Tractional retinal detachment: clinical guidelines

Applies toadults2026 editionH33.4, H33.5

Clinical Guidelines of the Russian Ministry of Health, adults. 2026 edition, ICD-10 codes: H33.4, H33.5.

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Brief for Practice

WhiteCoat Pro editorial summary of the guideline text, 2026 edition. Each point links to the original section — verify with it before prescribing.

Tractional retinal detachment occurs due to the contraction of proliferative membranes and vitreous retraction; upon secondary retinal tear formation, it becomes a combined tractional-rhegmatogenous detachment. These guidelines focus on disease recognition, diagnosis confirmation, selection of laser or surgical tactics, and postoperative management.

Key points

The main causes of TRD are proliferative diabetic retinopathy, central retinal vein occlusion or branch occlusion, hemophthalmos, trauma, uveitis, vasoproliferative tumors, and Eales disease. → in the text
TRD is classified by location and extent, etiology, as well as by variants requiring or not requiring surgical treatment, and by stages; variants with and without macular involvement are distinguished separately. → in the text
TRD is typically characterized by a slowly progressive visual field defect, decreased visual acuity when the macula is involved, floaters, a "fog" or "veil", phosphenes, and metamorphopsia. → in the text
Clinical signs of TRD: concave detachment without breaks, local retinal elevation in the traction zone, low height of detachment, significantly reduced retinal mobility, and absence of subretinal fluid shifting. → in the text
When a retinal tear develops, the clinical picture changes to a tractional-rhegmatogenous detachment, which progresses more rapidly. → in the text
Without timely pathogenetic treatment, the visual prognosis is unfavorable; the goal of treatment is to relieve traction and achieve partial or complete anatomical retinal attachment by the time of discharge. → in the text

Diagnostics

Take a history and assess complaints in every patient with suspected TRD to identify functional visual disorders and symptoms indicating disease duration; note that complaints may be absent for a long time. Level of reliability of evidence (LoRE): C, level of trustworthiness of evidence (LoTE): 5. → in the text
Perform a physical examination for comorbid systemic conditions and risk factors for complications, especially before surgery, to identify contraindications and reduce the risk of complications. LoRE: C, LoTE: 5. → in the text
Perform visometry, ophthalmotonometry, and biomicroscopy. Biomicroscopy is initially performed without mydriasis to detect early iris neovascularization; then the fundus is examined under medicinal mydriasis after prior assessment of anterior chamber depth. LoRE: C, LoTE: 5. → in the text
Perform ophthalmoscopy or fundus biomicroscopy with a wide pupil: assess the concave configuration of the detachment, presence of vitreoretinal membranes, local retinal elevation and mobility, as well as retinal breaks. → in the text
Use OCT for quantitative and qualitative assessment of the retina and treatment monitoring. If optical media clarity is insufficient, perform an ultrasound examination of the eyeball to assess vitreoretinal relationships. LoRE: C, LoTE: 5. → in the text
Static perimetry is required to assess retinal function and visual pathways; electrophysiological testing is performed for unexplained decreases in visual functions. LoRE: C, LoTE: 5. → in the text
When planning treatment, perform a complete blood count and biochemical tests, including glucose, HbA1c, and lipid profile; the scope of examination is specified taking into account the suspected etiology and comorbidities. LoRE: C, LoTE: 5. → in the text

Treatment

Conservative therapy is not recommended for TRD patients to achieve anatomical retinal attachment and prevent disease progression due to lack of efficacy. LoRE: C, LoTE: 5. → in the text
Focal laser photocoagulation of the fundus is performed after anterior vitrectomy or vitreoschisis surgery for peripheral breaks to block them and prevent rhegmatogenous detachment. LoRE: C, LoTE: 5. → in the text
Scleral buckling (circumferential or local) is indicated for peripheral breaks and stage C4–C5 anterior proliferative vitreoretinopathy to restore anatomical relationships and stabilize or improve best-corrected visual acuity. LoRE: C, LoTE: 4. → in the text
Anterior vitrectomy or vitreoschisis surgery is performed for concomitant hemophthalmos, proliferative vitreoretinopathy, epiretinal fibrosis, multiple or large peripheral breaks, macular hole, and other indications. LoRE: C, LoTE: 5. → in the text
During vitreoretinal surgery, indications permitting, techniques include vitrectomy and removal of proliferative tissue, membrane peeling, endolaser photocoagulation or endodiathermocoagulation, as well as tamponade with air, gas, perfluorocarbon liquid, or silicone oil. → in the text
Silicone oil is removed in the late postoperative period to prevent complications of long-term tamponade. The decision is made upon complete retinal adaptation for at least 1 month, absence of active proliferation and traction, absence of fresh preretinal and intravitreal hemorrhages and new breaks, presence of stable pigmented laser scars, normal intraocular pressure, and taking into account the degree of oil emulsification. LoRE: C, LoTE: 4. → in the text
Before and after surgery, topical antimicrobial and anti-inflammatory agents are used; for elevated intraocular pressure, antiglaucoma medications and miotics are prescribed. If necessary, systemic antimicrobials and systemic corticosteroids are used; treatment duration is determined by the physician based on the clinical picture, surgical specifics, and postoperative course. → in the text
In the postoperative period following scleral buckling (circumferential or local), transpupillary sectoral retinal photocoagulation is mandatory. → in the text
Scleral buckling (circumferential or local), anterior vitrectomy, or vitreoschisis surgery are performed under local anesthesia. LoRE: C, LoTE: 5. → in the text

When to refer and how to monitor

Decreased visual acuity in TRD generally requires immediate specialized treatment. → in the text
Planned hospitalization is necessary to perform surgery in a day-care or round-the-clock hospital setting. → in the text
Emergency hospitalization is indicated for endophthalmitis as a complication of vitreoretinal surgery. → in the text
In case of vitreous hemorrhage, ultrasound is performed; if vitreoretinal traction syndrome, TRD, or retinal break is detected, the patient is examined by an ophthalmologist to decide on laser or surgical treatment. → in the text
Postoperatively, the ophthalmologist examines the patient one or more times during the first month, followed by local follow-up every 6–12 months; in case of sudden vision loss or new complaints, an unscheduled examination is required. → in the text

Frequently asked questions

How does tractional detachment differ from rhegmatogenous detachment?

TRD is associated with the contraction of proliferative membranes and vitreous retraction; upon secondary retinal breaks formation, the detachment is classified as tractional-rhegmatogenous and progresses more rapidly. → in the text

What signs allow suspecting specifically TRD?

Characteristic signs include a concave detachment without breaks, local retinal elevation in the traction zone, low height of detachment, significantly reduced retinal mobility, and absence of subretinal fluid shifting. → in the text

Should TRD be treated conservatively?

Conservative therapy is not recommended to restore retinal attachment and prevent progression, as it lacks efficacy for these purposes. → in the text

When is vitrectomy chosen for TRD?

Indications include hemophthalmos, proliferative vitreoretinopathy, epiretinal fibrosis, multiple or large peripheral breaks, macular hole, and other indications. → in the text

How should patients be monitored after treatment?

Postoperatively, examinations are required during the first month, then every 6–12 months locally. An unscheduled examination is necessary in case of sudden vision loss or new visual symptoms; buckle extrusion and silicone oil emulsification are additionally monitored. → in the text

Status: Applied · approved by the Scientific and Practical Council of the Russian Ministry of Health
Database ID: 1075, edition 1 (ID 1075_1)
Publication date: September 22, 2026
Age category: adults
ICD-10 codes: H33.4 H33.5
Specialties: Ophthalmology
Developers: All-Russian Public Organization "Association of Ophthalmologists"
Official text: Ministry of Health of Russia Rubricator — 1075_1

List of Abbreviations

HIV – human immunodeficiency virus

ONH – optic nerve head

OCT – optical examination of the retina using a computerized analyzer

OCT-A – optical examination of the retina using a computerized analyzer in angiography mode

PVR – proliferative vitreoretinopathy

PDR – proliferative diabetic retinopathy

DM – diabetes mellitus

vitreous body

TRD – tractional retinal detachment

TRRD – tractional-rhegmatogenous retinal detachment

FA – fluorescein angiography of the eye

CRV – central retinal vein

Terms and Definitions

Ocular biomicroscopy is a method of intravital visual examination of the optical media and tissues of the eye, based on creating contrast between illuminated and non-illuminated areas, performed using a slit lamp and additional diagnostic lenses (in particular, for fundus biomicroscopy).

Hemophthalmos – vitreous hemorrhage, accumulation of blood in the vitreous body or vitreous cavity (in aphakia).

Optical coherence tomography of the retina (OCT) is a non-invasive, non-contact diagnostic method for in vivo visualization, qualitative, and quantitative analysis of the morphological features of fundus structures, based on the principle of light interferometry.

Optical coherence tomography angiography of the retina (OCT-A) is a non-invasive, non-contact diagnostic method for in vivo visualization, qualitative, and quantitative analysis of microcirculation in fundus structures, taking into account the segmentation of fundus layers.

Preretinal hemorrhage is an accumulation of blood in the retrohyaloid space.

Iris rubeosis is the growth of new blood vessels in the iris, typically accompanied by neovascularization of the anterior chamber angle structures and resulting from severe retinal ischemia.

1. Brief information on the disease or condition

1.1 Definition of the disease or condition

Tractional retinal detachment (TRD) is a retinal detachment associated with the contraction of connective tissue within proliferative membranes and vitreal retraction, characterized by fluid accumulation between the neurosensory retina and the retinal pigment epithelium. When secondary retinal tears form, the detachment is classified as combined tractional-rhegmatogenous retinal detachment (TRRD).

1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)

Tractional retinal detachment is a consequence of the progression of a proliferative process in the vitreous cavity, developing in various pathological conditions.

TRD most frequently develops as a result of the following conditions:

Proliferative diabetic retinopathy (PDR) [1];
Central retinal vein occlusion (CRVO) or its branch occlusion [2];
Hemophthalmos [3];
Vasoproliferative tumors [4];
Trauma [5];
Uveitis of various etiologies [6];
Eales' disease [7], and others.

