[Evaluating the efficacy of anti-VEGF therapy in patients with exudative age-related macular degeneration and concomitant glaucoma].

AIM: to evaluate the efficacy of anti-VEGF therapy in patients with exudative age-related macular degeneration (AMD) and glaucoma. MATERIAL AND METHODS: The study enrolled 117 patients (117 eyes) with exudative AMD and concomitant non-operated primary open-angle glaucoma (POAG). All patients were divided into several groups depending on their intraocular pressure (IOP) and stage of POAG. Hypotensive therapy included carbonic anhydrase inhibitors, beta-adrenergic antagonists (beta blockers) and alpha(2)-adrenergic agonists (alpha-2 mimetics). Lucentis (ranibizumab) was intravitreally injected thrice at monthly intervals. All patients underwent a standard ophthalmic examination, fluorescent retinal angiography, and optical coherence tomography. IOP was measured before the first and after the last injection by means of Icare PRO reboud tonometer. RESULTS: There was no statistically significant difference between groups Ia, IIa, Ib, and IIb in terms of IOP elevation. Glaucoma IIc and IIIa patients showed just a moderate increase in IOP that did not require regimen adjustment. There was, however, a single IIIb case of persistent IOP elevation, in which one-step penetrating trabeculectomy with intravitreal ranibizumab injection was later performed. Resolution of macular edema was achieved in all patients. Visual acuity (VA) varied between the groups demonstrating a tendency toward improvement in glaucoma Ia patients (p = 0.062) and stabilization in glaucoma IIa (p = 0.61), Ib (p = 0.07), and IIb (p = 0.29) patients. In some cases of low vision at baseline and subretinal fibrosis, VA changes were of no clinical significance. CONCLUSIONS: Intravitreal ranibizumab therapy proved effective in exudative age-related macular degeneration with concomitant glaucoma. Timely treatment of both AMD (i.e. before the development of subretinal fibrosis) and glaucoma contributes to therapeutic success in these patients.

[Contemporary pharmacogenetic approaches to the treatment of age-related macular degeneration].

A study on the role of CFH, HTRA and IL-8 gene polymorphism in age-related macular degeneration (AMD) development has been conducted. At the first stage of the study genetic testing was done in 69 patients with exudative AMD and 370 random Moscow citizens without the disease. The goal of the second stage was to determine the influence of gene polymorphism on patient's response to endovitreal ranibizumab treatment. For that, visual acuity and foveal thickness were assessed before and after ranibizumab injections in 120 patients with wet AMD. All patients were genotyped for the genes of interest. The results showed that the presence of homozygous 402H polymorphism in CFH gene, as well as homozygous (-625)A mutation in HTRA1 gene, determines certain clinical presentations. Moreover, visual acuity below 0.1 and presence of 402H, (-625)A and (-251)A alleles in both copies of all three genes (CFH, HTRA and IL-8) are negative predictors of disease severity and antiangiogenic treatment response.

[Age-related macular degeneration and glaucoma: intraocular pressure monitoring after intravitreal injections].

In recent decades the problem of low vision and blindness in elderly people became major and socially significant issue. The number of patients having age-related macular degeneration (AMD) in association with glaucoma grows all over the world that attaches medical and social value to this problem. 102 patients with AMD were under follow-up, 7 of them had primary open-angle glaucoma (POAG). Three consecutive injections of ranibizumab resulted in visual acuity increase from 0.21 +/- 0.17 till 0.37 +/- 0.12. The mean retinal thickness in foveal zone decreased from 289.36 +/- 88.73 till 230.47 +/- 88.02 microm. Ocular hypertension within 12 hours after procedure was observed in 13 (12.7%) of 102 patients. In all cases intraocular pressure (IOP) returned to preoperative values in 3 days after hypotensive medical treatment. In one case trabeculectomy was performed simultaneously with ranibizumab intravitreal injection, the next two injections were performed in a month intervals. So the problem of IOP increase after intravitreal injections remains unsolved. Glaucoma is not an absolute contraindication to intravitreal injections in treatment of exudative AMD although patients with associated conditions need individual approach in terms of both IOP compensation and number of ranibizumab injections.

[Influence of genetic mutations on clinical presentation of subretinal neovascularization. Report 2: The impact of HTRA and VEGF genes polymorphism].

A detailed analysis of influence of HTRA (serine peptidase) and VEGF (vascular endothelial growth factor) genes mutations is presented. The presence of one gene copy with allele of A- polymorphism rs1120638 of HTRA1 gen, T- polymorphism rs10490924 and de11443in54 of ARMS2 gene increases the risk of CNV in patients with AMD. The feature of clinical presentation in patients with CNV associated with (-625) A mutation of promoter region of HTRA1 gene in two chromosomes was fulminant course of the disease from exudative to scarring processes with fibrous tissue formation not just with sub-, but also intra- and preretinal localization. Genetic screening showed that combination of studied mutations (402H, (-625) A and (-251) A in both gene copies of CFH, HTRA and IL-8) results in the most severe and rapidly progressing form of the disease. Two new mutations were revealed in promoter region of VEGF gene: G > A replacement in position of (-72) nucleotide from transcription start and G > A replacement in 5'-nontranslated region of the 1st gene exon in position of (+31) nucleotide from transcription start.

