[Diagnosis and clinical features of non-exudative macular neovascularization]. / Diagnostika i klinicheskie osobennosti neekssudativnoi makulyarnoi neovaskulyarizatsii.

Macular neovascularization (MNV) is the process of new abnormal blood vessels formation in the choroid and/or retina. The widespread adoption of optical coherence tomography angiography (OCTA) has significantly expanded the possibilities of not only detecting pathological blood flow before the development of exudation and deterioration of visual acuity, but also determining its characteristics. The purpose of this review is to substantiate the criteria for choosing terminology and diagnostic markers of MNV. The term "non-exudative MNV" refers to type 1 neovascularization without intraretinal or subretinal exudation detected on repeated OCT scans in the course of at least 6 months. This type of MNV may include previously untreated, non-exudative membranes with a low tendency to exudate, as well as previously treated membranes that have become inactive or dormant and no longer require anti-angiogenic therapy. The criterion for dividing the non-exudative form of MNV into inactive (with a low growth rate and vascular density (VD) at baseline) and subclinical (with a high growth rate and VD) is the time of its activation, generally recognized as 6 months. The diagnostic criteria is the visualized "double layer" sign on OCT scans (retinal pigment epithelium and Bruch's membrane), as well as patterns of neovascular membranes of varying sizes, morphology and localization on OCTA scans. The cumulative risk of conversion from subclinical to exudative at two years of follow-up is 13.6 times higher than in eyes without detectable neovascularization, which highlights the importance of frequent monitoring in this healthy eye population for early detection of MNV signs.

[Choroidal microvascular dropout as a biomarker of glaucoma progression in patients with diabetes mellitus]. / Mikrososudistye narusheniya khorioidei kak biomarker progressirovaniya glaukomy pri sakharnom diabete.

PURPOSE: To study the occurrence, features of the development of choroidal microvascular dropout (CMvD) as a possible marker of the severity of the glaucoma process and to assess the impact of diabetes mellitus (DM) on the progression of these changes. MATERIAL AND METHODS: The study included 258 eyes (258 patients), which were divided into groups: 1st - 58 patients (58 eyes) with stage I POAG and DM; 2nd - 50 patients (50 eyes) with stage I POAG; 3rd - 50 patients (50 eyes) with stage III POAG and DM; 4th - 50 patients (50 eyes) with stage III POAG; 5th - 50 patients (50 eyes) with DM. The observation period lasted 24 months. The occurrence and dynamics of the development of CMvD, their relationship with structural and functional indicators of the optic disc in the course of observation were evaluated in patients with POAG and DM. RESULTS: CMvD was detected in stage I POAG in 17 eyes (34%), in patients with DM - in 27 eyes (54%), in the combined course of stage I POAG and DM - in 46 eyes (79.31%), in patients with stage III glaucoma - in 100% of cases. In patients with stage III glaucoma, the CMvD area indicators exceeded the values in other groups and practically did not differ regardless the presence of DM (0.59±0.13 mm2, p=0.005) and its absence (0.57±0.14 mm2, p=0.005). In the first year of follow-up, the increase in the area size of microvascular disorders in patients with POAG I was 5.88%, in comorbid patients - 3.84%, but by the end of the follow-up it increased by 19.23%, and in the group of patients with a high rate of progression - by 31.25%. Strong reliable correlations of CMvD with mean deviation (r=0.89) were revealed, as well as moderate correlations - with structural indicators of the optic disc (r=0.59) and with hemodynamic indicators (r=0.54 and r=0.52). CONCLUSION: Development of CMvD is both a result of glaucomatous damage to the optic nerve and a consequence of a disruption of its hemodynamics at the level of the deep capillary plexus. The results of the study demonstrate the adverse effect of DM on the course of glaucoma, which determines the initiation of microvascular disorders that aggravate the severity of the glaucoma process and the rate of its progression.

[Features of structural and microvascular changes of the choroid in angioretinopathy of various etiologies]. / Osobennosti strukturnykh i mikrovaskulyarnykh izmenenii khorioidei pri angioretinopatii razlichnoi etiologii.

