[Topical application of hypotensive drugs for the prevention of intraocular pressure elevation after intravitreal injections of anti-VEGF drugs]. / Mestnoe primenenie gipotenzivnykh preparatov s tsel'yu profilaktiki povysheniya urovnya vnutriglaznogo davleniya posle intravitreal'nykh in"ektsii anti-VEGF-preparatov.

The management protocol for patients with neovascular age-related macular degeneration (nAMD) involves multiple intravitreal injections (IVI) of anti-VEGF drugs. The ability to reduce the peak intraocular pressure (IOP) rise is greatly important in clinical practice. PURPOSE: This study evaluates the effect of topical hypotensive drugs on the short-term IOP rise after IVI of anti-VEGF drugs in patients with nAMD. MATERIAL AND METHODS: The prospective study included 80 patients with newly diagnosed nAMD. Before the start of treatment, the patients were divided into 4 groups of 20 people each: 1st - controls, who received no prophylactic drugs, in the 2nd, 3rd and 4th groups local instillations of one drop of hypotensive drugs brinzolamide 1%, brinzolamide-timolol, brimonidine-timolol were performed in the conjunctival sac twice: 1 day before the injection (at 20:00) and on the day of the injection 2 hours before the manipulation (at 08:00), respectively. IOP was measured in each patient using ICare Pro non-contact tonometer before injection, as well as 1 min, 30 and 60 min after injection. RESULTS: Prophylactic use of hypotensive drugs was associated with a significant decrease in IOP immediately after IVI compared to the same parameter in the 1st group (p<0.001), the maximum decrease in IOP values was observed when using a fixed combination of brimonidine-timolol by 12.1 mm Hg compared to the controls (p<0.001), the combination of brinzolamide-timolol reduced IOP by 8.5 mm Hg (p<0.001), brinzolamide 1% led to the smallest decrease in IOP - by 5.1 mm Hg (p<0.001). CONCLUSION: Study patients that received instillations of brimonidine-timolol combination of one drop into the conjunctival sac 1 day before the injection and on the day of the injection showed the maximum decrease in IOP compared to patients of the other groups.

[Prevention of intraocular pressure elevation following intravitreal injections]. / Profilaktika povysheniya urovnya vnutriglaznogo davleniya posle intravitreal'nykh in"ektsii.

Determining the role of vascular endothelial growth factor (VEGF) in the pathogenesis of intraocular neovascularization prompted the development of anti-VEGF therapy. In general, these intravitreal injections (IVI) are considered relatively safe. One of the side effects that can occur after IVI of anti-VEGF agents is ocular hypertension, it can be acute or persistent. Numerous studies investigating the prevention of ophthalmic hypertension have been carried out in connection with the proven risk of short-term intraocular pressure (IOP) elevation after anti-VEGF injections. Scientific literature describes several methods of preventing intraocular pressure spikes after IVI: prophylactic medications, anterior chamber paracentesis, scleral decompression. Despite the significant number of publications, there is no universal consensus on the necessity of prevention measures for IVI of anti-VEGF drugs since the clinical benefits of slightly reducing the short-term IOP spikes remain unclear. This literature review analyzes the prospects of preventing ocular hypertension after IVI of anti-VEGF agents.

[Effectiveness of anti-VEGF therapy for neovascular age-related macular degeneration in different types of exudative fluid localization]. / Effektivnost' anti-VEGF-terapii neovaskulyarnoi formy vozrastnoi makulyarnoi degeneratsii pri razlichnykh tipakh lokalizatsii ekssudativnoi zhidkosti.

