[Biomarkers of retinal ischemia in thrombotic microangiopathy associated with malignant arterial hypertension on optical coherence tomography]. / Markery retinal'noi ishemii pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei, po dannym opticheskoi kogerentnoi tomografii.

Malignant arterial hypertension is a clinical syndrome characterized by severe diastolic arterial hypertension with signs of ischemic damage to various organs. In some malignant arterial hypertension cases, thrombotic microangiopathy occurs - a rare life-threatening condition characterized by multiple systemic thrombosis of the microvasculature, including in the eyes, which can be clarified by optical scanning of the retina. PURPOSE: To determine markers of retinal ischemia in the eyes with thrombotic microangiopathy associated with malignant arterial hypertension. MATERIAL AND METHODS: The study included 6 patients (12 eyes) with thrombotic microangiopathy associated with malignant arterial hypertension who were examined by optical coherence tomography (OCT) and OCT angiography (OCT-A). All patients suffered from renal dysfunction, which etiology was determined by renal biopsy verifying the presence of renal thrombotic microangiopathy in all cases. RESULTS: According to OCT findings, there were bilateral local foci of thinning of the inner nuclear layer with elevation of the outer plexiform and outer nuclear layers of the retina in 5 out of 6 patients (83%). OCT-A revealed that in most cases (67%), these changes had perivascular localization and corresponded to the areas of attenuation of the deep capillary plexus. A statistically significant thinning of the inner nuclear layer of the retina was found in thrombotic microangiopathy associated with malignant arterial hypertension in comparison with the control group. CONCLUSION: Presence of renal thrombotic microangiopathy confirmed by renal biopsy and the anatomical similarity of the microvasculature of the kidneys and the eyes, give basis to consider the foci of «chronic¼ paracentral acute middle maculopathy detected with OCT in patients with malignant arterial hypertension as biomarkers of thrombotic microangiopathy of the eye.

[The role of optical coherence tomography angiography in the assessment of retinal microcirculation in thrombotic microangiopathy associated with malignant arterial hypertension]. / Rol' opticheskoi kogerentnoi tomografii s funktsiei angiografii v otsenke retinal'noi mikrotsirkulyatsii pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei.

Optical coherence tomography angiography (OCT-A) allows detailed assessment of the state of local blood flow in various systemic ischemic diseases, which include thrombotic microangiopathy (TMA) associated with malignant arterial hypertension (MAH). PURPOSE: To evaluate retinal microcirculation using OCT-A imaging data in the group of patients with TMA associated with MAH. MATERIAL AND METHODS: The study consisted of a qualitative and quantitative analysis of OCT-A data from 7 patients (14 eyes) with TMA associated with MAH and verified by renal biopsy. The control group included 7 healthy individuals (14 eyes). The following parameters were analyzed: area size of the foveal avascular zone FAZ, mm, vessel density (VD, %) and vessel skeleton density (VSD, %). The indicators were measured separately in the deep and superficial vascular plexuses and divided by localization into: the total density of the entire measured area, central density, density by quadrants (superior, inferior, nasal and temporal). All quadrants were subdivided into inner (corresponding to parafovea) and outer (corresponding to perifovea). RESULTS: Local foci of vascular attenuation of the deep retinal capillary plexus, pathological tortuosity of blood vessels in the deep and superficial retinal capillary plexuses were found in 100% of study group patients. Per-quadrant analysis of OCT-A finding in the macular zone revealed a statistically significant decrease in VD of the deep retinal capillary plexus (p<0.05). A direct correlation was found between glomerular filtration rate and the VD index in the outer inferior (r=0.567; p=0.034) and inner temporal quadrants (r=0.613; p=0.020) of the deep retinal capillary plexus, as well as the level of hemoglobin in blood serum and VD in inner temporal quadrant of the deep vascular plexus (r=0.596; p=0.025). CONCLUSION: Changes revealed with OCT-A are the symptoms of TMA in MAH patients spreading to the retinal microvasculature, mainly at the level of the deep retinal capillary plexus.

[Ocular microcirculation after revascularization of the internal carotid artery in the early postoperative period]. / Mikrotsirkulyatsiya glaza posle rekonstruktivnykh operatsii na sonnykh arteriyakh v rannem posleoperatsionnom periode.