PURPOSE: To study structural and microvascular changes in the choroid in patients with chronic kidney disease (CKD), diabetic retinopathy (DR) and arterial hypertension (AH), and their relationship with the level of renal function, carbohydrate metabolism and blood pressure. MATERIAL AND METHODS: The study involved 172 patients (325 eyes): 56 patients with CKD (109 eyes); 66 patients with DR (121 eyes); 50 patients with AH (95 eyes). All patients underwent comprehensive ophthalmological examination including visometry, biomicroscopy, ophthalmoscopy, optical coherence tomography (OCT) and OCT angiography. RESULTS: In patients with DR and CKD, a decrease in the thickness of the ganglion cell complex and the inner plexiform layer (GCL+IPL) was noted: in proliferative DR (PDR) - 62.45±4.25 µm, in stage 4-5 CKD - 75.23±6.43 µm; a decrease in choroidal thickness (CT) of minimal values in stage 4-5 CKD (179.9±37.72 µm) and PDR (211.0±40.7 µm). The decrease in choroidal vascularity index (CVI) depended on the stage of CKD and PDR (in PDR - 63.47±1.37, in stage 4-5 CKD - 65.93±2.01). Maximum decrease in perfusion density and vascular density was found in patients with DR (37.22±9.00% and 15.11±3.39 mm, respectively). An increase in the area, perimeter of the foveolar avascular zone (FAZ), and a decrease in the circularity index were noted in all groups, with most pronounced changes in PDR and stage 4-5 CKD. Patients with CKD were found to have strong correlations of CT and CVI with creatinine, urea, proteinuria and glomerular filtration rate (GFR). Patients with diabetes mellitus and PDR were revealed to have strong relations of CT, CVI, GCL+IPL, the area and perimeter of FAZ with creatinine levels and the duration of diabetes mellitus. CONCLUSION: Choroidal thickness and choroidal vascularity index are important diagnostic markers of disorders of chorioretinal microcirculation that allow stratifying individual assessment of risk factors for progression of both chronic kidney disease and diabetic retinopathy.

[New findings on pathogenetic mechanisms in the development of age-related macular degeneration]. / Novye dannye o patogeneticheskikh mekhanizmakh razvitiya vozrastnoi makulyarnoi degeneratsii.

Age-related macular degeneration (AMD) is a complex multifactorial disease that occurs due to disfunction and degeneration of retinal pigment epithelium (RPE) and choriocapillaris, as well as death of photoreceptors. The exact pathogenetic mechanism remains uncertain. The aging process is the main and the clearest risk factor of AMD. In the development of this condition, a special role belongs to the secretory phenotype of aging spreading from one cell to another and mediated by the secretion and release of growth factors, cytokines, chemokines, proteases, and other molecules. Another major contributor is oxidative stress caused by violations in the recirculation of vitamin A in the vision cycle and accompanied by accumulation of lipofuscin, which mediates the formation of iron-based oxidants that are toxic for mitochondria. Furthermore, prolonged oxidative stress and constant light exposure induce the development of inflammation in the retina. Accumulation of metabolic products and cellular defects with age can induce an inflammatory reaction that amplifies the damage. The inflammatory processes including innate immune response, activation of microglia and parainflammation that occur locally in the vascular membrane, pigment epithelium and neuroretina are very significant contributors to the age-related changes, their progression, and the development of advanced stages of AMD. Various growth factors play a special role in the development of choroidal neovascularization (CNV). Vascular endothelial growth factor A (VEGF-A) has traditionally been considered the main factor of neoangiogenesis and, consequently, the main therapeutic target, but in recent years various studies have determined the role of other factors - VEGF-B, C, D, PGF, Gal-1, angiopoietins. This article describes the main underlying mechanisms in the development of choroidal neovascularization including retinal aging, impaired metabolic activity, mitochondrial dysfunction, inflammatory reactions and genetic variations, as well as the role of various growth factors.

