[Biomechanics of diabetic vitreopapillary traction syndrome]. / Biomekhanika diabeticheskogo vitreopapillyarnogo traktsionnogo sindroma.

Diabetic vitreopapillary traction syndrome (VPT) is a variant of diabetic retinopathy (DR) that can lead to vision loss in advanced stages. This review reports on the biomechanics of the vitreous in the pathogenesis of proliferative DR, in particular diabetic VPT. The article analyzes and summarizes literature data, presents the views of different authors on this problem, and provides the results of Russian and foreign scientific research on this pathology. It is concluded that further research in this area can lead to a significant improvement in the results of therapy, timely diagnosis, and preservation of vision in patients with DR.

[Episcleral circular buckling in surgical treatment of recurrent rhegmatogenous retinal detachment after vitrectomy]. / Episkleral'noe krugovoe plombirovanie v khirurgii retsidivov regmatogennoi otsloiki setchatki na avitreal'nykh glazakh.

Despite the improvement of the surgical technique of vitreoretinal interventions, the number of recurrences of rhegmatogenous retinal detachment (RRD) remains quite high. PURPOSE: Evaluation of the effectiveness of episcleral circular buckling (ECB) in the treatment of recurrent RRD after vitrectomy due to progression of proliferative vitreoretinopathy (PVR). MATERIAL AND METHODS: The study analyzed the results of surgical treatment of 21 patients (21 eyes) with recurrent RRD after primary vitrectomy. All patients underwent standard preoperative examination including visometry, tonometry, ophthalmobiomicroscopy, and additionally, optical coherence tomography was performed to assess the involvement of the macular area; the presence of anterior proliferative vitreoretinopathy was determined by ultrasound biomicroscopy, axial eye length was measured with an optical biometer. All patients underwent ECB, in some cases combined with repeated vitreoretinal surgery. RESULTS: Preliminary results of the study showed high efficiency of ECB exclusively, as well as ECB combined with revision of the vitreal cavity in case of RRD recurrence after primary vitreoretinal surgery, which amounted to 95% after one additional operation and removal of silicone oil. CONCLUSIONS: Episcleral circular buckling in the treatment of recurrent RRD after vitreoretinal surgery is a multifunctional and safe method that allows achieving favorable functional and anatomical outcomes.

[Modern aspects of the treatment of submacular hemorrhages secondary to macular degeneration]. / Sovremennye aspekty terapii submakulyarnykh krovoizliyanii na fone makulyarnoi degeneratsii.

Age-related macular degeneration complicated by submacular hemorrhage if not treated timely leads to permanent loss of central vision. The basis of effective therapy is its early start, dislocation of blood from central parts of the retina and blockage of neovascularization. This review examines the current methods of treatment of submacular hemorrhages, anatomical and functional outcomes, risks of postoperative complications, as well as trends in the use of combined methods of surgical intervention.

[Vitreopapillary traction syndrome in patients with proliferative diabetic retinopathy]. / Vitreopapillyarnyi traktsionnyi sindrom pri proliferativnoi diabeticheskoi retinopatii.

PURPOSE: To draw attention to characteristic features of the clinical manifestations of vitreopapillary traction syndrome (VPTS) in patients with proliferative diabetic retinopathy (PDR), to determine the role of the biomechanical factor in pathophysiology of this syndrome, and to evaluate the results of surgical treatment. MATERIAL AND METHODS: The features of clinical manifestations of VPTS of 50 patients with PDR who were treated at the ophthalmology center of the National Medical and Surgical Center named after N.I. Pirogov in the period from 2014 to 2018 were analyzed retrospectively. The preoperative study included standard ophthalmological examination methods, as well as ultrasound B-scan, computer perimetry, optical coherence tomography (OCT), fluorescence angiography (FA) in the first two years of observation. The comparison group consisted of 45 patients with PDR without signs of VPTS, who were treated in the center during the same period of time. RESULTS: The obtained results suggest that the pathophysiology of VPTS in diabetes mellitus has distinctive features and is determined by the topography of the peripapillary zone, as well as choroidal vascularization of the optic nerve head; biomechanical factor plays an important role in the formation of a fibrovascular stem (FVS) in VPTS. CONCLUSION: The results indicate that patients with VPTS have a worse prognosis for achieving best corrected visual acuity (BCVA) after surgery than patients without signs of VPTS. Correct and timely diagnosis, early treatment by vitreoretinal surgery give a greater chance of achieving higher BCVA in the postoperative period in this category of patients.

