PECULIARITIES OF VITRECTOMY AND MORPHOLOGIC CHANGES IN THE EPIRETINAL MEMBRANE AFTER INTRAVITREAL AFLIBERCEPT IN PATIENTS WITH SEVERE PROLIFERATIVE DIABETIC RETINOPATHY.

Purpose: To examine the peculiarities of vitrectomy and morphologic changes in the epiretinal membrane after intravitreal aflibercept in patients with proliferative diabetic retinopathy.

Methods: Prospective study of 21 consecutive cases with proliferative diabetic retinopathy complicated by vascularized epiretinal membrane forming tractional retinal detachment that underwent pars plana vitrectomy 4 days after intravitreal injection of aflibercept. After removal, the epiretinal membranes were taken for histologic examination using light microscopy. Obliteration of neovascularization of epiretinal membranes, the lack of bleeding in the intraoperative and early postoperative periods, retinal attachment, and improvement of visual acuity were taken for the criteria of treatment effectiveness.

Results: On the fourth day after intravitreal injection, newly formed vessels of epiretinal membranes were completely obliterated. There was no bleeding during segmentation and delamination of epiretinal membranes during vitrectomy. In the early postoperative period, bleeding complications were not noted. A microscopic examination of epiretinal membranes showed single-thin-walled capillary vessels lined with endothelial cells, the lumen of which does not contain blood cells. Capillaries are submerged in the connective tissue of different degrees of maturity.

Conclusion: Intravitreal aflibercept resulted in the obliteration of neovascularization of epiretinal membranes, thus avoiding intraoperative and postoperative bleeding during vitrectomy. The improvement in visual acuity was noted in all cases. Histologic examination of epiretinal membranes determined single-thin-walled capillary vessels lined with endothelial cells without blood cells.