The pathogenesis is based on the breakdown of the inner and/or outer blood-retinal barrier [1, 2, 5]. Depending on the etiology, various factors lead to the damage of the blood-retinal barriers. Thus, in ischemic eye damage, for example, in diabetic retinopathy or CRVO, tight junctions of retinal vascular endothelial cells are disrupted, resulting in increased vascular permeability followed by the release of cell adhesion molecules, prostaglandins, cytokines, and pro-angiogenic factors into the vitreous cavity [1, 2]. In inflammatory diseases, diffuse (in non-granulomatous type) or focal (in granulomatous type) infiltration of the internal membranes of the eye by activated immune cells develops [6]. In penetrating eye trauma, following damage to the intraocular membranes, plasma elements and cytokines produced by leukocytes induce the migration of cellular elements and their adhesion to vitreous fibrils along the wound tract [5]. As a result of the breakdown of the blood-retinal barrier and the penetration of the aforementioned factors into the vitreous cavity, a proliferative process begins to develop. Their presence and concentration in the vitreous cavity serve as prognostic biomarkers for the development and severity of proliferation [8–10]. Active proliferation contributes to the formation of epiretinal membranes and vitreoretinal strands, the contraction of which leads to tractional forces on the retina, which can subsequently lead to the development of TRD [11].

1.3 Epidemiology of the Disease or Condition

The epidemiology of TRD as an isolated condition remains practically unstudied due to its multi-etiological nature. A study by Poulsen et al. reported a TRD incidence of 1.25 cases per 100,000 population in Denmark [12]. In a case series analyzed by Asaminew et al., among all retinal detachment cases, TRD was identified in 23.4% of patients, and TRRD in 3.2% of patients in Ethiopia [13]. A study by Nkanga et al. analyzed the etiology of TRD in an African population, establishing that the causes of TRD include PDR (77.5%), proliferative sickle cell retinopathy (3.8%), trauma (3.8%), and HIV-associated retinopathy (2.4%). In 12.5% of cases, the causes of TRD remain undetermined [14].

The incidence of TRD in PDR is predominantly assessed for cases requiring surgical treatment. According to studies, TRD is an indication for vitrectomy in up to 95% of surgical treatment cases for PDR complications [15–18].

For other etiological factors of TRD, population-based and large randomized studies are lacking; only individual cases or case series are presented [3, 4, 7, 19, 20–25].

1.4 Features of Coding the Disease or Condition

H33.4 – Traction detachment of retina

H33.5 – Other retinal detachments

1.5 Classification of the disease or condition

By localization and extent [26]

Involving the macular area;
Not involving the macular area.

By etiology [1–7, 19–25]

TRD in PDR;
TRD in proliferative post-occlusive retinopathy;
TRD in retinopathy of prematurity;
TRD associated with proliferative vitreoretinopathy (PVR) after trauma;
TRD associated with PVR due to other causes.

According to A.Dubey / S.Charles (2008/1986) [27, 28]

TRD requiring surgical treatment:
o TRD in the posterior pole in the central parts of the retina, including involvement of the macular zone;
o TRD localized in the superior hemisphere.

TRD not requiring surgical treatment (peripheral TRD localized in the inferior hemisphere).

According to P.Kroll (2007) [29]

Stage A – the retina is fully attached, but proliferative changes of the retina and vitreous body are present, predominantly localized in the optic disc area and posterior cortical layers of the vitreous body.
Stage B – local TRD due to contraction of the cortical layers of the vitreous body at the sites of attachment to the retina:
o Bn – when TRD is localized in the nasal segment;
o Bt – when TRD is localized in the temporal segment.

Stage C – extension of TRD to the macular area:
o C1 – TRD involving one retinal quadrant;
o C2 – TRD involving two retinal quadrants;
o C3 – TRD involving three retinal quadrants;
o C4 – TRD involving four retinal quadrants.

1.6 Clinical presentation of the disease or condition

TRD develops gradually and is associated with a progressive increase in traction from proliferative membranes [30, 31].

Symptoms of TRD include:

Slowly progressive visual field defect, which may remain unchanged for several months or years [13];
Gradual decrease in visual acuity when the macular zone is involved [13, 29];
Floaters, sensation of a «fog» or «veil» before the eyes [13];
Phosphenes (sensation of «flashes», «lightning») [13];
Metamorphopsia [13];
Rarely – eye redness, eye pain [13].

Signs of tractional retinal detachment during ocular biomicroscopy include:

Concave configuration of the detachment [32];
Absence of retinal breaks [32];
Significantly reduced retinal mobility, absence of the shifting subretinal fluid sign [32];
Low detachment height, which rarely reaches the ora serrata [32];
Maximum detachment height is observed at the site of traction [32];
If a tear occurs, the detachment acquires features of rhegmatogenous detachment and progresses faster (TRRD) [32].

2. Diagnostics, medical indications and contraindications for diagnostic methods

The clinical presentation is the basis for diagnosing tractional retinal detachment. The symptoms and clinical signs specified in clause 1.4 serve as the clinical criteria for establishing this disease:

presence of retinal detachment with a concave configuration and no rhegmatogenous component (in the absence of retinal breaks);
presence of pronounced traction from vitreoretinal membranes accompanied by local retinal elevation, with the maximum height of detachment located in the area of traction;
decreased or absent mobility of the detached retina, absence of subretinal fluid shift;
if a retinal break appears, transformation of the clinical picture into a traction-rhegmatogenous retinal detachment with a more rapid progression of the process (TRRD) [32].

The diagnosis is established based on ophthalmoscopy and confirmed by instrumental methods, including ocular ultrasonography (B-scan), with additional imaging methods used when necessary [5, 33].

2.1 Complaints and Anamnesis

It is recommended to take the medical history and assess complaints regarding eye pathology in all patients with suspected TRD to identify functional visual disorders and symptoms indicating the duration of the disease, which may influence the management strategy [26, 33-35].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: there may be an absence of complaints for a long time, despite disease progression (if the central parts of the retina are not involved). Patients may complain of decreased visual acuity, floaters, and the appearance of a "veil" in the visual field, occurring when TRD spreads to the macular area. Complaints of decreased visual acuity generally require immediate specialized treatment.

2.2 Physical Examination

It is recommended to perform a physical examination in patients with concomitant systemic diseases and risk factors for systemic complications for the diagnosis and management of TRD [26].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: a physical examination is advisable in the presence of concomitant systemic diseases and risk factors for systemic complications, such as nephropathy, cardiovascular diseases, neuropathy, prior to surgical treatment in order to identify potential contraindications to surgery and minimize the risk of complications [1, 2, 5, 6, 36, 37, 38]. The choice of specialist profile (endocrinologist, general practitioner, infectious disease specialist, otorhinolaryngologist, dentist, etc.) is determined by the etiological factor of TRD, planned treatment, and the presence of other concomitant systemic disease and risk factors for systemic complications in the patient.

2.3 Laboratory Diagnostics

It is recommended to perform a complete blood count, general biochemical blood test (blood glucose level testing, glycated hemoglobin (HbA1c) level testing, biochemical lipid profile test) in all TRD patients when planning treatment [26, 33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: the choice of laboratory tests is determined by the intended treatment strategy, presumed etiology of TRD, and the presence of concomitant systemic disease and risk factors for systemic complications in the patient.

2.4 Instrumental Diagnostics

It is recommended to perform visometry in all patients with suspected TRD during disease diagnosis, follow-up, and treatment monitoring to determine the severity of visual impairment [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to perform ophthalmotonometry in all patients with TRD during disease diagnosis, follow-up, and treatment monitoring to detect intraocular pressure abnormalities [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to perform slit-lamp biomicroscopy of the eye in all patients with TRD during disease diagnosis, follow-up, and treatment monitoring to detect iris neovascularization, assess the transparency of optical media, and identify posterior vitreous detachment [26, 33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: biomicroscopy of the eye must necessarily be performed first withoutmydriasis, as pupil dilation may hinder the detection of "early" iris neovascularization.

It is recommended to perform fundus biomicroscopy or ophthalmoscopy under medical mydriasis using anticholinergics (ATC code: S01FA) and sympathomimetics, except for antiglaucoma drugs (ATC code: S01FB), in all TRD patients during disease diagnosis, follow-up, and treatment monitoring to detect fundus changes, assess their severity, monitor status, and select the optimal management strategy [33, 39].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: fundus biomicroscopy using a non-contact diagnostic ophthalmic lens with a slit lamp (or ophthalmoscopy) is the primary method for diagnosing fundus changes in TRD of various origins during an ophthalmological consultation at any level (primary health care, specialized care) and setting (inpatient, outpatient). In all patients, in the absence of contraindications, it should be performed only with a dilated pupil (under medical mydriasis). It is important to remember that the depth of the anterior chamber must be assessed before pharmacological pupil dilation.

It is recommended to perform optical imaging of the retina using a computer analyzer (optical coherence tomography, OCT) in patients with TRD or suspected TRD during disease diagnosis, follow-up, and treatment monitoring for its quantitative and qualitative assessment, as well as to monitor treatment efficacy [26, 34].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: optical imaging of the retina using a computer analyzer should preferably be performed under pharmacological mydriasis, as this significantly improves scan quality.

It is recommended to perform optical imaging of the retina using a computer analyzer in angiography mode (optical coherence tomography angiography, OCT-A) (if technically available) under medical mydriasis using anticholinergics (ATC code: S01FA) and sympathomimetics, except for antiglaucoma drugs (ATC code: S01FB), during disease diagnosis, follow-up, and treatment monitoring in patients with reduced vision that cannot be explained by the transparency of optical media and the ophthalmoscopic picture, in order to identify and assess the area of ischemic zones in the macular region, as well as in patients with early retinal neovascularization for its precise localization [26].

GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)

Comments: the necessity and frequency of OCT-A are determined by the ophthalmologist depending on the clinical course of the disease. Optical imaging of the retina using a computer analyzer in angiography mode must be performed under pharmacological mydriasis, as this significantly improves examination quality.

It is recommended to perform ocular ultrasonography in all patients with TRD and insufficient transparency of optical media during disease diagnosis, follow-up, and treatment monitoring to diagnose abnormalities in vitreoretinal relationships [5, 26, 33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to perform static perimetry in patients with TRD during disease diagnosis, follow-up, and treatment monitoring to assess retinal function and visual pathways [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to perform electrophysiological studies (recording of electrical sensitivity and lability of the visual analyzer A05.26.003; electroretinography A05.26.001) in patients with unexplained reduction of visual functions to assess retinal function and visual pathways [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: the decision to prescribe other additional diagnostic methods is made by the physician based on the results of the baseline examination.

2.5 Other Procedures

Not applicable.