[Anti-VEGF therapy for diabetic retinopathy]. / Anti-VEGF preparaty v lechenii diabeticheskoi retinopatii.

Diabetic retinopathy (DR) is one of the most severe complications of diabetes mellitus, its treatment involves specialists of different areas - endocrinologists, diabetes specialists, therapists, cardiologists, surgeons, anesthesiologists etc. For ophthalmologists the objective is to diagnose ocular pathological changes associated with diabetes mellitus, and to prescribe required treatment in a timely manner. Treatment methods used in DR can be divided into three main groups: laser coagulation of the retina, intravitreal injection of medications - inhibitors of the vascular endothelial growth factor (VEGF) and glucocorticoids, as well as surgical treatment. The present literature review addresses the use of anti-VEGF drugs in the therapy of DR, specifically the latest medications, the most important studies on the treatment of DR and diabetic macular edema (DME), as well as post hoc analysis of such studies, the role of these medications in the therapy of refractory DME and proliferative stage DR. The review also addresses the upcoming strategies for therapy, as well as the importance of medications in prevention of DR and DME.

[Antiangiogenic therapy of neovascular age-related macular degeneration]. / Antiangiogennaya terapiya neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii.

The problem associated with the prevalence of retinal diseases, and age-related macular degeneration (AMD) in particular, is undoubtedly relevant. This aspect is based on steadily growing statistics on morbidity, a high number of randomized controlled trials (RCT) and published real world data (RWD). The analysis of RCT results being published by researchers on 15.05.19 showed 2915 studies were registered on the subject of retinal diseases; that exceeds the number of studies on glaucoma by approximately 1.38 times (2118 studies) and conjunctival lesions by 2.37 times (1230 studies). AMD is one of the leading causes of irreversible vision loss and blindness; its neovascular form leads to blindness in 80-90% of all cases. Even though the topic of nAMD therapy is widely highlighted in modern ophthalmology, today there are many aspects that require targeted solutions. The main controversial issues that determine the complexity of therapy and patient management include discrepancies in determination of reference points (disease activity criteria) for implementation of anti-VEGF dosing regimens, patients' compliance, prioritization issues in treatment, its continuity with potential for the increase of intervals between injections and monitoring visits.

[Effectiveness of multistage surgical treatment of advanced proliferative diabetic retinopathy complicated with primary cataract]. / Effektivnost' mnogoetapnogo khirurgicheskogo lecheniya proliferativnoi diabeticheskoi retinopatii, oslozhnennoi nachal'noi kataraktoi.