[Influence of genetic mutations on clinical presentation of subretinal neovascularization. Report 1: The impact of CFH and IL-8 genes polymorphism].

Genetic analysis was performed in patients with subretinal neovascularization (CNV). The results showed significant association of CFH (compliment factor H) gene polymorphism with increase (rs1061170, rs514943 and rs380390) or decrease (rs529825, rs7524776, rs1831281, rs2274700, rs1576340, rs12144939, rs7540032) of CNV development risk. The incidence of IL-8 gene mutation was significantly (p = 0.008) higher in patients after chorioretinitis. Apparently -125 > A polymorphism in patients with chorioretinitis increases risk of CNV development, thus promoting raise of proangiogenic factors concentration in eyes with inflammatory background. The clinical presentation in patients with AMD and myopic disease associated with (-125) A mutation of promoter region of IL-8 gene was similar to that of patients with chorioretinitis. The features are the following: focal pattern, no drusen and RPE detachment, predominantly classic form of CNV (without occult pattern), formation of well-organized newly developed vessels.

[Central serous chorioretinopathy: etiology and pathogenesis].

The review of the literature is devoted to the topical problem of retinology, namely the etiology and pathogenesis of central serous chorioretinopathy (CSC). It presents historical facts of studying this problem, basic theories of the development of the disease, and principles of its classification. The bulk of the review touches upon the impact of stress on the development of choriocapillary-Bruch's membrane-retinal pigment epithelium system dysfunction. A human stress reaction is accompanied by the poorest hypokinetic type of circulation. This gives rive to a significant hypertensive reaction (the highest systemic pressure), by showing a considerable increase in the total peripheral vascular resistance; there is also a high baseline cortisol level with a tendency towards depleted reserves of the pituitary-adrenal system and imbalance in the pituitary-thyroid system. A chief role has been recently assigned to these changes in the recurrence and development of complications in CSC.

[Role of fluorescence diagnosis using Photosens in patients with subretinal neovascular membrane].

The paper shows the capacity of fluorescence diagnosis (FD) in patients with subretinal neovascular membranes. Photosens was used as a photosensitizer (PS) (NIOPIK) in FD. The agent was intravenously injected in a dose of 0.05 mg/kg. To study the kinetics of tissue PS distribution, the authors employed a procedure of local fluorescence spectroscopy using a LESA-01-Biospek spectrometer, which was improved when applying the procedure for visual assessment of a visual fluorescence image. It was ascertained that the results of photodynamic therapy (PDT) should be compulsorily taken into account in processing its parameters. In some cases, PDT may be recommended on days 3, 5, and 7 after administration of an agent. By taking into account the pharmacodynamics of Photosens, 0.5 mg/kg, all patients should keep the light regime for 3 months.

[Photodynamic therapy for subretinal neovascular membranes. Communication 1. Results of treatment for age-related macular degeneration].

The purpose of the study was to assess the results of photodynamic therapy (PDT) for subretinal neovascular membranes (SNM) in age-related macular degeneration (ARMD), by using the Russian drug Photosens. According to the treatment performed, all the patients were divided into 2 groups: 1) 18 patients with the neovascular form of ARMD who received a course of PDT; 2) 14 patients with the same form who had drug therapy. Photosens (aluminum phthalocyanine) was intravenously injected in a dose of 0.05 mg/kg. The irradiation conditions were as follows: a session was carried out, using a laser at a wavelength of 675 nm, in an exposure light dose of 120 J/cm2. The number of sessions ranged from 3 to 5 a week, depending on the clinical picture of SNM. The total light dose was not greater than 500 J/ cm2. PDT showed a higher efficiency, as compared to drug therapy. PDT using Photosens increases and stabilizes visual acuity in 50% of cases, improves retinal functional activity (an increase in the mean value of a b-wave amplitude), and causes positive changes in the morphometric values of the mean neuroepithelial thickness above SNM and in the foveola.

[Value of color doppler imaging in the diagnosis of occlusive retinal venous lesions].

A hundred and twenty-five patients aged 47 to 72 years who had retinal venous occlusions were examined. Occlusion of the central retinal vein (CRV) was observed in 82 (65.6%) patients and that of CRV branches was seen in 43 (34.4%) patients. In all the patients, color Doppler imaging (CDI) was performed to study blood flow in the ophthalmic artery, central retinal artery (CRA), CRV, and short posterior ciliary arteries. The study indicated a marked reduction in diastolic velocity, no diastolic component of the Doppler blood flow spectrum, and a significant increase in the CRA resistance index (from 0.9 to 1.0), and a pronounced decrease in the maximum systolic velocity in the CRV, as well as a considerable reduction in blood flow velocity parameters, and a rise in the resistance index in the ophthalmic artery and short posterior ciliary arteries. CDI is a highly informative, non-invasive technique that makes it possible to study the blood flow in the CRA and CRV for the evaluation the severity of disease and the efficiency of therapy for occlusive retinal venous lesions.