3. Treatment, including drug and non-drug therapies, diet therapy, and pain management

3.1 Conservative Treatment

It is not recommended to use conservative therapy in patients with TRD to achieve anatomical retinal reattachment and prevent disease progression due to lack of efficacy [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

3.2 Laser Treatment

It is recommended to perform focal laser photocoagulation of the fundus in TRD patients after anterior vitrectomy or vitreoschisis surgery if peripheral breaks are present, in order to block retinal breaks and prevent rhegmatogenous retinal detachment [40].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

3.3 Surgical Treatment

3.3.1 Extrascleral surgery

It is recommended to perform episcleral circumferential and (or) local buckling in TRD patients in the presence of peripheral breaks and development of anterior PVR C4-C5 to restore normal anatomical relationships, stabilize, or improve best-corrected visual acuity [41, 42].

LeRR CLoE 4Level of recommendation confidence C (level of evidence – 4)

Comments: performed in an operating room; under local anesthesia (using instillation, with para- or retrobulbar injection if necessary, including local anesthesia using local anesthetics (ATC code: S01H) under drug-induced mydriasis (using anticholinergics S01FA and sympathomimetics, excluding antiglaucoma drugs (ATC code: S01FB), including fixed combinations), after treating the eyelid skin, periorbital area, and ocular surface with antiseptics and disinfectants (ATC code: D08A) (including iodine preparations), using antimicrobials (ATC code: S01A), anti-inflammatory drugs (ATC code: S01B) for ophthalmological use, if necessary with concomitant manipulations, including anterior vitrectomy or vitreoschwartectomy, intravitreal administration of medicinal products, air, silicone oil, tamponade of the vitreal cavity with an ophthalmological material for temporary replacement of the human vitreous body: perfluoroorganic compounds (or other high-molecular-weight compound), intravitreal replacement of the ophthalmological material for temporary replacement of the human vitreous body: perfluoroorganic compounds with silicone oil, removal of silicone oil from the vitreal cavity in patients with RRD in the presence of peripheral tears, development of anterior PVR C4-C5 [41-45], and use of 23–27G pars plana vitrectomy when indicated.

Surgical technique: a conjunctival incision is made at a distance of no more than 4 mm from the limbus, the rectus muscles are isolated and secured on traction sutures, the tear is localized using either indirect binocular ophthalmoscopy, wide-angle systems integrated into the operating microscope, or a 3D ophthalmic visualization system (3D Ophthalmic Visualization System RZN 2017/6557). The buckle is fixed to the sclera in the projection of the retinal tear. When indicated, additional buckling, cryopexy, transscleral subretinal fluid drainage, transscleral endotamponade with ophthalmological gas or air may be performed pars plana, use of an illuminator via a 23–27G valved port, paracentesis, anterior chamber puncture in case of elevated intraocular pressure, scleral ballooning, pneumatic retinopexy [46, 47]; in case of reduced optical media transparency due to lens opacity, ultrasound phacoemulsification with posterior chamber intraocular lens implantation, pseudophakic lens implantation, and other manipulations using an operating ophthalmic microscope, contact or non-contact wide-angle visualization systems may be performed. In the postoperative period, transpupillary sectoral laser photocoagulation of the retina is mandatory.

It is recommended before and after episcleral circumferential and/or local buckling to instill into the conjunctival cavity antimicrobials (ATC code: S01A), antiglaucoma preparations and miotics (ATC code: S01E) (in case of increased intraocular pressure), anti-inflammatory drugs (ATC code: S01B), anti-inflammatory drugs in combination with antimicrobials (ATC code: S01C), and, if necessary, subconjunctival and/or parabulbar and/or intramuscular and/or intravenous injections of systemic antimicrobials (ATC code: J) (in the absence of medical contraindications), including systemic antibacterial drugs (ATC code: J01), systemic corticosteroids (ATC code: H02A), and corticosteroid/antimicrobial/mydriatic combinations (ATC code: S01CB) for the prevention of postoperative complications [48-54].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

Comments: the duration of instillation and injection of medicinal products before and after vitreoretinal surgery is determined by the physician based on a comprehensive assessment of the clinical presentation, the course of the surgery, and the postoperative period.

It is recommended to remove ophthalmological sponge silicone implants (IG per TU 9398-021-18037666-2001 made of MC silicone rubber) for RRD surgery when indicated, in order to eliminate signs of rejection of the plombage material and restore normal anatomical relationships [52, 55-57].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

Comment: performed in an operating room, under local anesthesia using instillation of local anesthetics S01H, with para- or retrobulbar injection if necessary, including local anesthesia using local anesthetics S01H (combined anesthesia if necessary), under drug-induced mydriasis (using anticholinergics (ATC code: S01FA) and sympathomimetics, excluding antiglaucoma drugs (ATC code: S01FB), including fixed combinations), after treating the eyelid skin, periorbital area, and ocular surface with antiseptics and disinfectants (ATC code: D08A (including iodine preparations)), using antimicrobials (ATC code: S01A), anti-inflammatory drugs (ATC code: S01B) for ophthalmological use, if necessary with concomitant manipulations, including anterior vitrectomy or vitreoschwartectomy, intravitreal administration of medicinal products, air, silicone oil, vitreal cavity tamponade (with perfluoroorganic or other high-molecular-weight compound), intravitreal replacement of perfluoroorganic compound with silicone oil, removal of silicone oil from the vitreal cavity in patients with RRD [42, 57-58]. During the removal of ophthalmological sponge silicone implants (IG per TU 9398-021-18037666-2001 made of MC silicone rubber) for RRD surgery when indicated, the following procedures may be performed: placement of additional ophthalmological sponge silicone implants (IG per TU 9398-021-18037666-2001 made of MC silicone rubber), cryopexy, transscleral endotamponade with ophthalmological gas or air via pars plana, use of an illuminator via a 23–27G valved port, paracentesis, anterior chamber puncture in case of elevated intraocular pressure, scleral ballooning, pneumatic retinopexy; in case of reduced optical media transparency due to lens opacity, ultrasound phacoemulsification with posterior chamber intraocular lens implantation, pseudophakic lens implantation, and other manipulations using an operating ophthalmic microscope, contact or non-contact wide-angle visualization systems FSZ 2011/10375 may be performed.

It is recommended before and after the removal of ophthalmological sponge silicone implants (IG per TU 9398-021-18037666-2001 made of MC silicone rubber) for RRD surgery to instill into the conjunctival cavity antimicrobials (ATC code: S01A), antiglaucoma preparations and miotics (ATC code: S01E) (in case of increased intraocular pressure), anti-inflammatory drugs (ATC code: S01B), anti-inflammatory and antimicrobial combinations (ATC code: S01C), and, if necessary, subconjunctival and/or parabulbar and/or intramuscular and/or intravenous injections of systemic antimicrobials (ATC code: J) (in the absence of medical contraindications), including systemic antibacterial drugs (ATC code: J01), systemic corticosteroids H02A, and corticosteroid/antimicrobial/mydriatic combinations (ATC code: S01CB) for the prevention of postoperative complications [50, 52, 55-56, 59-60].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

3.3.2 Vitreoretinal surgery

It is recommended to perform anterior vitrectomy or vitreoschwartectomy in patients with RRD when indicated by concomitant hemophthalmus, proliferative vitreoretinopathy, epiretinal fibrosis, multiple or large peripheral retinal tears, macular hole, etc., with the aim of restoring, stabilizing, or improving best-corrected visual acuity [61-71].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comment: performed in an operating room using 23-27Ga technology; under local anesthesia (instillation, if necessary with para- or retrobulbar injection, including local anesthesia using local anesthetics (ATC code: S01H)) under medical mydriasis (using anticholinergics (ATC code: S01FA) and sympathomimetics, excluding antiglaucoma preparations (ATC code: S01FB), including fixed combinations), after treating the eyelid skin, periocular area, and ocular surface with antiseptics and disinfectants (ATC code: D08A) (including iodine preparations), using anti-infectives (ATC code: S01A), anti-inflammatory drugs (ATC code: S01B) for ophthalmologic use, if necessary with possible concomitant manipulations, vitreal cavity tamponade (using an ophthalmic material for temporary replacement of the human vitreous body: perfluorocarbon compound), endovitreal replacement of the perfluorocarbon compound with silicone oil, endovitreal injection of air, silicone oil, gas, A22.26.017 endolaser coagulation with an ophthalmic laser system, A22.26.034 endodiathermocoagulation, episcleral circumferential and/or local buckling, removal of silicone from the vitreal cavity, schisis/membrane dissection, membrane peeling, if necessary combined with phacoemulsification and intraocular lens implantation.

Surgical technique: a transscleral puncture is performed 3-4 mm from the limbus (the distance is measured using the opposite end of the trocar marked with 3 and 4 mm) with the insertion of three or more trocars with valved ports, and an infusion cannula. For effective treatment of the vitreous body (VB) area close to the retinal plane, removal of the posterior cortical layers, and proliferative tissue, it is preferable to use vitrectomes whose port is maximally displaced toward the distal end, as well as gentle surgical segmentation and/or delamination techniques using a vitrectomy probe, toothed forceps, and/or sterile, disposable, vertical or horizontal ophthalmic scissors 23-27Ga [62, 69-70]. Hemostasis control is ensured by endodiathermocoagulation and/or elevation of pressure in the irrigation system, and temporary tamponade with a perfluorocarbon compound [70-71]. In the presence of retinal tears, VB removal is performed up to the ora serrata using a 23-27Ga vitrectome, sclerocompression with thorough treatment of the edges of the retinal tear if present, aspiration of subretinal fluid (passive or active), A16.26.086 endovitreal air injection, A22.26.017 endolaser coagulation of retinal ischemia zones and retinal tears, if necessary using endovitreal injection of air, silicone oil, intraoperative ophthalmic gas material for retinal tamponade, or perfluorocarbon compound.

It is recommended before and after anterior vitrectomy or vitreoschisis/membrane dissection to instill anti-infectives S01A, antiglaucoma preparations and miotics S01E (in case of elevated intraocular pressure), anti-inflammatory drugs S01B, and anti-inflammatory drugs in combination with anti-infectives S01C into the conjunctival sac; if necessary, subconjunctival and/or parabulbar and/or intramuscular and/or intravenous injections of systemic anti-infectives J (in the absence of medical contraindications), including systemic antibacterial drugs J01, systemic corticosteroids H02A, and corticosteroid/anti-infective/mydriatic combinations S01CB for the prevention of postoperative complications [72-75].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to remove silicone oil from the vitreal cavity in patients who have undergone surgery for retinal detachment, in the long-term postoperative period after anterior vitrectomy or vitreoschisis/membrane dissection, to prevent complications associated with excessively prolonged silicone oil endotamponade [76-78].