Vitreoretinal surgery (VRS) is the «gold standard¼ for surgical treatment of patients with proliferative diabetic retinopathy (PDR). However, the timing for the removal of primary cataract in this category of patients remains uncertain. PURPOSE: To evaluate the effectiveness of multistage surgical treatment of patients with advanced PDR complicated with primary cataract. MATERIAL AND METHODS: The study involved 94 cases of surgical treatment of patients with PDR and complicated primary cataract. These patients were divided into two groups depending on the treatment tactics. In the first group, patients were subjected to a two-step surgical procedure: VRS with silicone oil tamponade performed as the first step in their treatment followed by phacoemulsification, silicone oil removal, and IOL implantation, respectively, as the second step. In subgroup 1a - VRS was performed with standard pharmacological support. In subgroup 1b - intravitreal injection of angiogenesis inhibitors preceded VRS. In the second group, the first step was phacoemulsification performed simultaneously with vitreoretinal surgery with silicone oil tamponade; the second step consisted of removing silicone oil from the vitreous cavity. Subgroup 2a - surgical treatment was performed with standard pharmacological support (similar to subgroup 1a). Subgroup 2b - intravitreal injection of anti-VEGF drugs preceded VRS. RESULTS: Visual functions improved in 88.8% and 83.4% of cases in subgroups 1a and 1b, and in 51.3% and 66.7% in subgroups 2a and 2b, respectively. CONCLUSIONS: The study confirms the effectiveness of staged (multi-step) surgical treatment of patients with advanced proliferative diabetic retinopathy and complicated primary cataract. Conducting phacoemulsification sometime later along with silicone oil removal in PDR patients with preoperative intravitreal injection of angiogenesis inhibitors is a gentler approach for the anatomic structures of the eye during the first stage (VRS) and contributes to the reduction in the number of intraoperative and postoperative complications.

[Changes in perfusional and morphological parameters of the macular area after silicone oil tamponade of the vitreous cavity]. / Dinamika perfuzionnykh i morfologicheskikh parametrov makulyarnoi zony pri silikonovoi tamponade vitreal'noi polosti.

PURPOSE: To compare the changes of the macular morphological and functional parameters in the postoperative period in patients with silicone oil tamponade after successful surgery of the macula-on rhegmatogenous retinal detachment (RRD). MATERIAL AND METHODS: The study included 20 eyes operated on for macula-on RRD, which made up the first group, and the control group (20 eyes) for comparison. All patients of the study group underwent vitrectomy using silicone oil tamponade. Standard ophthalmological examination was performed on the 3rd day (early postoperative period) and the 14th day (late postoperative period), including OCT and OCT-A that were used to assess morphological and functional changes. RESULTS: A significant decrease in visual acuity was seen on the 3rd day after surgery involving the use of silicone oil tamponade, in comparison with the 14th day (p=0.0237) and the control group (p=0.0001). A decrease in the FD parameter (p=0.045), a decrease in vascular density in the fovea (p=0.020) and parafovea (p=0.024) in SCP were found on the 3rd day in comparison with control. On the 14th day of postoperative observation, a tendency was detected for choroidal perfusion to restore, as well as significant increase in FD (p=0.016), and an increase in vascular density in parafovea (p=0.01) compared with the early postoperative period. No statistically significant changes were seen in the FAZ area and vessel density DCP (p>0.05).

[The method of closing macular holes with partial preservation of the internal limiting membrane]. / Sposob zakrytiia makuliarnykh razryvov s chastichnym sokhraneniem vnutrennei pogranichnoi membrany.

Macular hole is an urgent vision impairment problem among the population of developed countries. The main method of treatment of the macular hole is vitrectomy with removal of the internal limiting membrane (ILM). However, the pilling has been recently proved to have negative impact on neurophysiological processes in the macular zone. PURPOSE: To suggest a new technique and to evaluate the dynamics of anatomical and functional parameters after surgery for macular hole with preservation of ILM. MATERIAL AND METHODS: The study examined the results of treatment of 52 patients (52 eyes) with end-to-end macular holes of stages 2 to 4 according to the Gass classification. Patients of the 1st group underwent standard surgical treatment: vitrectomy and then circular maculorhexis. Patients of group 2 were operated according to the original method with partial preservation of ILM in the foveolar zone. All patients underwent standard ophthalmological examination before and after the surgery. The morphometric data was evaluated using optical coherence tomography (OCT). Statistical processing of the results was carried out using IBM SPSS Statistics 23 software. RESULTS: Morphofunctional parameters of the retina did not differ between patients of the two groups before treatment. According to the results of surgical treatment, on day 7 after the operation, higher indices of functional parameters of the retina were observed in patients of the 2nd group. On day 30, patients of group 2 were observed to have an increase in best-corrected visual acuity (BCVA) in comparison with these indicators on day 7, and a significant increase in comparison with the data before surgery. In patients of group 1, no improvement of vision was observed. It was also revealed that holes with permanent cystic cavities have the worst prognoses in terms of increasing visual functions and restoring the foveolar profile. CONCLUSION: The described procedure allows partial preservation of ILM, which reduces the risk of intraoperative damage to the retinal layers; the observed functional results were higher.