Carotid artery stenosis is the most common cause of ischemic stroke and transient ischemic attacks in the population of developed countries. Carotid endarterectomy (CEA) and carotid stenting (CAS) are effective treatments for carotid stenosis. In view of the need to improve the diagnosis of this condition and the anatomical relationship of the internal carotid arteries and vessels of the eye, studying retinal microvasculature has become an urgent problem. The theory suggesting that changes in ocular blood flow parameters may reflect disease status in patients with internal carotid artery (ICA) stenosis requires further investigation. PURPOSE: To study the impact of CEA and CAS interventions on ocular blood flow in patients with clinically significant ICA stenosis in the early postoperative period. MATERIAL AND METHODS: Thirty-two patients with hemodynamically significant stenosis (≥75%) of the left or right ICA were examined using optical coherence tomography angiography (OCT-A) and flowmetry before and after CEA or CAS in order to assess the changes in ocular blood flow parameters. RESULTS: There were no significant differences in hemodynamic parameters in the eyes on the side of the stenotic and non-stenotic ICA before revascularization. In the early postoperative period (3-7 days) in the ipsilateral eyes, there was an increase in blood flow density and vascular density at the level of the superficial and deep plexuses in the macular area (p≤0.05), as well as an increase in the ocular blood flow volume, the level of tolerated intraocular pressure (p≤0.05) and a decrease in intraocular pressure (p≤0.05) bilaterally. In the contralateral eyes, after ICA revascularization there was a partial improvement in microcirculation parameters according to OCT-A (p≤0.05). Peripapillary blood flow density and peripapillary vessel density did not change significantly either on the ipsilateral or the contralateral side. CONCLUSION: In patients with clinically significant ICA stenosis, ICA revascularization by stenting or endarterectomy contributed to an improvement in retinal microcirculation and retrobulbar blood flow in both eyes. OCT-A and flowmetry allow non-invasive assessment of retinal microvessels and retrobulbar blood flow, and the measurements provided by these methods can serve as valuable biomarkers for predicting and monitoring hemodynamic changes in patients who undergo CEA and CAS surgeries.

[Ocular ischemic changes in thrombotic microangiopathy associated with malignant arterial hypertension (case study)]. / Ishemicheskie izmeneniya glaza pri tromboticheskoi mikroangiopatii, assotsiirovannoi so zlokachestvennoi arterial'noi gipertenziei (klinicheskoe nablyudenie).

The article presents a clinical observation of visual organ damage as an extrarenal manifestation of thrombotic microangiopathy in malignant arterial hypertension with an analysis of structural and functional changes in the eye by modern examination methods. The presence of renal thrombotic microangiopathy was verified by kidney biopsy. Optical coherence tomography was used to determine structural changes in the inner and outer layers of the retina in the form of their disorganization, areas of thickening of the nerve fiber layer, intraretinal inclusions and cysts, alterations of the ellipsoid zone and retinal pigment epithelium. Optical coherence tomography angiography revealed areas of vascular pattern attenuation in the deep and superficial retinal plexuses corresponding to OCT-detected foci of disorganization of the inner retinal layers. Color Doppler imaging showed absence of the diastolic component of the Doppler spectrum with an increase in the peripheral resistance index RI up to 1.0 in the central retinal artery and posterior short ciliary arteries in both eyes. Functional changes observed with multifocal electroretinography and microperimetry corresponded to the structural changes. Taking into account the similarity of microcirculation in the kidneys and the eyes, the probable pathogenetic mechanism underlying the detected structural and functional symptoms of ischemic damage to the visual organ in malignant arterial hypertension is chronic thrombotic microangiopathy. An interdisciplinary approach to studying thrombotic microangiopathy, including those associated with malignant arterial hypertension, using high-tech examination methods can be useful for timely diagnosis and treatment of this pathology.

[Neurodegenerative biomarkers of the response to diabetic macular edema treatment]. / Neirodegenerativnye biomarkery otveta na terapiyu diabeticheskogo makulyarnogo oteka.