Level of Recommendation Consensus CLevel of Evidence 4Level of recommendation consensus C (level of evidence – 4)

Comment: performed in an operating room; under local anesthesia (instillation, if necessary with para- or retrobulbar injection, including local anesthesia using local anesthetics (ATC code: S01H)) under medical mydriasis (using anticholinergics S01FA and sympathomimetics, excluding antiglaucoma preparations (ATC code: S01FB), including fixed combinations), after treating the eyelid skin, periocular area, and ocular surface with antiseptics and disinfectants (ATC code: D08A) (including iodine preparations), using anti-infectives (ATC code: S01A), anti-inflammatory drugs (ATC code: S01B) for ophthalmologic use, if necessary with concomitant manipulations, including repeat vitreal cavity tamponade (with perfluorocarbon or another high-molecular-weight compound), endovitreal replacement of perfluorocarbon compound with silicone oil, endovitreal injection of air, silicone oil, gas, endolaser coagulation, endodiathermocoagulation [76-78].

The duration of silicone oil endotamponade of the vitreal cavity is determined by the physician based on the results of patient follow-up monitoring. The decision to terminate silicone tamponade is made by the physician based on the evaluation of the following factors:

- complete retinal attachment for at least 1 month;

- absence of signs of proliferative activity;

- absence of tractional forces on the retina;

- absence of fresh preretinal and intravitreal hemorrhages;

- complete closure of old retinal breaks and absence of new ones;

- well-formed, pigmented, clearly demarcated laser scars;

- normal intraocular pressure level;

- degree of silicone oil emulsification.

During the removal of silicone oil from the vitreal cavity, pars plana 23-27G trocar-cannulas are used (valved ports are preferred); membrane peeling, retinotomy, retinal endolaser coagulation with a 532 nm laser, endodiathermocoagulation, endotamponade with ophthalmic gas, perfluorocarbon compound, or silicone oil may be performed, along with the placement of a chandelier illumination system through an additional 23-27Ga port; if optical media transparency is reduced due to lens opacity, ultrasound phacoemulsification with posterior chamber pseudophakic intraocular lens implantation and other manipulations may be performed using an operating ophthalmic microscope, contact or non-contact wide-angle visualization systems, or a digital visualization system providing intraoperative real-time stereoscopic imaging.

It is recommended before and after silicone oil removal from the vitreal cavity to instill anti-infectives (ATC code: S01A), antiglaucoma preparations and miotics (ATC code: S01E) (in case of elevated intraocular pressure), anti-inflammatory drugs S01B, and anti-inflammatory drugs in combination with anti-infectives (ATC code: S01C) into the conjunctival sac; if necessary, subconjunctival and/or parabulbar and/or intramuscular and/or intravenous injections of systemic anti-infectives (ATC code: J) (in the absence of medical contraindications), including systemic antibacterial drugs (ATC code: J01), systemic corticosteroids (ATC code: H02A), and corticosteroid/anti-infective/mydriatic combinations (ATC code: S01CB) for the prevention of postoperative complications [72-75, 79-80].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

3.3.3 Diet therapy

Diet therapy in patients with retinal detachment and concomitant type 1 or type 2 diabetes mellitus is carried out in accordance with the clinical guidelines "Type 1 Diabetes Mellitus in Adults" and "Type 2 Diabetes Mellitus in Adults" [1, 81-87].

3.3.4 Pain management

It is recommended to perform episcleral circumferential and/or local buckling under local anesthesia (instillation, if necessary with para- or retrobulbar injection, including local anesthesia using local anesthetics (ATC code: S01H)) for pain relief [41-46].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to remove MC silicone rubber sponge ophthalmic implants under local anesthesia (instillation, if necessary with para- or retrobulbar injection, including local anesthesia using local anesthetics S01H) in all patients for pain relief [56-57].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

It is recommended to perform anterior vitrectomy or vitreo-schwartrectomy under local anesthesia (using instillation, if necessary with a para- or retrobulbar injection, including local anesthesia with local anesthetics (ATC code: S01H)) in all patients for pain relief [66-68].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

It is recommended to remove silicone oil from the vitreous cavity under local anesthesia (using instillation, if necessary with a para- or retrobulbar injection, including local anesthesia with local anesthetics (ATC code: S01H)) in all patients for pain relief [78].

GCR CLoE 3Grade of Recommendation C (Level of Evidence – 3)

4. Medical Rehabilitation and Sanatorium-Resort Treatment

It is recommended to select contact correction A23.26.002 for patients with residual ametropia after surgical treatment of retinal detachment to achieve early visual rehabilitation [88].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

5. Prevention and Dispensary Observation

It is recommended to perform diode transscleral laser photocoagulation of the peripheral retina and/or ciliary body in the presence of retinal ischemia zones and/or other predisposing factors for TRD when panretinal photocoagulation is not feasible due to compromised optical media transparency [89].

Level of Recommendation CLevel of Evidence 4Level of Recommendation C (level of evidence – 4)

It is recommended to perform an ultrasound examination of the eyeball in all patients presenting with vitreous hemorrhage for the early detection of vitreoretinal tractions as a risk factor for TRD development [90].

GRC CLEL 4Grade of Recommendation C (Level of Evidence – 4)

Comments: the frequency of ultrasound examinations in hemophthalmos is determined individually by an ophthalmologist, depending on the course of the process. If vitreoretinal traction syndrome, tractional retinal detachment, or retinal tear is detected, the patient must be examined by an ophthalmologist to determine the feasibility and possibility of performing laser or surgical intervention [29].

It is recommended to perform periodic examination of the fellow eye for the early diagnosis of tears or potential retinal detachment in all patients [33].

GDR CLE 5Grade of recommendation C (level of evidence – 5)

Comments: The ophthalmologist conducts examinations of postoperative patients one or more times during the first month after treatment, taking into account the postoperative ophthalmological status; subsequent monitoring is carried out by the local ophthalmologist once every 6–12 months after treatment to monitor for potential late complications [33]. The duration of follow-up is determined by the attending physician based on the postoperative ophthalmological status. In addition to standard control parameters, it is necessary to monitor for signs of rejection of the buckling material (in cases of episcleral surgery) and signs of silicone emulsification (in cases of vitreoretinal surgery). In the event of an unexpected decrease in visual acuity or the appearance of any visual symptoms, an examination by an ophthalmologist should be performed as soon as possible, regardless of the scheduled visit date.

To determine the subjective satisfaction of patients with the treatment outcomes, various assessment tools can be used, in particular the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) (Appendix G1-GN) [91-92].

6. Organization of Medical Care

Issues concerning the organization of medical care for TRD are primarily related to the timeliness of diagnosis and the possibility of performing early treatment before the development of macular detachment. The methods and timelines of medical care depend on the type of tractional retinal detachment [93-94].

Primary specialized health care is provided by an ophthalmologist in the outpatient department of a medical organization.

Treatment (laser interventions, episcleral surgery, or vitreoretinal surgery) is performed by an ophthalmologist on an outpatient basis, in a day hospital setting, or in an inpatient setting. The basis for discharging a patient from a medical organization is the complete completion of the planned treatment.

Indication for planned hospitalization in a medical organization:

the need to perform surgical interventions in a day hospital or inpatient setting.

Indication for emergency hospitalization in a medical organization:

endophthalmitis as a complication of vitreoretinal intervention [91].

Indication for patient discharge from a medical organization:

1) completion of treatment or a stage of specialized, including high-tech, medical care in an inpatient or day-care setting, provided there are no treatment complications requiring drug correction and/or inpatient medical interventions;

2) refusal of the patient or their legal representative from specialized, including high-tech, medical care in an inpatient or day-care setting;

3) need to transfer the patient to another medical organization.

7. Additional Information

In the absence of timely pathogenetic treatment for TRD, the visual prognosis is unfavorable [84]. It is necessary to achieve the relief of retinal tractions and partial/complete anatomical retinal reattachment by the time of hospital discharge [33, 93-96].

It is necessary to inform the patient about the prognosis of the natural course of the disease in the absence of treatment, and about the steady progression of anatomical and functional changes in TRD up to complete vision loss. The patient must understand that the effectiveness of TRD treatment depends on the timely performance of surgical and/or laser intervention.

In the postoperative period, it is necessary to explain to the patient the recommended frequency of examinations by an ophthalmologist depending on the severity of the clinical picture, as well as the need for unscheduled examinations if any new visual disturbances appear.

In cases of irreversible blindness or low vision, the patient must be fully informed about the opportunities for vocational, social, and psychological rehabilitation.

If retinal laser photocoagulation is performed, the following points must be discussed with the patient:

the need for follow-up examinations and, if necessary, additional laser or surgical treatment.

In case of episcleral and vitreoretinal surgery, the following points must be discussed with the patient:

it is important to warn the patient about the features of the postoperative course and possible ocular manifestations (irritation, eye redness, pronounced eyelid edema combined with abundant discharge, eye pain, foreign body sensation behind the eyelids or unpleasant feeling when blinking, etc.), the severity of which depends on the specifics of the performed surgery and the individual sensitivity of the body to the surgical trauma;
it is important to explain to the patient that temporary glasses or contact lenses may be required during the rehabilitation period; final prescription glasses should ideally be fitted no earlier than 2-3 months after surgery (the timing of lens prescription is decided individually);
in the event of symptoms and changes characteristic of TRD in the operated eye, the patient must be informed of the need for an unscheduled examination by an ophthalmologist;
it is important to warn the patient about the gradual improvement of vision in the postoperative period, and that as vision recovers, complaints of distorted lines and objects, or double vision may occur (as a rule, these symptoms gradually subside over several weeks or months);
it is important to warn the patient to adhere to the prescribed regimen (specific head position, temporary restriction of activity, specifics of bed rest) after surgery, which may have a specific therapeutic value. Individual recommendations must be clarified during the medical consultation;
it is important to warn the patient of the need to immediately report symptoms that may suggest intraocular inflammation (endophthalmitis): eye pain or increased discomfort in the eye, increased eye redness, blurred or decreased vision, increased photosensitivity, increased number of "floaters" in the visual field.