[Ozurdex in the treatment of diabetic macular edema. When to prescribe?] / Ozurdeks v terapii diabeticheskogo makuliarnogo oteka. Kogda naznachat'?

Retinal damage in diabetes is known to manifest in two main ways: diabetic retinopathy and diabetic macular edema. The most effective anti-inflammatory drugs today are glucocorticoids, a classic representative of which is dexamethasone. Two things that should be considered by ophthalmologists in the therapy of macular edema are the switching point to dexamethasone implant when the effectiveness of anti-vasoproliferative drugs is unsatisfactory, and the identification of the main predictors of diabetic macular edema that make glucocorticoids the drugs of first choice. The data from real clinical practice was used to develop the indications for intravitreal administration of a glucocorticoid as the therapy of first choice for diabetic macular edema. Glucocorticoids are prescribed to patients diagnosed with diabetic macular edema who has a history of acute cerebrovascular events, myocardial infarction or other cardiovascular and cerebrovascular diseases, as well as patients with a very high risk of a vascular catastrophe. Intravitreal glucocorticoids can be prescribed to patients who cannot follow the schedule of frequent visits and/or are not able to visit the hospital during the first 6 months after the administration of the drug. Considering the local character of its ophthalmic action, the method can be recommended for treating patients with pseudophakic eyes, persistent diabetic macular edema, or patients who underwent vitrectomy.

[Macular pigments in retinal degenerative processes]. / Makuliarnye pigmenty pri degenerativnykh protsessakh setchatki.

Macular pigments (MP) - carotenoids, which determine the structure of the central part of the retina, play an important role in the work of its foveolar part. The main function of MP is to maintain full functionality of the macular area of the retina, which is based on the possibility of reducing color aberrations in the absorption of blue light and patients' ability for dark adaptation. Epidemiological studies have revealed a direct correlation between the low MP and the increased risk of developing age-related macular degeneration. However, global studies on the issue such as CARMA, CARMA, AREDS I, AREDS II, Rotterdam Study, and TOZAL study have proved the possibility of correcting the level of MP in the retina when they're taken as food additives, effectively reducing the risk of developing degenerative processes in the retina. In addition, studies have determined the optimal formula for food additives to stabilize the functionality of the macular area. The most important components of the additive have been shown include lutein, zeaxanthin, ascorbic acid, selenium, zinc, α-tocopherol acetate.

[Effect of internal limiting membrane peeling on morpho-functional state of the retina in patients with proliferative diabetic retinopathy (preliminary report)]. / Vliianie pilinga vnutrennei pogranichnoi membrany na morfofunktsional'nye pokazateli setchatki pri proliferativnoi diabeticheskoi retinopatii (predvaritel'noe soobshchenie).

PURPOSE: To compare morpho-functional parameters of retina during vitrectomy with and without internal limiting membrane (ILM) peeling in patients with proliferative diabetic retinopathy. MATERIAL AND METHODS: The study included 55 patients (55 eyes) that had underwent vitreoretinal surgery in the setting of antivasoproliferative therapy for proliferative diabetic retinopathy. Patients of the 1st group (n=27) underwent vitrectomy with silicone tamponade, 2nd group (n=28) received similar treatment with the addition of ILM peeling. Three months after the treatment, all patients had silicone oil removed. RESULTS: Best Corrected Visual Acuity before treatment was 0.06±0.02 in both groups; after the treatment it improved to 0.1±0.05 (p<0.05) in the 1st group and to 0.25±0.05 (p1-2<0.05) in the 2nd group. Thickness of the 'nerve fiber layer - internal limiting membrane' in the macular area was 28.67±2.21 µm in both groups before the treatment. By 3-month follow-up its thickness increased to 46.44±2.56 µm (p<0.05) in the 1st group due to the formation of epiretinal membrane (ERM). In patients of the 2nd group 'nerve fiber layer' area thickness amounted to 28.41±1.88 µm (p1-2<0.05) and ERM could not be identified in any of them. CONCLUSION: ILM peeling during vitrectomy with following silicone oil tamponade eliminates the risk of ERM formation in patients with proliferative diabetic retinopathy in the follow-up period of up to 6-month and results in better morpho-functional parameters in comparison with patients who received similar treatment but without peeling.