There are currently no reliable biomarkers for predicting the response to treatment of diabetic macula edema (DME). PURPOSE: To asses the predictive role of neurodegenerative biomarker of the response to anti-VEGF therapy of DME. MATERIAL AND METHODS: Examination and treatment was carried out on 14 patients (20 eyes) with DME. The eyes were divided into 2 groups by the type of diabetes: 6 eyes with type 1 diabetes and 14 eyes with type 2 diabetes. The duration of diabetes was 16.5±7.9 years, the level of glycated hemoglobin was 8.4±2%. A number of indicators were evaluated using optical coherence tomography (OCT) in order to determine the neurodegenerative biomarkers of the response to anti-VEGF treatment. All patients underwent standard loading course of Aflibercept (5 intravitreal injections). RESULTS: Significant improvement in Best Corrected Visual Acuity (BCVA) and decrease of central retinal thickness (CRT) was seen after the treatment course. Data analysis revealed a correlation between functional outcomes of the treatment, and the following pathological changes in the retina: thickness of retinal nerve fiber layer (RNFL), thickness of the complex of ganglion cell and inner plexiform layers in the macular region (GCL+), thickness of the RNFL and GCL+ complex (GCL++) in the macular region, ΔCRT, as well as BCVA, patient age, and type of diabetes. Anatomical outcomes correlate with the stage of diabetic retinopathy, RNFL, GCL+, GCL++, violation of the integrity of the ellipsoid zone before treatment. CONCLUSION: The course of intravitreal administration of the Aflibercept drug has been established to be an effective method of treating patients with clinically significant DME. Neurodegenerative biomarkers of the response to the anti-VEGF drug therapy have been determined: thickness of the peripapillary RNFL, GCL+ and GCL ++, as well as integrity of the ellipsoid zone.

[Persistent hyaloid artery in an adult (a case report)]. / Persistiruyushchaya arteriya steklovidnogo tela u vzroslogo (klinicheskoe nablyudenie).

The article presents a clinical case of a functioning hyaloid artery in a 69-year-old patient. The results of OCT-angiography made it possible to detect the presence of blood flow in the projection of the persistent hyaloid artery (PHA) on the cross-section and en-face images. The vascular bed of PHA spreading along the posterior surface of the lens in the form of separate branches was visualized by slit-lamp biomicroscopy. The uniqueness of this clinical case lies in the low probability of such findings in the elderly. The presence of a developing cataract indicates the need for an individual approach in determining treatment strategies. In our opinion, the consistent use of laser coagulation technologies and laser photodestruction of PHA will minimize the risk of hemophthalmos and tractional retinal detachment during the upcoming cataract surgery.

[Differential diagnosis of hydroxychloroquine-induced retinal damage]. / Differentsial'naya diagnostika porazheniya setchatki pri toksicheskom vozdeistvii gidroksikhlorokhina.

Coronavirus infection is currently en extremely relevant scientific topic due to the emergence of a new serotype that causes a condition identified as Severe Acute Respiratory Syndrome (SARS)-COV-2. Chloroquine and hydroxychloroquine have a long history of use against other infectious diseases, they are available and inexpensive, so the possibility of using them in vivo and in vitro to suppress the infectious agent was examined. Despite the noted therapeutic potential of these drugs, it was necessary to take into account the toxicological aspects that dictate the importance of rational use of 4-aminoquinoline derivatives. This review analyzes literature on the development patterns of hydroxychloroquine retinopathy, basic principles of diagnosis and differentiation of this condition from other types of retinal pathology.

[Anti-VEGF drugs in the treatment of neovascular glaucoma]. / Anti-VEGF-preparaty v lechenii neovaskuliarnoi glaukomy.

Neovascular glaucoma (NVG) is the most frequently occurring type of secondary glaucoma characterized by significant decrease in visual functions. Its pathogenesis consists mainly of ischemia of the posterior segment, which is often secondary to proliferative diabetic retinopathy or ischemic central retinal vein occlusion. Development of neovascularization in the eye is associated with processes that change homeostatic balance between proangiogenic (vascular endothelial growth factor (VEGF)) and antiangiogenic (pigment epithelium-derived factor (PEDF)) factors. The aim of the therapy is to reduce the production of aqueous humour. Application of antiangiogenic preparations in patients with NVG as adjuvant therapy is the method of choice for both prevention and treatment of the disease. The article reviews literature on current possibilities of using anti-VEGF drugs in the treatment of NVG.