Criteria for Evaluating the Quality of Medical Care

No.	Quality criteria	Performance evaluation
1.	Visometry was performed	YES/NO
2.	Ocular biomicroscopy performed	YES/NO
3.	Ultrasound examination of the eyeball has been performed	YES/NO
4.	Static perimetry was performed	YES/NO
5.	Diode transscleral laser photocoagulation of the peripheral retina and/or ciliary body and/or surgical intervention was performed (depending on medical indications and in the absence of medical contraindications)	YES/NO

References

Show references

Clinical guidelines. Diabetes mellitus: diabetic retinopathy, diabetic macular edema. 2023 // URL: https://cr.minzdrav.gov.ru/recomend/115_2 (accessed: 15.07.2024).
Clinical guidelines. Retinal vein occlusions // URL: http://avo-portal.ru/documents/fkr/KP_OVS_13_09_21.pdf (accessed: 15.07.2024).
Trese M.G.J., Lee R., Garretson B.R., Mahmoud T.H. Preventing Iatrogenic Retinal Breaks in Cutter-Associated Traction from Chronic Vitreous Hemorrhage (CATCH) // Ophthalmic Surg Lasers Imaging Retina. 2022. Vol. 53. No. 10. P. 584-585. DOI: 10.3928/23258160-20220920-03
Adeghate J.O., Goldburg S.R., Marr B., et al. Repair of a Tractional Retinal Detachment in the Setting of an Idiopathic Vasoproliferative Tumor // Ophthalmic Surg Lasers Imaging Retina. 2023. Vol. 54. No. 8. P. 485-488. DOI: 10.3928/23258160-20230726-02
Eye Injuries / under the general editorship of R.A. Gundorova, V.V. Neroev, V.V. Kashnikov. - M.: GEOTAR-Media, 2014. - 560 p.
Clinical guidelines. Non-infectious uveitis. 2024 // URL: https://cr.minzdrav.gov.ru/recomend/787_1 (accessed: 15.07.2024).
Ersöz M.G., Hocaoğlu M., Sayman Muslubaş I.B., et al. Vitrectomy Due to Vitreous Hemorrhage and Tractional Retinal Detachment Secondary to Eales' Disease // Turk J Ophthalmol. 2021. Vol. 51. Vol. 2. P. 102-106. DOI: 10.4274/tjo.galenos.2020.43709
Ricker L.J., Kessels A.G., de Jager W., et al. Prediction of proliferative vitreoretinopathy after retinal detachment surgery: potential of biomarker profiling // Am J Ophthalmol. 2012. Vol. 154. No. 2. P. 347-354.e2. DOI: 10.1016/j.ajo.2012.02.004
Kon C.H., Occleston N.L., Aylward G.W., Khaw P.T. Expression of vitreous cytokines in proliferative vitreoretinopathy: a prospective study // Invest Ophthalmol Vis Sci. 1999. Vol. 40. No. 3. P. 705-712. PMID: 10067974
Rusnak S., Vrzalova J., Hecová L., et al. Defining the seriousness of proliferative vitreoretinopathy by aspiration of cytokines from the anterior chamber // Biomark Med. 2013. Vol. 7. No. 5. P. 759-767. DOI: 10.2217/bmm.13.65
Wilson C.A., Khawly J.A., Hatchell D.L., Machemer R. Experimental traction retinal detachment in the cat // Graefes Arch Clin Exp Ophthalmol. 1991. Vol. 229. No. 6. P.568-573. DOI: 10.1007/BF00203323
Poulsen C.D., Peto T., Grauslund J., Green A. Epidemiologic characteristics of retinal detachment surgery at a specialized unit in Denmark // Acta Ophthalmol. 2016. Vol. 94. No. 6. P. 548-555. DOI: 10.1111/aos.13113
Asaminew T., Gelaw Y., Bekele S., Solomon B. Retinal detachment in southwest Ethiopia: a hospital based prospective study // PLoS One. 2013. Vol. 8. No. 9. P. e75693. DOI: 10.1371/journal.pone.0075693. Erratum in: PLoS One. 2013. Vol. 8. No. 10. DOI:10.1371/annotation/2b8e3b87-642d-4f8a-8810-2161ad74f730
Nkanga D.G., Agweye C.T., Okonkwo O.N., et al. Collaborative Retina Research Network (CRRN), Study Report 1. Tractional Retinal Detachment: Prevalence and Causes in Nigerians //J West Afr Coll Surg. 2023. Vol. 13. No. 4. P. 58-62. DOI: 10.4103/jwas.jwas_40_23
Shroff C.M., Gupta C., Shroff D., et al. Bimanual microincision vitreous surgery for severe proliferative diabetic retinopathy: outcome in more than 300 eyes // Retina. 2018. Vol. 38. Suppl. 1. P. S134-S145. DOI: 10.1097/IAE.0000000000002093
Stewart M.W., Browning D.J., Landers M.B. Current management of diabetic tractional retinal detachments // Indian J Ophthalmol. 2018. Vol. 66. No. 12. P. 1751-1762. DOI: 10.4103/ijo.IJO_1217_18
Choovuthayakorn J., Khunsongkiet P., Patikulsila D., et al. Characteristics and Outcomes of Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy Patients in a Limited Resource Tertiary Center over an Eight-Year Period // J Ophthalmol. 2019. Vol. 2019. 9481902. DOI: 10.1155/2019/9481902
Brănişteanu D.C., Bilha A., Moraru A. Vitrectomy surgery of diabetic retinopathy complications // Rom J Ophthalmol. 2016. Vol. 60. No. 1. P. 31-36. PMID: 27220230
Criswick V.G., Schepens C.L. Familial exudative vitreoretinopathy // Am J Ophthalmol. 1969. Vol. 68. No. 4. P. 578-594. DOI: 10.1016/0002-9394(69)91237-9
El Moize Z., Lezrek O., Ez-Zahraoui M., et al. Posterior persistent fetal vasculature associated with tractional retinal detachment // J Fr Ophtalmol. 2019. Vol. 42. No. 5. P. 540-541. DOI: 10.1016/j.jfo.2018.11.010
London N.J., Hovakimyan A., Cubillan L.D., et al. Prevalence, clinical characteristics, and causes of vision loss in patients with ocular toxoplasmosis // Eur J Ophthalmol. 2011. Vol. 21. No. 6. P. 811-819. DOI: 10.5301/EJO.2011.6403
Ahn S.J., Ryoo N.K., Woo S.J. Ocular toxocariasis: clinical features, diagnosis, treatment, and prevention // Asia Pac Allergy. 2014. Vol. 4. No. 3. P. 134-141. DOI: 10.5415/apallergy.2014.4.3.134
Brazier D.J., Gregor Z.J., Blach R.K., et al. Retinal detachment in patients with proliferative sickle cell retinopathy // Trans Ophthalmol Soc U K (1962). 1986. Vol. 105. Pt. 1. P. 100-105. PMID: 3459293
Grewal P.S., Kertes P.J. Macular hole and tractional retinal detachment secondary to proliferative sickle cell retinopathy // Can J Ophthalmol. 2022. Vol. 57. No. 4. P. e119. DOI: 10.1016/j.jcjo.2021.08.015
Wald K.J., Mehta M.C., Katsumi O., et al. Retinal detachments in incontinentia pigmenti // Arch Ophthalmol. 1993. Vol. 111. No. 5. P. 614-617. DOI: 10.1001/archopht.1993.01090050048026
Mishra C., Tripathy K. Retinal Traction Detachment // Treasure Island. StatPearls Publishing. 2024. URL: https://www.ncbi.nlm.nih.gov/books/NBK558952/ (accessed: 15.08.2024)
Dubey A.K., Nagpal P.N., Chawla S., Dubey B. A proposed new classification for diabetic retinopathy: the concept of primary and secondary vitreopathy // Indian J Ophthalmol. 2008. Vol. 56. No. 1. P. 23-29. DOI: 10.4103/0301-4738.37592
Charles S., Flinn C.E. The natural history of diabetic extramacular traction retinal detachment // Arch Ophthalmol. 1981. Vol. 99. No. 1. P. 66-68. DOI: 10.1001/archopht.1981.03930010068003
Kroll P., Rodrigues E.B., Hoerle S. Pathogenesis and classification of proliferative diabetic vitreoretinopathy // Ophthalmologica. 2007. Vol. 221. No. 2. P. 78-94. DOI: 10.1159/000098253
Shishkin M.M., Safarli N.N., Kasatikova E.V., Antonyuk S.V. Sparing vitreoretinal surgery in advanced proliferative diabetic retinopathy: rationale, technique, long-term results // Bulletin of the N.I. Pirogov National Medical and Surgical Center. 2009. Vol. 4. No. 2. P. 23-28. UDC: 617.735-002-02:616.633.66:616-089
Kazaykin V.N. Diabetic retinopathy: clinical presentation, diagnosis, and treatment. - M.: LLC "SPC Medinform", 2016.
Kanski's Clinical Ophthalmology. A Systematic Approach / John F. Salmon ; [trans. from English] ; ed. by Academician of the RAS V.V. Neroev. — 9th ed. — M.: LLC "Publishing House 'Medical Information Agency'", 2023. — 1014 + XIV p.: ill.
Ophthalmology: National Guidelines / ed. by S.E. Avetisov, E.A. Egorov, L.K. Moshetova, V.V. Neroev, Kh.P. Takhchidi. – 2nd ed. – M.: GEOTAR-Media, 2018. – 904 p.
Joo CW, An Y, Kim YK, Kim YD, Park SP, Kim KL. Tractional Retinal Detachment in Eyes with Vitreous Hemorrhage and Proliferative Diabetic Retinopathy and Posterior Vitreous Detachment in Fellow Eye. Korean J Ophthalmol. 2023 Jun;37(3):207-215. doi: 10.3341/kjo.2022.0161.
Bromeo AJ, Veloso A, Lerit SJ, Gomez MC. Tractional retinal detachment ('crunch' phenomenon) from intravitreal anti-vascular endothelial growth factor injection in central retinal vein occlusion. BMJ Case Rep. 2021 Apr 28;14(4):e240506. doi: 10.1136/bcr-2020-240506.
Li DQ, Choudhry N. Tractional Retinal Detachment Secondary to Diabetic Retinopathy. JAMA Ophthalmol. 2018 Oct 1;136(10):e183507. doi: 10.1001/jamaophthalmol.2018.3507.
Clinical guidelines. Type 1 diabetes mellitus in adults. 2022 // URL: https://cr.minzdrav.gov.ru/recomend/286_2 (accessed: 15.07.2024).
Clinical guidelines. Type 2 diabetes mellitus in adults. 2022 // URL: https://cr.minzdrav.gov.ru/recomend/290_2 (accessed: 15.07.2024).
Brinton, D.A. Retinal detachment – Principles and practice / D.A. Brinton, C.P. Wilkson. – Oxford: University Press. Inc., 2009. – P. 49-50.
Du S, Yang X, Zha Y, Chen X, Zhang J, Kuhn F. Direct Laser Photocoagulation of the Retinal Pigment Epithelium: A Novel Method to Seal Retinal Breaks during Pars Plana Vitrectomy for Retinal Detachment. Discov Med. 2023 Dec;35(179):988-994. DOI: 10.24976/Discov.Med.202335179.95.
Schwartz SG, Kuhl DP, McPherson AR, Holz ER, Mieler WF. Twenty-year follow-up for scleral buckling. Arch Ophthalmol. 2002 Mar;120(3):325-9. doi: 10.1001/archopht.120.3.325.
Jonas JB, Jäger M, Hemmerling TM. Continuous retrobulbar anesthesia for scleral buckling surgery using an ultra-fine spinal anesthesia catheter. Can J Anaesth. 2002 May;49(5):487-9. doi: 10.1007/BF03017926.
Miller S.A., Shafrin F., Bresnik G.H., et al. Scleral buckling procedure for retinal detachments secondary to proliferative diabetic retinopathy // Am J Ophthalmol. 1980. Vol. 89. No. 1. P. 103-112. DOI: 10.1016/0002-9394(80)90236-6.
Lai CC, Yang PJ, Yang KJ, Chuang LH, Chen TL. Evaluation of peribulbar anesthesia in encircling scleral buckle surgery and its postoperative pain course. Changgeng Yi Xue Za Zhi. 1999 Dec;22(4):609-14.
Vogt G, Heiden M, Lösche CC, Lipfert P. A preoperative retrobulbar block in patients undergoing scleral buckling reduces pain, endogenous stress response, and improves vigilance. Reg Anesth Pain Med. 2003 Nov-Dec;28(6):521-7. doi: 10.1016/j.rapm.2003.09.004
Tornambe P.E. Pneumatic retinopexy: the evolution of case selection and surgical technique. A twelve-year study of 302 eyes // Trans Am Ophthalmol Soc. 1997. Vol. 95. P. 551-578. PMID: 9440187.
Malakyan N.Yu. Capabilities of micro-invasive surgery in the combined treatment of retinal detachments: diss. ... cand. of med. sciences: 14.01.07. - M.:, 2012. - 117 p.
Doft BH, Lipkowitz J, Kowalski R, Taylor F. An experimental model to assess factors associated with scleral buckle infection. Retina. 1983;3(3):212-7. doi: 10.1097/00006982-198300330-00012.
Kim SJ, Flach AJ, Jampol LM. Nonsteroidal anti-inflammatory drugs in ophthalmology. Surv Ophthalmol. 2010 Mar-Apr;55(2):108-33. doi: 10.1016/j.survophthal.2009.07.005.