[Anti-VEGF dosing regimen for neovascular age-related macular degeneration treatment]. / Rezhimy naznacheniia anti-VEGF-preparatov pri terapii neovaskuliarnoi vozrastnoi makuliarnoi degeneratsii.

antivasoproliferative therapy is a revolutionary option in the therapy of Neovascular Age-related Macular Degeneration (nAMD). In addition to the problem of choosing an anti-VEGF drug, it is equally important to choose the mode of its intravitreal administration. The basic dosing regimen is fixed monthly intravitreal injections. The effectiveness of monthly intravitreal injections has been demonstrated in randomized clinical trials; however, this regimen is associated with heavy workload on the healthcare system and patients. This fact leads to the constant search of the optimal administration mode for anti-VEGF drugs, which would reduce the number of injections by increasing the interval between them. VIEW1 and VIEW2 randomized clinical trials showed that the optimal dosing regimen for aflibercept is 1 injection every other month after 3 initial monthly doses, and that it reduces the burden of treatment. The Pro Re Nata (PRN) and Observe-and-Plan (O&P) regimens also reduce the number of injections, but the antivasoproliferative effect of the therapy with these regimens may be decreased. In addition, when using the PRN regimen, patients need regular monitoring visits and examinations between injections. The basis of another Treat and Extend (T&E) regimen is the principle of achieving the maximum possible interval between injections while preserving the achieved anatomical and functional results of the treatment. The individualized approach implemented in T&E results in pronounced functional improvements avoiding negative effect onits efficiency. However, the rapid, steady and unpredictable course of nAMD imposes certain restrictions on its implementation of T&E in clinical practice, especially in the first year of treatment. Therefore, when choosing the optimal regimen for anti-VEGF therapy, in addition to the criteria for the duration and mechanism of action of the corresponding anti-VEGF drug, the individual characteristics of the course of the disease should also be considered.

[Selective symptomatic therapy of macular edema due to occlusive processes in retinal venous system]. / . Simptomaticheskaia selektivnaia terapiia makuliarnogo oteka pri okkliuzionnykh protsessakh v sisteme retinal'nykh ven.

AIM: to evaluate the effect of dexamethasone intravitreal implant on the functional state of the eye in macular edema associated with central retinal vein occlusion. MATERIAL AND METHODS: The study included two groups of patients: group 1 (control group) - 8 patients (16 eyes) without ocular pathology and group 2 (study group) - 8 patients (8 eyes) with macular edema on the background of newly diagnosed thrombosis of the central retinal vein. All the patients from the study group underwent insertion of an intravitreal dexamethasone implant - Ozurdex. Best corrected visual acuity (BCVA) and retinal light sensitivity of the central visual field were followed up. The maximum follow-up period was 12 months. RESULTS: In group 1 (controls), BCVA averaged 0.93±0.2 and retinal light sensitivity of the central visual field - 19.01±1.18 dB. In group 2, baseline BCVA and retinal light sensitivity were 0.08±0.02 and 4.23±0.2 dB, 1 month after Ozurdex implantation - 0.21±0.04 and 11.77±0.98 dB, at 12 months - 0.23±0.17 and 5.2±0.78 dB, respectively. CONCLUSION: Macular edema associated with central retinal vein thrombosis has a strong deteriorating effect on the functional state of the eye. The dexamethasone intravitreal implant in patients with postthrombotic macular edema contributes to functional improvement, including BCVA and light sensitivity of the central retina, over the first year. At that, different functional parameters show different dynamics after dexamethasone treatment. Light sensitivity values, in contrast to BCVA, change unevenly and significantly during the year. Intravitreal implantation of a dexamethasone implant in patients with postthrombotic macular edema is an effective symptomatic treatment of occlusive processes within the retinal venous system.