[Structural and microvascular changes in the retina and choroid in patients with chronic kidney disease]. / Osobennosti strukturnykh i mikrovaskulyarnykh izmenenii setchatki i khorioidei pri khronicheskoi bolezni pochek.

PURPOSE: To study the main structural and microvascular changes in the retina and choroid in patients with diabetic retinopathy (DR) and chronic kidney disease (CKD), and their relationship with impaired renal function. MATERIAL AND METHODS: The study included 158 patients (304 eyes). The 1st group consisted of 50 patients with CKD (97 eyes); group 2 - 65 patients with DR (119 eyes), group 3 - 43 patients with CKD and DR (86 eyes). All study patients underwent complete ophthalmological examination, including optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular region. RESULTS: The analysis of structural parameters in groups of patients showed a decrease in the thickness of the ganglion cell layer and the inner plexiform layer of the retina in patients with DR (70.85±14.49 µm), with the lowest value in the CKD+DR group (65.84±15.34 µm) in comparison with the CKD group (75.64±10.32 µm). In the groups of patients with CKD, the thickness of the choroid (207.3±40.36 µm) was significantly reduced in comparison with the group of patients with DR (258.8±26.63 µm) and correlated with the stage of the disease. Patients in the CKD+DR group had the lowest perfusion and vascular density in the macular region (31.23±10.91% and 13.15±2.73 mm), an increase in the area and perimeter of the foveal avascular zone (0.55±0.26 mm2, 3.30±0.84 mm). Pronounced correlations of decrease in choroidal thickness, vascular density, and perfusion volume with low glomerular filtration rate and CKD stage, as well as urea and creatinine levels were determined. An increase in the area of the foveal avascular zone correlated with lower retinal capillary density, decreased perfusion volume, and the stage of both DR and CKD. CONCLUSION: Structural and hemodynamic disorders of the retina and choroid can be recognized as significant biomarkers for non-invasive diagnosis of microvascular complications of diabetes mellitus and impaired renal function.

[Optical coherence tomography angiography in the diagnosis of retinal microvascular changes in chronic kidney disease (clinical observations)]. / Opticheskaya kogerentnaya tomografiya-angiografiya v diagnostike mikrovaskulyarnykh izmenenii setchatki pri khronicheskoi bolezni pochek (klinicheskie nablyudeniya).

One distinctive pathological sign of chronic kidney disease (CKD) is microcirculatory disorders, which mark it as a microvascular disease. Similarity in the blood supply of the retina and kidneys, in the anatomy of their vascularization lead to identical complications in these organs. The retinal-choroidal microvascular system is easily accessible for clinical and morphological assessment and can be examined by the reproducible and non-invasive method - optical coherence tomography (OCT) and OCT angiography (OCTA). The study of significant diagnostic tomographic retinal biomarkers in CKD and monitoring of their changes are of great clinical importance. The article presents clinical cases of changes in the retina and choroid depending of the stage of CKD. Retinal microvascular changes precede functional impairment. A significant decrease in retinal and choroidal thickness correlates with a decrease in the glomerular filtration rate (GFR) and the degree of albumin excretion in the urine. All clinical cases were observed to exhibit retinal microcirculation disorders, capillary rarefaction in both capillary plexuses accompanied by a decrease in vessel density and a decrease in the circularity index of the foveal avascular zone as a result of regression of the parafoveal capillary networks. OCTA allowed visualization of morphological changes at the microcirculatory level in the form of blunt ends of capillaries, their increased tortuosity and the presence of local areas of decreased perfusion. The severity of retinal microvascular changes varied depending on the stage of CKD and was not associated with either age or the presence of diabetes mellitus. Assessment of the retinal microvasculature can help with monitoring of microvascular lesions, early prediction of the risk of development and progression of decreased renal function, as well as allow avoiding aggressive diagnostic biopsy.

[Ophthalmic safety profile of antiangiogenic therapy]. / Profil' oftal'mologicheskoi bezopasnosti antiangiogennoi terapii.

