Terminals syndrome – veno-occlusive complications of the postoperative period in proliferative diabetic retinopathy

Background.Complications of diabetic retinopathy (DR), such as vitreous haemorrhage and tractional retinal detachment, are indications for vitreoretinal surgical treatment. An urgent problem is the identification of instrumental and clinical changes and signs that may reflect the risks of developing postoperative complications and the need for additional treatment. Purpose. To demonstrate in a series of clinical cases a symptom complex of changes (“terminal syndrome”) in proliferative DR, which is a potential predictor of haemorrhagic and proliferative changes in the postoperative period. Material and methods. Six clinical cases are presented in which the presence of “terminals syndrome” in patients was determined – a combination of the inner retinal layers edema (according to OCT) and the presence of epiretinal proliferative tissues dense fixation zones in the area of the temporal vascular arcades distal branches. Patients underwent three-port vitrectomy with membrane peeling, diathermocoagulation of bleeding vessels and residual proliferative membrane fragments. The follow-up period was up to 12 months. Results. Up to 3 months from the surgery- four patients, and by 6 months – all patients showed signs of retinal venous occlusion of the temporal vascular arcades distal branches caused by changes in the residual fragment of the epiretinal membrane. Simultaneously, the development of rubeosis iridis was observed in five cases, macular edema in two cases, and vitreous haemorrhage requiring revision surgery in two cases. Conclusion.“Terminals syndrome” signs at the preoperative stage or intraoperatively is a risk factor in the development of retinal venous occlusion and requires measures to prevent both its development and subsequent complications.