[Foveolar effects of dexamethasone intravitreal implant in central retinal vein occlusion].

AIM: To evaluate functional and morphometric parameters of the central retina in patients with postocclusive macular edema treated with dexamethasone intravitreal implant injection. MATERIAL AND METHODS: We examined 5 patients (5 eyes) with newly diagnosed central retinal vein occlusion complicated by macular edema, including 4 men and 1 woman aged 55.8±3.65 years (experimental group). All the patients received a single injection of dexamethasone intravitreal implant. The maximum follow-up period was 12 months. The control group consisted of 5 presbiopic patients (10 eyes) aged 59.14±3.14 years. RESULTS: One month after injection, the best corrected visual acuity (BCVA) and central retinal light sensitivity improved (from 0.09±0.03 to 0.19±0.05 and from 3.18±0.19 to 11.07±0.97 dB, correspondingly), while foveolar thickness decreased from 425.36±57.87 to 273.75±36.65 µm. One year after the treatment, BCVA remained high and averaged 0.21±0.14. The total light sensitivity also remained higher than that at baseline, however, decreased down to 4.8±0.76 dB. Optical coherence tomography showed some flatness of the fovea. Foveolar thickness appeared 1.5 times higher than that in the control group and 1.2 times higher than that at the 1-month follow-up after dexamethasone intravitreal implant injection. Over the whole follow-up period, IOP has never significantly exceeded the baseline, optical media remained clear. CONCLUSION: 1. Dexamethasone intravitreal implant has been shown effective in resolving postocclusive macular edema, improving visual functions, and increasing central retinal light sensitivity within the first month after injection. 2. Positive changes in morphometric parameters of the central retina induced by the injection involve inner segments of photoreceptors as well as the outer nuclear, outer plexiform and inner nuclear layers. The morphofunctional effect persists for no less than 12 months after injection. 3. Over the 1-year follow-up period, there has been no negative influence of the implant on either intraocular pressure level, or lens transparency.

[Central retinal changes after ranibizumab injection for wet age-related macular degeneration].

AIM: to assess the dynamics of macular morphofunctional parameters in wet age-related macular degeneration after three injections of ranibizumab. MATERIAL AND METHODS: A total of 76 patients with classic choroidal neovascular membrane were examined. The latter could be seen on optical coherence tomography scans before the treatment as an optically heterogeneous formation beneath the neurosensory epithelium. The point of fixation was located 2-10 degrees from the fovea according to microperimetry testing. Wedge-like reduction of light sensitivity down to 0-2 dB corresponded to the area of neovascularization. RESULTS: Macular sensitivity improved from 7.24 ± 2.73 dB to 13.88 ± 1.94 dB (p < 0.05) after a course of three ranibizumab injections, the most significant changes taking place after the third one. The point of fixation moved somewhat back to the fovea after each injection. Morphological parameters of neovascular membranes gradually decreased: after the first injection the height went down to 20.29 ± 17.84 µm and the width--down to 1200 ± 300 µm on average, after the second one the height was 14.39 ± 9.83 µm, width--1000 ± 175 µm, after the third one the height and the width were 13.31 ± 8.13 µm and 900 ± 100 µm correspondingly (p < 0.05). CONCLUSION: Antivascular therapy reduces the pathological effect of neovascular membrane throughout the whole treatment period. The dynamics of studied parameters are characterized by an apparent response to the first injection, which indicates the advisability of further treatment.