresponded to the conclusion: the likelihood of developing macular edema is unlikely.

After endovitreal treatment of retinal detachment, the visual acuity of the patient was 0.3. During the rehabilitation period, the patient did not have macular edema.

Claims (5)

A method for predicting the development of macular edema in endovitreal treatment of retinal detachment by microinvasive vitrectomy, including preoperative examination, characterized in that kinetic perimetry is performed as part of the preoperative examination and the total value of 8 meridians of the visual field is calculated, then using the biomicroscopy method and B-scan data the number of detached retinal quadrants, after which the likelihood of developing macular edema is determined by the formula: A = 1 / (1 + 2.72 ^{- (- 12.637 + 0.017 * B + 2.978 * C)} ), where And - the likelihood of developing macular edema; In - the total value of 8 meridians of the field of view according to the kinetic perimetry; C is the number of exfoliated quadrants.

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