Surgery of cicatricial stage of choroidal neovascular membrane with autologous conditioned plasma

Abstract

Purpose. To estimate the effectiveness of the cicatricial stage of choroidal neovascular membrane (CNM) surgery with retina fixation after retinotomy of paracentral areas with autologous conditioned platelet rich plasma (ACP) and without endolaser photocoagulation and silicone oil tamponade. 
Material and methods. 17 CNM patients aged 49 to 82 with visual acuity from 0.02 eccentric to 0.08 were operated. The operation consisted in 25-, 27+-gauge vitrectomy, removal of the posterior hyaloid membrane and the inner limiting membrane (in the presence of an epiretinal membrane), paracentral retinotomy, removal of the choroidal neovascular membrane via retinotomy, pneumoretinopexy, 2–3 layer instillation of ACP in the retinotomy area without endolaser photocoagulation and silicone oil tamponade, seamless closure of sclera- and conjunctivotomy with a layer of autologous conditioned plasma. 
Results. Full retinal reattachment and closure of the retinotomy opening in the late postoperative period was noted in all patients. No case of recurrent retinal detachment was recorded. Complete closure of sclera- and conjunctivotomy with no additional suture fixation was achieved in all cases. In the long-term period after the removal of the cicatricial choroidal membrane, visual acuity was 0.03–0.2. 
Conclusion. The modern surgery of the cicatricial stage of CNM using ACP to close the retinotomy defect after removal of cicatricial CNV without endolaser coagulation of the retina and silicone tamponade, followed by seamless blocking of the sclero- and conjunctivotomy with ACP produces excellent anatomical and functional results, minimizing the risk of postoperative complications.