Antiangiogenic therapy with inhibitors of vascular endothelial growth factor (anti-VEGF) has not only fundamentally changed the treatment outcomes of vasoproliferative eye diseases, but also became the most common ophthalmic surgical manipulation. At the same time, in 36-48% of bilateral lesions there is a need to perform injections in both eyes, making relevant the issues of safety and prevention of severe complications that threaten irreversible loss of visual function. The article reviews the results of randomized clinical trials and real clinical practice, analyzes the incidence and causes of its most dangerous complication - endophthalmitis, characterizes the clinical course depending on the type of drug used, and considers the possibility of reducing the risk of this complication occurring. Special attention is paid to the safety profile of a new VEGF inhibitor - brolucizumab - which has received registration for the treatment of neovascular age-related macular degeneration (nAMD). Specialists dealing with retinal pathologies acknowledge the need to monitor the state of the anterior and posterior parts of the eye in order to detect the signs of intraocular inflammation as quickly and early as possible. Drug efficacy, treatment regimen, duration of action and safety are the main characteristics that should determine the personalized approach in each clinical case.

[Development, clinical manifestations and diagnosis of retinal changes in chronic kidney disease]. / Osobennosti razvitiya, klinicheskie proyavleniya i diagnostika izmenenii setchatki pri khronicheskoi bolezni pochek.

Chronic kidney disease (CKD) is a significant public health problem with a high risk of developing age-dependent eye diseases. Renal glomeruli and the choroid have similar structures and vascular networks; the internal hematoretinal barrier and the glomerular filtration barrier have similar developmental path; the renin-angiotensin-aldosterone hormonal system is found in both the eye and the kidneys. All this determines the similarity of physiological and pathogenetic features of the development of diseases associated with these organs. The article discusses general risk factors and pathophysiological mechanisms of development of retinal and renal lesions in CKD, the influence of various factors of pathogenesis on their development and progression. The anatomical similarity of vascularization, accompanied by microvascular changes in the retina and kidneys, leads to similar complications in both organs. Optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A) are accurate, well reproducible and non-invasive methods for diagnosing and assessing changes in the retinal microvascular bed, which make it possible to assess microvasculature changes in the kidneys. In CKD, the retina shows signs of impaired capillary perfusion, a decrease in their density, expansion of intercapillary spaces, a rarefaction of the density of the parafoveolar capillary network, which may indicate a decrease in peritubular capillary blood flow, blood circulation of the kidneys in general and their ischemia. Significant thinning of the retina and choroid, along with a decrease in macular volume, even in the initial stages of CKD, is accompanied by impaired renal function (changes in the estimated glomerular filtration rate and urinary albumin excretion), which is a sign of systemic microvascular lesion and pathological process in the kidneys. Therefore, monitoring of retinal vessels using OCT and OCT-A can become a reliable indicator of the progression of renal microvascular changes at any stage of the disease.

[Leukocyte telomere length and response to antiangiogenic therapy in patients with neovascular age-related macular degeneration.]

Age-related macular degeneration (AMD) is becoming the leading cause of vision loss in people over 60 years of age. The neovascular form of AMD (nVMD) is characterized by choroidal neovascularization (CNV), the main trigger of which is vascular endothelial growth factor (VEGF), the inhibition of which is the current standard of treatment. Significant variability of response to anti-VEGF therapy determines the relevance of the search for biological markers - prognostic criteria of treatment response. We analyzed the response of 110 nVMD patients to anti-VEGF therapy depending on the functional and anatomical parameters of the retina (according to optical coherence tomography, OCT) and leukocyte telomere length (LTL, was assessed by quantitative PCR). Positive dynamics of best corrected visual acuity (BCVA) was observed in 100% of eyes. The central retinal thickness (CRT) decreased after the 3rd injection to 265 [234-306] µm, by the end of the observation period - to 211 [190-262] µm. The retention of activity of the subretinal neovascular membrane (SNM) at the end of the observation period correlated with lower values of the initial BCVA and high values of the initial CRT. An association of LTL with response to treatment was revealed: in patients with higher LTL the active form of SNM was more often switched to inactive after three injections, while with lower LTL, the activity of SNM was more often preserved, which determined the need for more intravitreal injections.