PURPOSE: To assess the effectiveness of anti-VEGF therapy in different types of fluids localization in neovascular age-related macular degeneration (AMD). MATERIAL AND METHODS: The study included 16 people (16 eyes) with exudative AMD. The study included patients with fibrovascular detachment of the retinal pigment epithelium (RPE), subretinal and intraretinal fluid. The patients were divided into two groups: in the first group, fibrovascular RPE detachment was combined with subretinal fluid (9 eyes); in the second group, fibrovascular RPE detachment was accompanied by both sub- and intraretinal fluid (7 eyes). All patients underwent standard ophthalmological examination, which included visometry, biomicroscopy, and ophthalmoscopy under conditions of drug-induced mydriasis. Additionally, OCT of the macular region and OCT-angiography were performed. RESULTS: Over the entire observation period, the first group of patients received an average of 5.11 intravitreal injections (IVI), the second group - 5.14 IVI. Visual acuity was comparable in both groups at the beginning of the study. Subsequently, the treatment resulted in an increase in visual acuity after 3 months in the first (p=0.066) and second (p=0.043) groups, as well as after 12 months in both groups (p=0.043). In the first group of patients, after 12 months, an increase in RPE detachment was observed (p=0.942), which suggests that the disease activity remains underestimated on OCT when RPE detachment and subretinal fluid are combined. In the first group, complete resorption of subretinal fluid occurred in 2 people. In the second group, resorption of subretinal and intraretinal fluid occurred in 6 people. CONCLUSION: Regardless of the subtype of fluid, anti-VEGF therapy is an effective method for treating exudative AMD. Intravitreal injections are necessary both in the presence of intra- and/or subretinal fluid, and fluid under RPE. The greatest difficulty is assessment of the fluid under the RPE.

[Antiangiogenic therapy for types I and II macular neovascularization in age-related macular degeneration]. / Antiangiogennaya terapiya pri I i II podtipakh makulyarnoi neovaskulyarizatsii pri vozrastnoi makulyarnoi degeneratsii.

The neovascular form of age-related macular degeneration (AMD) is characterized by growth of newly formed vessels, accumulation of fluid and, in most cases, presence of retinal pigment epithelium detachment. Depending on its localization in relation to retinal pigment epithelium (RPE), macular neovascularization (MNV) can be considered type 1 when it is located under the RPE, and type 2 when it is invading the RPE and the neurosensory part of the retina. PURPOSE: To conduct a retrospective analysis of the use of anti-VEGF therapy in AMD patients with types I and II of MNV. MATERIAL AND METHODS: The study enrolled 89 AMD patients (89 eyes) with active MNV who have been under observation for 3 years. In the course of treatment all patients underwent standard ophthalmological examination that included visometry, biomicroscopy and ophthalmoscopy with mydriasis, as well as optical coherence tomography. RESULTS: Anti-VEGF therapy was found to stabilize best corrected visual acuity (BCVA) in both types of MNV (I and II). Comparison of the intraretinal and subretinal fluids (IRF and SRF) revealed that initially neuroepithelium detachment is more frequent (approximately in 90% of eyes) than IRF (30-40%). Antiangiogenic therapy is associated with better resorption of SRF, by the third year of the follow-up the neuroepithelium detachment is visualized in 60% of patients, while IRF remains and is observed in 40% of cases. CONCLUSION: Antiangiogenic therapy has shown good functional and morphological effectiveness in both first and second types of MNV.

[Retinal pigment epithelial tear in age-related macular degeneration]. / Razryvy retinal'nogo pigmentnogo epiteliya pri vozrastnoi makulyarnoi degeneratsii.

Retinal pigment epithelial tear (RPET) occurs in a number of diseases, most often in age-related macular degeneration (AMD). RPET develops in the setting of retinal pigment epithelium (RPE) detachment and represents a violation of the integrity of its monolayer accompanied by the formation of a demarcation line between the RPE atrophy area and RPE folds. Its incidence varies widely. In the earlier studies, diagnosis of RPET was performed using fluorescent angiography or angiography with indocyanine green (ICG-FA). The advent of optical coherence tomography made the detection of RPET easier and more accessible. The mechanism of RPET formation is quite polymorphic and ambiguous. Scientific literature contains descriptions of the occurrence of RPET when using both ranibizumab and aflibercept, and bevacizumab in equal proportions, implying that the drug choice does not affect the occurrence of complications. Continuous monitoring and adherence to anti-VEGF therapy leads to better anatomical and functional results in the long term, which is crucial for improving the quality of life of patients with age-related macular degeneration. This article reviews the literature and presents current data on RPET, identifies risk factors and mechanisms of its development, provides classification, and describes modern options for its diagnosis and treatment.

