Хирургия катаракты у пациентов с сахарным диабетом. Профилактика и оптимизация терапии диабетического макулярного отека

Сахарный диабет (СД) является серьезной проблемой общественного здравоохранения, примерно одна треть пациентов имеет признаки диабетической ретинопатии (ДР), катаракта развивается в более раннем возрасте и в 2–5 раз чаще. Показано увеличение частоты возникновения макулярного отека (МО) после факоэмульсификации катаракты (ФЭК) у пациентов с СД в 1,80 раза и в 6,23 раза — при наличии ДР. Критическим сроком ухудшения состояния сетчатки является 2-й месяц после ФЭК, что определяет необходимость проведения активной терапии и мониторинга. Пациентам с ранее существовавшим диабетическим макулярным отеком (ДМО), если катаракта не ставит под угрозу повседневную активность и имеется адекватная прозрачность оптических сред, предпочтительно отложить оперативное лечение для максимальной стабилизации состояния сетчатки по данным оптической когерентной томографии (ОКТ) при двух последовательных ежемесячных посещениях. При наличии выраженного нарушения прозрачности хрусталика рекомендуется ФЭК с интравитреальной инъекцией анти-VEGF или стероидов за 1 мес до операции при строгом мониторинге состояния сетчатки методом ОКТ. При отсутствии макулярных изменений и наличии риска развития ДМО необходимо применение нестероидных противовоспалительных препаратов. Недопустима профилактическая интравитреальная терапия при отсутствии МО.

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