[Different types localisation of retinal fluid as prognostic biomarkers in the choice of anti-VEGF therapy for age-related macular degeneration]. / Rol' razlichnykh tipov lokalizatsii retinal'noi «zhidkosti¼ kak prognosticheskikh biomarkerov v vybore rezhima antiangiogennoi terapii pri vozrastnoi makulyarnoi degeneratsii.

Age-related macular degeneration is an advanced chronic disease and the main cause of vision loss in geriatric patients. Optical coherence tomography (OCT) is a modern method of retinal imaging allowing to detect different types of fluid: intraretinal fluid (IRF), subretinal fluid (SRF) and fluid under pigment epithelial detachment (PED). Finding relevant imaging biomarkers is necessary for identification of basic activity criteria of the disease, choosing treatment algorithms, determining treatment duration and termination criteria, and predicting the outcomes. Presence of IRF is associated with poor functional outcomes. Its presence is an indication for early beginning of treatment aimed at full resorption of the fluid with further possible careful extension of anti-VEGF therapy intervals with a regular follow-up. Degenerative intraretinal cysts developing in the background of subretinal fibrosis in absence of choroidal neovascularization (CNV) should be a sign for discontinuation of anti-VEGF therapy due to the lack of targets. Presence of SRF is associated with favorable outcomes and good treatment prognosis and is not a barrier to the extension of treatment intervals even up to the maximum of 16 weeks as described in existing randomized controlled trials, on the condition of no other CNV activity. PED with active CNV is one of the biomarkers that reveal the need for long-term aggressive therapy. In case of its size gain, it is necessary to restart the anti-VEGF treatment to prevent visual loss in the long-term. Combination of different fluid types is a sign of lasting disease history with a poor outcome prognosis. In this case, anti-VEGF treatment should be started as soon as possible with long-term fixed regimen or Treat-and-extend (T&E) with minimal suitable interval for the patient and precise monitoring of the condition of retina until complete suppression of activity. Developing a personalized approach in each case plays an important role in preserving visual functions.

[Anti-VEGF therapy for diabetic macular edema. From theory to clinical practice]. / Antiangiogennaia terapiia diabeticheskogo makuliarnogo oteka. Ot teorii k klinicheskoi praktike.

PURPOSE: To evaluate clinical effectiveness of aflibercept therapy for patients with diabetic macular edema (DME) - both naïve to the drug and unresponsive to previous anti-VEGF treatment. MATERIAL AND METHODS: The study included 127 patients (127 eyes) divided into two groups. The first group consisted of 100 primary DME patients (100 eyes) with mean age of 68.48±2.56 years and average disease duration of 12.50±7.85 years. The second group comprised 27 patients (27 eyes) with resistant macular edema who had received three or more 0.5 mg ranibizumab loading injections. Their average age was 66±4.12 and the mean number of previous anti-VEGF injections before changing therapy was 4.56±1.21. The evaluation parameters included Best Corrected Visual Acuity (BCVA) and Central Retinal Thickness (CRT) that were assessed initially and after each 2 mg aflibercept injection (at 1-month intervals during the 6 months of DME therapy). RESULTS: The average number of aflibercept injections in the first group was 4.34±1.22. BCVA improved in 100% of patients of that group after the 3rd injection with resulting mean value of 0.32±0.15. Maximum BCVA improvement was seen after the 6th injection amounting to 0.46±0.2. CRT decreased in 100% of patients of that group after the 1st injection. One month after the therapy start, CRT decreased in average by 17.96% - to 370.89±50.55 µm; at 3 months, CRT was 344.65±48.56 µm; after 6 month - 283.40±49.76 µm. All patients of the second group had retinal morphology restored, visual function improved in 55% of patients. Mean CRT decrease was 180±44 µm, BCVA improvement - 0.13±0.08, mean number of aflibercept injections - 4.86±0.9. CONCLUSION: Aflibercept can be used as first-choice drug for treatment of DME patients (both therapy-naïve and unresponsive to previous ranibizumab therapy) to improve anatomical parameters and visual function.