[Real clinical practice of antiangiogenic therapy in patients with age-related macular degeneration. Retrospective analysis of functional results]. / Real'naya klinicheskaya praktika primeneniya antiangiogennoi terapii u patsientov s vozrastnoi makulyarnoi degeneratsiei. Retrospektivnyi analiz funktsional'nykh rezul'tatov.

PURPOSE: To assess the functional results of antiangiogenic therapy in patients with exudative form of age-related macular degeneration (AMD) in real clinical practice. MATERIAL AND METHODS: The study included 90 people (90 eyes) with active choroidal neovascularization (CNV) on the background of AMD. All patients were divided into 6 groups depending on the year of treatment - from 2013 to 2018, all patients were divided into 6 groups and overall the retrospective study sited at Research Institute of Eye Diseases (Moscow) lasted 8 years. All patients underwent standard ophthalmological examination including visometry, biomicroscopy and ophthalmoscopy under drug-induced mydriasis, as well as optical coherence tomography, fundus angiography and OCT-angiography. RESULTS: According to the results of the analysis of OCT data obtained from 2013 to 2017, among all patients with exudative AMD, patients with types I and II of CNV and single patients with RAP prevailed, which explains the high visual acuity - about 0.5 - in all groups after the start of the treatment (table 1 and 2). In 2018, 33.3% of patients were diagnosed with RAP (the same number of eyes as with types I and II of CNV), which can be explained by the introduction of OCT-angiography into wide clinical practice. The lack of increase in visual acuity is most likely associated with a small amount of intravitreal injections (IVI) - 4.8 IVI in the first year and 3.3 IVI in the second injection year. In patients who received more than three IVI in the first year of observation, visual acuity increased from 0.49±0.03 to 0.6±0.03 (p=0.04), in the case of less than three IVI in the first year, visual acuity was not changed, amounting to 0.42±0.1 before and 0.44±0.1 (p=0.655) after the treatment. CONCLUSIONS: Patients of all groups exhibited proportional stabilization of visual acuity, a decrease in the thickness of the retina and total macular volume. The lack of improvements of visual acuity is most likely associated with a small amount of IVI.

[Anti-VEGF therapy in the treatment of neovascularization secondary to angioid streaks (a case report)]. / Primenenie anti-VEGF-terapii pri lechenii neovaskulyarizatsii vsledstvie angioidnykh polos (klinicheskoe nablyudenie).

The article presents a clinical case of using anti-VEGF therapy in the treatment of retinal neovascularization consequent to angioid streaks (AS). Angioid streaks are linear breaks or divergences in an abnormally brittle or calcified Bruch's membrane. The development of choroidal neovascularization (CNV) due to AS is one of the most serious complications of the disease and the main cause of visual impairment, especially in active middle-aged patients. Currently, determination of the morphology and activity of CNV is done using multimodal macular imaging methods such as optical coherence tomography of the retina (OCT), optical coherence tomography angiography (OCT-A), fluorescin angiography (FA), indocyanine green angiography (ICGA) and autofluorescence. With the discovery of anti-VEGF therapy, it became possible to improve and stabilize functional results in this group of patients.

[Analysis of changes in central macular thickness based on optical coherence tomography angiography findings in retinal vein occlusion]. / Izmeneniya tsentral'noi zony glaznogo dna pri retinal'nykh venoznykh okklyuziyakh po dannym opticheskoi kogerentnoi tomografii-angiografii.