Kohli P, Tripathy K. Scleral Buckling. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580486/?utm_source=chatgpt.com
Bali E, Feron EJ, Peperkamp E, Veckeneer M, Mulder PG, van Meurs JC. The effect of a preoperative subconjuntival injection of dexamethasone on blood-retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial. Graefes Arch Clin Exp Ophthalmol. 2010 Jul;248(7):957-62. doi: 10.1007/s00417-010-1319-8.
Chhablani J, Nayak S, Jindal A, Motukupally SR, Mathai A, Jalali S, Pappuru RR, Sharma S, Das T, Flynn HW Jr, Pathengay A. Scleral buckle infections: microbiological spectrum and antimicrobial susceptibility. J Ophthalmic Inflamm Infect. 2013 Dec 13;3(1):67. doi: 10.1186/1869-5760-3-67.
De Wit D, Newman D. Novel antibiotic regime for pseudomonal scleritis complicating scleral buckling surgery. BMJ Case Rep. 2010 Apr 29;2010:bcr01.2009.1514. doi: 10.1136/bcr.01.2009.1514.
Folk JC, Cutkomp J, Koontz FP. Bacterial scleral abscesses after retinal buckling operations. Pathogenesis, management, and laboratory investigations. Ophthalmology. 1987 Sep;94(9):1148-54. doi: 10.1016/s0161-6420(87)33313-5.
Fallico M, Alosi P, Reibaldi M, Longo A, Bonfiglio V, Avitabile T, Russo A. Scleral Buckling: A Review of Clinical Aspects and Current Concepts. J Clin Med. 2022 Jan 9;11(2):314. doi: 10.3390/jcm11020314.
Tsui I. Scleral buckle removal: indications and outcomes. Surv Ophthalmol. 2012 May-Jun;57(3):253-63. doi: 10.1016/j.survophthal.2011.11.001.
Covert D.J., Wirostko W.J., Han D.P., et al. Risk factors for scleral buckle removal: a matched, case-control study // Am J Ophthalmol. 2008. Vol. 146. No. 3. P. 434-439. DOI:10.1016/j.ajo.2008.05.023
Han D.P., Covert D.J., Wirostko W.J., et al. Scleral buckle removal in the vitrectomy era: a 20-year clinical experience // Retina. 2013. Vol. 33. No. 2. P. 387-391. DOI: 10.1097/IAE.0b013e31826415d9
Eshraghi H, Prenner JL, Zhang R, Roth DB, Wheatley HM, Fine HF, Mantopoulos D. Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes. Ophthalmic Surg Lasers Imaging Retina. 2021 Mar;52(3):138-144. doi: 10.3928/23258160-20210302-04.
Oz O, Lee DH, Smetana SM, Akduman L. A case of infected scleral buckle with Mycobacterium chelonae associated with chronic intraocular inflammation. Ocul Immunol Inflamm. 2004 Mar;12(1):65-7. doi: 10.1076/ocii.12.1.65.28069.
Stewart MW, Browning DJ, Landers MB. Current management of diabetic tractional retinal detachments. Indian J Ophthalmol. 2018 Dec;66(12):1751-1762. doi: 10.4103/ijo.IJO_1217_18.
Iyer SSR, Regan KA, Burnham JM, Chen CJ. Surgical management of diabetic tractional retinal detachments. Surv Ophthalmol. 2019 Nov-Dec;64(6):780-809. doi: 10.1016/j.survophthal.2019.04.008.
Cruz-Iñigo YJ, Acabá LA, Berrocal MH. Surgical management of retinal diseases: proliferative diabetic retinopathy and traction retinal detachment. Dev Ophthalmol. 2014;54:196-203. doi: 10.1159/000360467.
Berrocal MH. ALL-PROBE VITRECTOMY DISSECTION TECHNIQUES FOR DIABETIC TRACTIONAL RETINAL DETACHMENTS: Lift and Shave. Retina. 2018 Sep;38 Suppl 1:S2-S4. doi: 10.1097/IAE.0000000000001884.
Oellers P., Mahmoud T.H. Surgery for proliferative diabetic retinopathy: New tips and tricks // J Ophthalmic Vis Res. 2016. Vol. 11. No. 1. P. 93-99. DOI: 10.4103/2008-322X.180697
Xu Q, Ren M, Guan J, Shi G, Ni Y, Luan J. Efficacy and safety of trans-sub-Tenon's retrobulbar anesthesia for pars plana vitrectomy: a randomized trial. BMC Ophthalmol. 2022 Jun 30;22(1):289. doi: 10.1186/s12886-022-02507-7.
Licina A, Sidhu S, Xie J, Wan C. Local versus general anaesthesia for adults undergoing pars plana vitrectomy surgery. Cochrane Database Syst Rev. 2016 Sep 19;9(9):CD009936. doi: 10.1002/14651858.CD009936.
Nicholson AD, Singh P, Badrinath SS, Murugesan R, Sundararaj I, Vardarajan S, Krishnan M, Nagarajan K, Gopal L, Sharma T, et al. Peribulbar anesthesia for primary vitreoretinal surgery. Ophthalmic Surg. 1992 Oct;23(10):657-61.
Sharma T., Fong A., Lai T.Y., et al. Surgical treatment for diabetic vitreoretinal diseases: a review // Clin Exp Ophthalmol. 2016. Vol. 44. No. 4. P. 340-354. DOI: 10.1111/ceo.12752
Smiddy W., Flynn H. Vitrectomy in the management of diabetic retinopathy // Surv Ophthalmol. 1999. Vol. 43. No. 6. P. 491-507. DOI: 10.1016 s0039-6257(99)00036-3
Arevalo J.F., Serrano M.A., Arias J.D. Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment // World J Diabetes. 2014. Vol. 5. No. 5. P. 724-729. DOI: 10.4239/wjd.v5.i5.724
Mangouritsas G, Mourtzoukos S, Portaliou DM, Georgopoulos VI, Dimopoulou A, Feretis E. Glaucoma associated with the management of rhegmatogenous retinal detachment. Clin Ophthalmol. 2013;7:727-34. doi: 10.2147/OPTH.S42792.
Aptel F, Colin C, Kaderli S, Deloche C, Bron AM, Stewart MW, Chiquet C; OSIRIS group. Management of postoperative inflammation after cataract and complex ocular surgeries: a systematic review and Delphi survey. Br J Ophthalmol. 2017 Nov;101(11):1-10. doi: 10.1136/bjophthalmol-2017-310324.
Patel D, Borkar DS, Madhava M, Obeid A, Mellen PL, Regillo CD, Garg SJ; Wills Eye Retinal Detachment Study Group. Incidence of Management Changes at the Postoperative Day One Visit After Pars Plana Vitrectomy for Retinal Detachment. Am J Ophthalmol. 2021 Feb;222:271-276. doi: 10.1016/j.ajo.2020.09.034.
Bonfiglio V, Reibaldi M, Macchi I, Fallico M, Pizzo C, Patane C, Russo A, Longo A, Pizzo A, Cillino G, Cillino S, Vadalà M, Rinaldi M, Rejdak R, Nowomiejska K, Toro MD, Avitabile T, Ortisi E. Preoperative, Intraoperative and Postoperative Corticosteroid Use as an Adjunctive Treatment for Rhegmatogenous Retinal Detachment. J Clin Med. 2020 May 21;9(5):1556. doi: 10.3390/jcm9051556.
Takhchidi Kh.P., Metaev S.A., Glinchuk N.Ya., Gazal N.A. Rationale for early removal of silicone oil in the treatment of severe retinal detachments of various origins // Bulletin of OSU. 2004. No. 13. P. 60-65.
Abu-Yaghi N.E., Abu Gharbieh Y.A., Al-Amer A.M., et al. Characteristics, fates and complications of long-term silicone oil tamponade after pars plana vitrectomy // BMC Ophthalmol. 2020. Vol. 20. No. 1. P. 336. DOI: 10.1186/s12886-020-01608-5
Mete A, Kimyon S, Saygılı O, Güngör K, Temizer M. Comparison of topical and retrobulbar anesthesia in terms of pain experience during silicone oil extraction. Arq Bras Oftalmol. 2018 Apr;81(2):95-101. doi: 10.5935/0004-2749.20180023.
Johnson RN, Flynn HW Jr, Parel JM, Portugal LM. Transient hypopyon with marked anterior chamber fibrin following pars plana vitrectomy and silicone oil injection. Arch Ophthalmol. 1989 May;107(5):683-6. doi: 10.1001/archopht.1989.01070010701030.
Jonas JB, Knorr HL, Rank RM, Budde WM. Intraocular pressure and silicone oil endotamponade. J Glaucoma. 2001 Apr;10(2):102-8. doi: 10.1097/00061198-200104000-00006.
Laurenzi A., Bolla A.M., Panigoni G., Doria V., Uccellatore A., Peretti E., et al. Effects of Carbohydrate Counting on Glucose Control and Quality of Life Over 24 Weeks in Adult Patients With Type 1 Diabetes on Continuous Subcutaneous Insulin Infusion: A randomized, prospective clinical trial (GIOCAR). Diabetes Care. 2011; 34(4): 823 – 827. doi: 10.2337/dc10-1490.
Samann A., Muhlhauser I., Bender R., Kloos C., Muller U.A. Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: a prospective implementation study. Diabetologia. 2005; 48(10): 1965-1970. doi: 10.1007/s00125-005-1905-1.
Bell K.J., Barclay A.W., Petocz P., Colagiuri S., Brand-Miller J.C. Efficacy of carbohydrate counting in type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2014; 2(2): 133-140. doi: 10.1016/S2213-8587(13)70144-X.
Elliott J., Lawton J., Rankin D., Emery C., Campbell M., Dixon S., et al. The 5 x 1 DAFNE study protocol: a cluster randomised trial comparing a standard 5 day DAFNE course delivered over 1 week against DAFNE training delivered over 1 day a week for 5 consecutive weeks. BMC Endocr Disord. 2012; 12(1): 28. doi: 10.1186/1472-6823-12-28.
Haas L., Maryniuk M., Beck J., Cox C.E., Duker P., Edwards L., et al. National Standards for Diabetes Self-Management Education and Support. Diabetes Care. 2013; 36 (Supplement_1): S100-S108. doi: 10.2337/dc13-S100.
Evert A.B., Boucher J.L., Cypress M., Dunbar S.A., Franz M.J., Mayer-Davis E.J., et al. Nutrition Therapy Recommendations for the Management of Adults With Diabetes. Diabetes Care. 2014; 37 (Supplement_1): S120-S143. doi: 10.2337/dc14-S120.
Davies M.J., D'Alessio D.A., Fradkin J., Kernan W.N., Mathieu C., Mingrone G., et al. Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2018; 41(12): 2669-2701. doi: 10.2337/dci18-0033.
Beekhuis H., Talsma, M., Vreugdenhil, W., et al. Changes in refraction after retinal detachment surgery corrected by extended wear contact lenses for early visual rehabilitation // Retina. 1993.
McHugh DA, Schwartz S, Dowler JG, Ulbig M, Blach RK, Hamilton PA. Diode laser contact transscleral retinal photocoagulation: a clinical study. Br J Ophthalmol. 1995 Dec;79(12):1083-7. doi: 10.1136/bjo.79.12.1083.
Chu H.C., Chan M.Y., Chau C.W.J., et al. The use of ocular ultrasound for the diagnosis of retinal detachment in a local accident and emergency department // Hong Kong Journal of Emergency Medicine. 2017. Vol. 24. No. 6. P. 263-267. DOI: 10.1177/102490791773508Owen CG, Rudnicka AR, Smeeth L, Evans JR, Wormald RP, Fletcher AE. Is the NEI-VFQ-25 a useful tool in identifying visual impairment in an elderly population? BMC Ophthalmol. 2006 Jun 9;6:24. doi: 10.1186/1471-2415-6-24.
Okamoto F, Okamoto Y, Fukuda S, Hiraoka T, Oshika T. Vision-related quality of life and visual function after vitrectomy for various vitreoretinal disorders. Invest Ophthalmol Vis Sci. 2010 Feb;51(2):744-51. doi: 10.1167/iovs.09-3992.
Atkov O.Yu., Leonova E.S. Patient Management Plans "Ophthalmology" Evidence-Based Medicine. - M.: GEOTAR-Media, – 2011. – P. 83-99.
Frings A., Markau N., Katz T., et al. Visual recovery after retinal detachment with macula-off: is surgery within the first 72 h better than after? // Br J Ophthalmol. 2016. Vol. 100. No. 11. P. 1466-1469. DOI: 10.1136/bjophthalmol-2015-308153
Frolychev I.A. Experimental substantiation of staged treatment of postoperative endophthalmitis using a perfluoroorganic compound with antibacterial drug solutions: Cand. Sci. (Med.) diss.: 14.01.07. Moscow, 2019. 143 p.
Konovalova K.I., Shishkin M.M., Fayzrakhmanov R.R. Phacoemulsification of early-stage cataract in patients with advanced proliferative diabetic retinopathy as a second stage after vitreoretinal surgery. Diabetes Mellitus. 2020;23(5):452-458. (In Russ.). DOI: 10.14341/DM12256
Mason J.O. 3rd, Colagross C.T., Vail R. Diabetic vitrectomy: risks, prognosis, future trends // Curr Opin Ophthalmol. 2006. Vol. 17. No. 3. P.281-285. DOI: 10.1097/01.icu.0000193098.28798.18

