Rationale for Clinical Approaches to the Use of Modern Pharmacological Neuroprotection in Patients after Endovitreal Surgery of Rheumatogenic Retinal Detachment

Abstract

Background. Annual disability index among patients with rheumatogenic retinal detachment (RRD) is 2–9 %. One of the factors, causing the development of morphofunctional disorders of macula, is the change in intraocular hemodynamics. Aim: substantiation of rational timing of neuroprotection with cytoflavin depending on the prediction of visual functions after endovitreal surgery of RRD.Materials and methods. There were 21 patients (21 eyes) with RRD. A three-port vitrectomy with silicone tamponade and its subsequent removal was performed. Two groups of patients: the 1st group – 10 patients with tolerable prediction of restoration of visual functions (increasing of visual acuity to 0.4–0.2 relative units), the 2nd group – 11 people with low level of visual prognosis (increasing of visual acuity to 0.15 and lower). All patients received cytoflavin at both stages of surgery. We used laser doppler flowmetry (microcirculation index (MI) and microcirculation efficiency index (MEI)). The criteria of “sufficiency” of cytoflavin receiving was periods of recovery of MI and MEI to indexes that were not significantly different from the norm.Results. Dynamics of response of chorioretinal microcirculation at both stages of endovitreal surgery of RRD was unidirectional. At the same time, the indexes of MI and MEI under influence of cytoflavin in patients with tolerable level of visual prognosis reached maximum index at the 15th day of observation as at the stage of silicone oil tamponade and after its removal; and in patients with low level of visual prognosis only at the 25th day of observation.Conclusions. Therapy with cytoflavin neuroprotection in patients after endovitreal surgery of RRD leads to significant increase of indexes of chorioretinal blood flow. The period of cytoflavin treatment justified until achievement of the required positive dynamics of chorioretinal microcirculation depending on the level of visual prognosis: tolerable – 15 days, low – 25 days.