AIM: To investigate the relationship between OCT angiography measurements and central fundus changes in patients with retinal vein occlusion (RVO). MATERIAL AND METHODS: The study enrolled 21 RVO patients aged from 55 to 86 years (69.9±2.28 years), including 8 patients with ischemic central RVO (I-CRVO; 73.6±3.4 years on average) and 13 patients with branch RVO (BRVO; 67.6±3.0 years on average). Of the latter, 8 cases were ischemic (I-BRVO) and 5 non-ischemic (NI-BRVO). OCT angiography (OCTA) was performed using RTVue XR Avanti (Optovue, USA) tomograph in the Angio Retina mode. RESULTS: A direct correlation was found between visual acuity and the degree of macular perfusion when assessing a scanning area of 6x6 mm. Having compared the degree of perfusion in groups, we have revealed that it changed significantly regardless of the size of the area scanned and the radius of the region of interest. Patients with ischemic CRVO demonstrated the lowest perfusion (Flow Area). As to ischemic and non-ischemic BRVO patients, the difference between them was only noticed with small scanning area (3x3 mm). Another statistically significant difference was shown for the blood flow index in the I-CRVO and NI-BRVO groups with scan area of 3x3 mm. Of 8 I-CRVO patients, 4 demonstrated areas of hypoperfusion within both superficial and deep vascular plexuses, while the other 4 - within the deep plexus only. In the I-BRVO group, 7 patients had hypoperfusion within both superficial and deep vascular plexuses and just 1 - within the deep plexus. In the NI-BRVO group all 5 patients had hypoperfusion of deep layers with no involvement of the superficial plexus. CONCLUSION: The value of information on vascular perfusion in all layers of the central retina provided by OCT angiography is very high, which makes it useful for the detection of microvascular abnormalities in patients with retinal vein occlusions.

[The role of lipid metabolism and antioxidant system changes in the development of retinal vein occlusion].

PURPOSE: To compare changes in lipid metabolism and antioxidant status in patients with retinal vein occlusion (RVO) with that in patients with a history of ischemic stroke and in patients with no clinical manifestations of atherosclerosis. MATERIAL AND METHODS: A total of 111 patients were enrolled in the study. Group 1 included 80 patients with RVO and grade 2-3 stage II-III essential hypertension, group 2-11 patients with grade 3 stage III essential hypertension, high cardiovascular risk and a history of ischemic stroke. The control group included 20 patients with no clinical manifestations of atherosclerosis. All patients underwent a standard ophthalmic examination, fluorescent retinal angiography, lipid metabolism and redox system assessment. RESULTS: The levels of low-density lipoproteins (LDL) and cholinesterase were higher in study groups than in controls regardless the type of RVO. A statistically proven increase in oxidized LDL (oxLDL) was found in patients with complicated hypertension and ischemic RVO. A direct correlation was determined between the level of anti-oxLDL IgG and lipid peroxidation activity (LP) (R = 0.376; p = 0.136) as well as the levels of glutathione peroxidase (GPx) (R = 0.529; p = 0.029) and GPx per gram of hemoglobin (R = 0.543; p = 0.024) in patients with branch RVO. Redox system assessment showed a decrease of thiols and an increase of LP metabolites. CONCLUSION: The results demonstrated that retinal vein occlusions develop under disorders of lipid metabolism similar to those in patients with a history of ischemic stroke. The correlation between the level of anti-oxLDL IgG and LP points to the redox system involvement in the intricate pathogenesis of RVO.

[Pathogenesis of retinal vein occlusions].

Retinal vein occlusion (RVO) is a multifactorial disease and its pathogenesis is still not fully understood. Mechanical, hemodynamic, rheological, coagulation, biochemical, and immunological factors are involved. Two currently prevalent theories of RVO pathogenesis are the mechanical theory and the "coagulopathic" theory. The latter implies an imbalance between thrombogenic factors and antithrombogenic protection. According to some authors, endothelial dysfunction plays a large part in thrombosis development, neoangiogenesis, vascular remodeling, intravascular activation of platelets and leucocytes. In recent studies increasing emphasis is being placed on investigation of immune-mediated mechanisms of vein occlusions. RVO can also be associated with combined hypoxic and free radical tissue damage.