Appendix A1. Working Group Composition

Shishkin M.M.	MD, Professor, Chief Specialist, Professor at the Department of Eye Diseases, Institute for Advanced Training of Doctors, National Pirogov Medical Surgical Center of the Ministry of Health of the Russian Federation, Member of the Association of Ophthalmologists, Honored Doctor of the Russian Federation
Fayzrakhmanov R.R.	MD, Head of the Ophthalmology Center, Head of the Department of Eye Diseases, Institute for Advanced Training of Doctors, National Pirogov Medical Surgical Center of the Ministry of Health of the Russian Federation, Member of the Association of Ophthalmologists
Shadrichev F.E.	PhD, Head of the Ophthalmological Department of the Regional Endocrinological Center, City Consultative and Diagnostic Center No. 1, Assistant at the Professor Yu.S. Astakhov Department of Ophthalmology with Clinic, First Pavlov State Medical University of St. Petersburg of the Ministry of Health of the Russian Federation, Member of the Association of Ophthalmologists
Petrachkov D.V.	PhD, Head of the Department of Innovative Vitreoretinal Technologies, Krasnov Research Institute of Eye Diseases
Shklyarov E.B.	PhD, Ophthalmologist at the Ophthalmological Department of the Regional Endocrinological Center, City Consultative and Diagnostic Center No. 1, Assistant at the Department of Family Medicine, Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation, Member of the Association of Ophthalmologists

Appendix A2. Methodology for Developing Clinical Guidelines

Target audience for these clinical guidelines:

Ophthalmologists
General practitioners (family medicine)

Methods used for collecting/selecting evidence: electronic database searches; analysis of modern scientific developments on TRD in Russia and abroad; synthesis of practical experience of Russian and foreign specialists. Description of methods used for collecting/selecting evidence: the evidence base for the recommendations includes publications from the Cochrane Library, EMBASE, and MEDLINE databases, as well as monographs and articles in leading specialized peer-reviewed domestic medical journals on the subject. Methods used for assessing the quality and strength of evidence: expert consensus, significance assessment according to a rating scheme.

Table 1. Scale for assessing levels of evidence (LE) for diagnostic methods (diagnostic interventions)

LoE	Definition
1	Systematic reviews of studies with reference standard control or systematic review of randomized clinical trials using meta-analysis
2	Individual studies with reference standard control or individual randomized clinical trials and systematic reviews of studies of any design, except for randomized clinical trials, using meta-analysis
3	Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies
4	Non-comparative studies, case report
5	Only justification of mechanism of action or expert opinion is available

Table 2. Scale for assessing levels of evidence (LoE) for prevention, treatment, and rehabilitation methods, including those based on natural therapeutic factors (preventive, therapeutic, and rehabilitative interventions)

LoE	Definition
1	Systematic review of randomized controlled trials with meta-analysis
2	Individual randomized clinical trials and systematic reviews of studies of any design, except for randomized clinical trials using meta-analysis
3	Non-randomized comparative studies, including cohort studies
4	Non-comparative studies, case reports or case series, case-control studies
5	Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available

Table 3. Scale for assessing grades of recommendation (GoR) for prevention, diagnostic, treatment, and rehabilitation methods, including those based on natural therapeutic factors (preventive, diagnostic, therapeutic, and rehabilitative interventions)

GoR	Definition
A	Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent)
C	Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent)
C	Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent)

Procedure for updating clinical guidelines.

The clinical guidelines update mechanism provides for their systematic revision—at least once every three years, as well as upon the emergence of new evidence-based data regarding the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.

Appendix A3. Reference Materials

These clinical guidelines were developed taking into account the following documents:

International Classification of Diseases, Injuries and Causes of Death, 10th Revision (ICD-10). World Health Organization.
Nomenclature of medical services. Order of the Ministry of Health of the Russian Federation No. 804n dated October 13, 2017, "On Approval of the Nomenclature of Medical Services." Order of the Ministry of Health of the Russian Federation No. 205n dated May 2, 2023, "On Approval of the Nomenclature of Positions of Medical and Pharmaceutical Workers."
Federal Law No. 323-FZ dated November 21, 2011 «On the Fundamentals of Protecting the Health of Citizens in the Russian Federation».
Order of the Russian Ministry of Health No. 633n dated October 24, 2025 «On Approval of the Procedure for Providing Medical Care to the Adult Population in the Profile "Ophthalmology"».
Decree of the Government of the Russian Federation No. 2406-r dated October 12, 2019, "On Approval of the List of Vital and Essential Drugs, as well as Lists of Medicinal Products for Medical Use and the Minimum Assortment of Medicinal Products Required for the Provision of Medical Care."
Decree of the Government of the Russian Federation No. 2188 dated December 29, 2025 «On the Program of State Guarantees of Free Medical Care to Citizens for 2026 and for the Planning Period of 2027 and 2028».
Sanitary and Epidemiological Rules and Regulations SP 2.1.3678-20 «Sanitary and Epidemiological Requirements for the Operation of Premises, Buildings, Structures, Equipment, and Vehicles, as well as Working Conditions for Business Entities Engaged in the Sale of Goods, Performance of Work, or Provision of Services» (Decree of the Chief State Sanitary Doctor of the Russian Federation No. 44 dated December 24, 2020).
Sanitary-epidemiological rules and regulations SanPiN 3.3686-21 "Sanitary and epidemiological requirements for the prevention of infectious diseases" (Resolution of the Chief State Sanitary Doctor of the Russian Federation No. 4 dated January 28, 2021).
"Management of planned hospitalization in a multidisciplinary hospital. Methodological Recommendations No. 2001/144" (approved by the Ministry of Health of the Russian Federation on November 9, 2001).
"MR 3.1.5.0076/1-13. 3.1.5. Epidemiology. Prevention of infectious diseases. HIV infection. Pre- and post-test counseling as prevention of HIV transmission."
Order of the Ministry of Health of the Russian Federation No. 1129n dated October 20, 2020, "On Approval of the Rules for Conducting Mandatory Medical Examination to Detect Human Immunodeficiency Virus (HIV Infection)."