[Prognostic factors of antiangiogenic therapy response in neovascular macular degeneration]. / Prognosticheskie faktory éffektivnosti antiangiogennoi terapii pri neovaskuliarnoi vozrastnoi makuliarnoi degeneratsii.

The apparent success of antiangiogenic therapy in patients with neovascular age-related macular degeneration (nAMD) shows the significance of effect prognosis and continuous observation. PURPOSE: to study the influence of prognostic factors on the dynamics of functional and morphological response during anti-VEGF therapy in patients with nAMD. MATERIAL AND METHODS: Retrospective analysis of anti-angiogenic therapy results was performed on the data of 1020 patients with nAMD. Some patients were put into two subgroups: 100 patients with retinal pigment epithelium detachment (PED) and 100 patients without PED. Comparative analysis of functional and morphological parameters was performed in the subgroups. RESULTS: Baseline visual acuity (VA) in patients with PED (0.14±0.1) was significantly (р<0.05) lower than in patients without PED (0.32±0.21) and had negative correlation with PED presence (r=-0.61, р<0.05). By the end of the 12 months follow-up Best Corrected Visual Acuity (BCVA) was 0.52±0.28 and 0.62±0.28 (р>0.05) in patients with PED and without PED respectively. Mean number of injections in patients with PED was 5.7±2.5 compared to 3.5±1.2 in patients without PED (р<0.05). After 12 months VA in patients with PED was associated with baseline BCVA (r=0.59, р<0.05), VA after 4th injection (r=0.84, р<0.05) and baseline retinal thickness (r=0.60, р<0.05). CONCLUSION: PED in patients with nAMD was shown to be an unfavorable factor associated with significantly lower baseline BCVA that requires careful monitoring. At least three 'loading' injections are required to determine drug responsiveness and acquire functional and morphological response data. Correlation of BCVA values at different timepoints (baseline/after 3 'loading' doses/after 12 month) was found.

[Anti-VEGF therapy for age-related macular degeneration]. / Antiangiogennaia terapiia vozrastnoi makuliarnoi degeneratsii.

PURPOSE: To evaluate the clinical effectiveness of aflibercept in treatment of patients with neovascular age-related macular degeneration (nAMD). MATERIAL AND METHODS: The first group included 156 treatment-naive nAMD patients (156 eyes). The second group consisted of 29 patients (38 eyes) with nAMD who had previously received at least 3 loading injections of 0.5 mg ranibizumab but exhibited no morphological effect from the therapy. All patients included in the study were treated with 2.0 mg aflibercept. The follow-up period was 13 months. RESULTS: In the first group, the average number of injections was 5.1±0.39. A change in best corrected visual acuity (BCVA) after three loading injections was observed in all eyes of the group and amounted to 0.43±0.2. The final visual acuity was 0.47±0.22. After the first injection, central retinal thickness (CRT) in all patients of the group decreased to 346.14±54.53 µm; by the end of treatment it was 281.64±34 µm. Dry macula was achieved in 109 patients (69.9%), which corresponded to the highest BCVA of 0.84±0.14. In 26 patients (16.7%), subretinal fluid (SRF) remained and visual acuity was 0.57±0.22; 14 patients (9%) had pigment epithelium detachment (PED) and visual acuity of 0.63±0.08. Presence of residual intraretinal fluid (IRF) in 7 patients (4.5%) reliably defined the lowest functional result of 0.1±0.22. In the second group, 100% of patients after the first injection of aflibercept had decreased retinal thickness (by an average of 36.99 µm), while the increase in visual acuity was noted only after 3 injections in 67.5% of the eyes. By the end of the follow-up, CRT was 231.44±18.4 µm, decreased on average by 83.65 µm, and the final BCVA was 0.31±0.19. The number of injections was 5.7±1.7. CONCLUSION: Aflibercept can be used as the first choice drug in the treatment of nAMD for it improves the anatomical parameters of the retina and the visual functions.