Table 1. Summary table of classifications and indications for surgical treatment of TRD

Classification	Relative indications (observation is possible)	Absolute indications (surgical treatment)
A.Dubey/S.Charles (2008/1986) [28, 29]	Peripheral TRD localized in the inferior hemisphere	TRD in the posterior pole involving the central retina, including involvement of the macular area
A.Dubey/S.Charles (2008/1986) [28, 29]	Peripheral TRD localized in the inferior hemisphere	TRD localized in the superior hemisphere
P.Kroll (2007) [30]	Stage A	Stage C (any substage)
P.Kroll (2007) [30]	Stage B (any localization)	Stage C (any substage)

Appendix B. Physician Action Algorithms

Appendix B. Algorithms for Physician Actions — Tractional Retinal Detachment

Appendix C. Patient Information

Tractional retinal detachment (TRD) is a severe ophthalmological condition that leads to irreversible blindness if appropriate and timely treatment is not provided. Over time, TRD tends to progress. The rate of TRD progression is influenced by the condition of the vitreous body, the severity of the tractional component, and the severity of the underlying disease. Predisposing factors for the development of TRD include conditions accompanied by changes in the structure of the vitreous body and retina: proliferative diabetic retinopathy, retinopathy of prematurity, familial exudative vitreoretinopathy, toxoplasmosis, central retinal vein occlusion, hemophthalmus, trauma, uveitis, and others.

International practical experience has shown that a timely clinical diagnosis and appropriate surgical treatment for this pathology ensure a favorable prognosis and the preservation of visual functions. The patient must be aware that laser treatment may require repeated sessions, the frequency and scope of which are determined by the physician.

Following the surgical intervention, the patient will be informed about the specifics of the rehabilitation and visual recovery period. They will be recommended to continue outpatient treatment, which includes instilling medications to prevent inflammatory reactions in the eye and taking agents that promote the restoration of impaired functions. The patient must follow the prescribed regimen (specific head positioning, temporary activity restrictions, specific bed rest requirements) after surgery, which may have significant therapeutic value. Individual recommendations should be clarified during a doctor's consultation. Patients who have undergone surgery for TRD must be informed about strict restrictions on physical activity, visiting baths or saunas for a month after surgery, and engaging in sports for a month after surgery; a slight increase in physical activity may be permitted later, only after consultation with the attending physician. In the postoperative period, the patient will be informed of the recommended frequency of ophthalmological examinations depending on the severity of the clinical picture, as well as the necessity of unscheduled examinations if any new visual disorders appear. The patient must strictly follow all medical recommendations.

Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools

Appendix G1. National Eye Institute Visual Function Questionnaire

Russian title: National Eye Institute Visual Function Questionnaire.

Original title (if applicable): The National Eye Institute Visual Function Questionnaire (NEI-VFQ 25)

Source (official developer website, validation publication):

Type (underline):

rating scale index questionnaire

other (specify):

Purpose: subjective assessment of visual function by the patient.

Assessment tool, content:

Russian-language version of the NEI-VFQ 25 questionnaire:

1. Overall, would you say your health is:

excellent.........................1

very good...................2

good..............................3

fair..........................4

poor.................................5

2. At the present time, would you say your vision in both eyes (with glasses or contact lenses, if you use them) is excellent, good, fair, poor, or very poor?

excellent.........................1

good..............................2

fair..........................3

poor.................................4

very poor......................5

completely blind.............6

3. How often do you worry about your eyesight?

never............................................ 1

rarely............................................... 2

sometimes............................................. 3

often............................................... 4

constantly....................................... 5

4. How much pain or discomfort do you experience in and around your eyes (e.g., burning, itching, or an aching pain)?

none of the time.......................1

mild................. 2

moderate.......................... 3

severe.............................. 4

very severe.................... 5

5. How much difficulty do you have reading ordinary print in a newspaper?

not at all difficult....................................................... 1

a little difficult......................................................... 2

quite difficult....................................................... 3

extremely difficult................................................. 4

stopped doing this due to vision......................... 5

stopped doing this for other reasons

or have no interest in it.............................. 6

6. How much difficulty do you have doing the work or other everyday activities you would like to do because of your vision?

good near vision: cooking, sewing, minor home repairs, or using hand tools?

not at all difficult....................................................... 1

a little difficult.......................................................... 2

quite difficult........................................................ 3

extremely difficult.................................................. 4

stopped doing this due to vision.......................... 5

stopped doing this for other reasons

or have no interest in it............................... 6

7. Because of your eyesight, how much difficulty do you have finding something on a shelf crowded with items?

not at all difficult...................................................... 1

a little difficult...........................................................2

quite difficult.........................................................3

extremely difficult.................................................. 4

stopped doing this due to vision.......................... 5

stopped doing this for other reasons

or have no interest in it............................... 6

8. How much difficulty do you have reading street signs, traffic signs, or store names?

not at all difficult........................................................ 1

a little difficult........................................................... 2

moderately difficult......................................................... 3

extremely difficult................................................... 4

stopped doing this because of eyesight........................... 5

stopped doing this for other reasons

or have no interest in doing so................................ 6

9. Because of your eyesight, how much difficulty do you have stepping down steps, stairs, or curbs in dim light or at night?

not at all difficult....................................................... 1

a little difficult.......................................................... 2

quite difficult........................................................ 3

extremely difficult.................................................. 4

stopped doing this due to vision...........................5

stopped doing this for other reasons

or have no interest in it............................... 6

10. Because of your eyesight, how much difficulty do you have noticing objects off to the side while walking?

not at all difficult.......................................................1

a little difficult..........................................................2

moderately difficult........................................................3

extremely difficult................................................. 4

stopped doing this because of eyesight..........................5

stopped doing this for other reasons

or have no interest in it.............................. 6

11. Because of your eyesight, how much difficulty do you have seeing how people react to things you say?

not at all difficult...................................................... 1

a little difficult.......................................................... 2

quite difficult........................................................ 3

extremely difficult.................................................. 4

stopped doing this due to vision.......................... 5

stopped doing this for other reasons

or have no interest in doing so.................................6

12. Because of your eyesight, how much difficulty do you have picking out and matching your clothes?

not at all difficult...................................................... 1

a little difficult......................................................... 2

quite difficult....................................................... 3

extremely difficult................................................. 4

stopped doing this due to vision......................... 5

stopped doing this for other reasons

or have no interest in it.............................. 6

13. Because of your eyesight, how much difficulty do you have visiting with people in their homes?

not at all difficult...................................................... 1

a little difficult......................................................... 2

moderately difficult........................................................3

extremely difficult................................................. 4

stopped doing this due to vision......................... 5

stopped doing this for other reasons

or have no interest in doing so............................. 6

14. Because of your eyesight, how much difficulty do you have going to movies, plays, or sporting events?

no difficulty at all......................................................1

a little difficulty.........................................................2

moderately difficult...................................................... 3

extremely difficult................................................ 4

stopped doing this due to vision....................... .5

stopped doing this for other reasons

or have no interest in doing so............................. 6

15. If you currently drive: how much difficulty do you have driving during the day in familiar places?

not at all difficult....................... 1

a little difficult.......................... 2

moderately difficult........................ 3

extremely difficult.................. 4

16. How much difficulty do you have driving at night in familiar places?

not at all difficult...................................................... 1

a little difficult.......................................................... 2

quite difficult........................................................ 3

extremely difficult.................................................. 4

stopped doing this due to vision.......................... 5

stopped doing this for other reasons

or have no interest in it............................... 6

16a. How difficult is it for you to drive in difficult conditions, such as bad weather, rush hour, highways, or city traffic?

not at all difficult..................................................... 1

a little difficult........................................................ 2

moderately difficult...................................................... 3

extremely difficult................................................ 4

stopped doing this because of eyesight........................ 5

stopped doing this for other reasons

or have no interest in doing so............................. 6

17. Because of your eyesight, do you accomplish less than you would like?

All of the time.............. 1

Most of the time...................... 2

Some of the time.................... 3

A little of the time...................... 4

Never....................5

18. Because of your eyesight, are you limited in how long you can work or do other activities?

All of the time...............1

Most of the time...................... 2

Some of the time.....................3

A little of the time...................... 4

Never...................5

19. How often do you have to give up things you would like to do because of pain or discomfort in and around your eyes, such as burning, itching, or an aching pain?

All of the time............. 1

Most of the time..................... 2

Some of the time................... 3

A little of the time..................... 4

None of the time.................. 5

20. Because of my eyesight, I stay home most of the time:

definitely true.............................1

mostly true.............................. 2

don't know............................................... 3

mostly false........................... 4

definitely false.......................... 5

21. I am often annoyed and frustrated because of my vision problems:

definitely true.............................1

mostly true.............................. 2

don't know............................................... 3

mostly false........................... 4

definitely false.......................... 5

22. Because of my eyesight, I have much less control over what I do:

definitely true............................. 1

mostly true............................... 2

don't know................................................ 3

mostly false........................... 4

definitely false.......................... 5

23. Because of my eyesight, I have to rely too much on what other people tell me:

definitely true............................. 1

mostly true................................2

don't know................................................ 3

mostly false............................ 4

completely untrue........................... 5

24. Because of my eyesight, I frequently need help from other people:

definitely true............................. 1

mostly true............................... 2

don't know................................................ 3

mostly false........................... 4

definitely false.......................... 5

25. I worry that because of my eyesight, I might do something that will embarrass myself or others:

definitely true............................. 1

mostly true............................... 2

don't know.................................................3

mostly false............................ 4

completely untrue........................... 5

Interpretation

All questions in the questionnaire are grouped into blocks assessing the patient's physical, mental, and social functioning in relation to their visual quality of life. The total score across all sections of the method allows for assessing the degree of reduction in the patient's quality of life relative to their visual functions.

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H40.3, H40.4, H40.5, H40.6, H40.8, H40.9…children2024full text