[Clinical associations between photoreceptor status and visual outcomes in diabetic macular edema]. / Klinicheskie paralleli sostoyaniya fotoretseptorov setchatki i vosstanovleniya zritel'nykh funktsii pri diabeticheskom makulyarnom oteke.

AIM: to investigate morphological changes and visual acuity response to ranibizumab therapy in patients with different OCT-types of diabetic macular edema (DME) as well as different state of the inner and outer photoreceptor segments (IS and OS) and the outer limiting membrane (OLM); to study relationships between functional and morphological parameters before and after the treatment; to study the effect of glycated hemoglobin levels on morphological parameters and ME duration. MATERIAL AND METHODS: The study included 113 patients (113 eyes) with DME, who underwent 3 once-monthly intravitreal injections of ranibizumab (the mean patient age, 63.5±2.2 years; men, 51.3%; type 2 diabetes, 81.4%). Basing on the results of OCT, 3 groups were formed: group 1 (40 patients) - intact IS and OS; group 2 (32 patients) - disturbed photoreceptor segments integrity, but intact OLM; group 3 (41 patients) - destruction of both layers. RESULTS: Visual acuity at baseline and after the treatment was the highest in group 1 (p<0.05). In all groups, most parameters that indicated the state of photoreceptor segments and the OLM improved. Correlation analysis revealed a statistically significant negative correlation between visual acuity at baseline and after the treatment and morphological parameters (p<0.05). There was also a direct correlation between the morphometric parameters at baseline and after the treatment (p<0.05). The most favorable type of DME in terms of preserving the integrity of photoreceptor segments and the OLM was sponge-like edema, while DME with neuroepithelial detachment and mixed-type DME were prognostically unfavorable. Moreover, the state of photoreceptors and the OLM depended on the duration of ME and the level of glycated hemoglobin. Thus, the integrity of the inner and outer photoreceptor segments as well as the outer limiting membrane can contribute to prognosis for functional outcomes in DME patients that receive antiangiogenic therapy.

[Effectiveness of diffuse diabetic macular edema treatment in relation to structural changes in macular region]. / Effektivnost' lecheniya diffuznogo diabeticheskogo makulyarnogo oteka v zavisimosti ot strukturnykh izmenenii makulyarnoi oblasti.

AIM: to describe baseline functional and anatomical parameters of the macular region and how they change under ranibizumab therapy depending on the type of diabetic macular edema (DME) determined with optical coherence tomography (OCT). MATERIAL AND METHODS: The study included 100 patients (100 eyes) with diabetes mellitus and DME (38 men and 62 women) aged 61.9±5.6 years with the mean disease duration of 8.48 years. Basing on OCT findings, 4 groups (25 patients each) were formed: sponge-like DME, cystoid DME, DME with serous neuroepithelium detachment (NED), and mixed DME (cystoid DME and serous NED). All patients received 3 consecutive monthly injections of 0.5 mg ranibizumab. The relationship between anatomical, functional, and clinical parameters was analyzed. RESULTS: The lowest visual acuity (VA) at baseline was found in patients with mixed DME (р<0.05). The greatest increase in VA after the 3 injections was noted in patients with sponge-like DME - 0.34±0.18. Retinal thickness was significantly lower (р<0.05) in sponge-like DME as compared to other groups both at baseline and after the treatment. Foveolar thickness decreased after the treatment in all groups, the effect being the most pronounced (the edema got reduced by 42.4%, р<0.05) in cystoid DME. The most significant reduction in macular volume (by 2.7 mm3) as well as its lowest absolute post-treatment values were reported for patients with cystoid edema (9.01 mm3, р<0.05 as compared to sponge-like and mixed DME). Correlation analysis revealed an evident relationship between the improvement in VA (ΔVA) and the decrease in macular volume (р<0.05). Of clinical parameters, only diabetes duration correlated with the extent of VA improvement (r=-0.3; p<0.05). CONCLUSION: The effectiveness of intravitreal ranibizumab therapy for diffuse DME depends on the morphological type of macular edema by OCT. Moreover, it correlates with diabetes duration.