[Patterns of structural and functional changes in the retina and choroid in acute posterior multifocal placoid pigment epitheliopathy]. / Zakonomernosti strukturno-funktsional'nykh izmenenii setchatki i khorioidei pri ostroi zadnei mul'tifokal'noi plakoidnoi pigmentnoi epiteliopatii.

PURPOSE: The study analyzes the patterns of pathological changes in the retina and choroid in acute posterior multifocal placoid pigmented epitheliopathy (APMPPE). MATERIAL AND METHODS: The results of the examination of two patients with bilateral APMPPE were analyzed retrospectively. The examination had included visometry, tonometry, static perimetry, autofluorescence, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). RESULTS: The analysis revealed signs of the inflammatory nature of the choriocapillary vascular wall lesion with the development of their local obstruction and, consequently, local ischemia of the retinal pigment epithelium (RPE) and the outer layers of the retina in the acute period. At the same time, partial destruction of the ellipsoid zone, uneven hyperreflectivity of the RPE with local areas of its elevation and impaired connection with photoreceptors were revealed. The subsequent restoration of choriocapillaris perfusion was accompanied by significant restoration of the functional and structural state of the RPE over a larger area, as well as partial restoration of the ellipsoid zone of the retina. Two years after the onset of the disease, separate areas of defects of the RPE and the outer retina were observed, coinciding in localization with zones of severe circulatory deficiency at the level of choriocapillaris in the acute stage. CONCLUSION: According to the results of multimodal imaging, choriocapillaritis is the initial link in the pathogenesis of APMPPE. The change in RPE and the outer retina is secondary to the local ischemic zones due to choriocapillaris nonperfusion. The nature of RPE change over a larger area manifests as a functional structural disorder, with the potential for recovery in case of choriocapillaris reperfusion.

[Complex assessment of retinal ischemic damage in patients with retinal vein occlusion]. / Kompleksnaia otsenka ishemicheskogo povrezhdeniia setchatki pri okkliuzii retinal'nykh ven.

PURPOSE: To evaluate the effectiveness of treatment and the possibility of restoring visual functions in patients with retinal vein occlusion (RVO) depending on the initial degree of macular ischemia. MATERIAL AND METHODS: The study included 84 patients with RVO. The main inclusion criteria were the presence of macular edema in the setting of RVO with the duration of no more than 3 months and without any previous treatment. All patients underwent intravitreal injections of an angiogenesis inhibitor, followed by laser treatment when necessary. A comparative analysis of the results was carried out in groups that were opposite in terms of the clinical effect - before the start of the therapy, after 1 month, and after 12 months. All patients and the control group members underwent standard ophthalmological examination as well as electroretinography, fluorescence angiography, optical coherence tomography (OCT), and OCT angiography. RESULTS: Based on data obtained during 12 months of the follow-up, the comparative analysis of the initial ophthalmic status of patients with RVO with opposite clinical effect resulted in derivation of 3 clinical groups that correspond to the degrees of macular ischemia - mild, moderate and severe. CONCLUSION: Determination of the degree of macular ischemia at the stage of primary diagnosis can improve the treatment effectiveness and inform the patients about the sequence and duration of anti-VEGF therapy. Intravitreal injections of ranibizumab in retinal vein occlusion are carried out before the elimination of macular edema and further in the on-demand mode, while the number of injections can vary from one to monthly injections during the year.

[Nd:YAG laser goniopuncture as a mandatory adjuvant procedure after non-penetrating deep sclerectomy (long-term observation results)]. / Nd:YAG-lazernaia goniopunktura kak obiazatel'naia ad''iuvantnaia protsedura posle nepronikaiushchei glubokoi skleréktomii (rezul'taty dolgosrochnogo nabliudeniia).

Today, Nd:YAG laser goniopuncture (LGP) is considered a mandatory non-penetrating deep sclerectomy adjuvant procedure. However, its indications and timing remain debatable. PURPOSE: To evaluate the effect of Nd:YAG laser goniopuncture on the long-term hypotensive effectiveness of non-penetrating deep sclerectomy. MATERIAL AND METHODS: The study included 114 patients after non-penetrating deep sclerectomy (NPDS). In the control group (n=58), Nd:YAG laser goniopuncture was performed within 3.4±1.9 (1.5-6.7) months, and in the main group (n=56) - within 1.12±0.08 (0.9-1.5) months after the surgery. Ultrasound biomicroscopy (UBM) was used to evaluate the semiotics of trabecular-Descemet's membrane (TDM), intrascleral canal (ISC) and filtering bleb. The follow-up period was 5 years. RESULTS: According to UBM data, the thickness (0.10±0.009 mm) and density (50±6%) of TDM (p=0.0001) increased before LGP in the control group, the height of ISC decreased to 0.49±0.19 (0.20-0.40) (p=0.03), the height of UBM scan - to 1.49±0.05 (1.41-2.9) (p=0.0001); IOP (P0) was 18.48±4.7 (11.2-22.9) mmHg (p=0.001). In the main group before LGP, TDM thickness was 0.08±0.006 mm, density was 40±5%, and IOP (P0) was 15.7±4.1 (9.1-18.5) mm Hg. Complete hypotensive success was achieved in 83.6% of cases in the control group and 96.2% in the main group in 6 months; 68.07% and 92.59% in 12 months; 41.3% and 75.8% in 24 months; 15.25% and 48.93% in 36; 15% and 34.8% in 60 months after the surgery, respectively (p=0.0001, 95% confidence interval). CONCLUSION: TDM is an additional level of retention of aqueous humor and plays key role in the formation of outflow pathways after NPDS. Performing LGP in the early postoperative period is an effective and safe adjuvant option, which excludes the influence of TDM on the formation of aqueous humor outflow pathways and significantly increases the long-term hypotensive efficacy of non-penetrating deep sclerectomy.

[Role of immunological factors in the development of myopic choroidal neovascularization]. / Vliyanie immunologicheskikh faktorov na mekhanizmy formirovaniya miopicheskoi khorioidal'noi neovaskulyarizatsii.

AIM: To study the concentration of cytokines in the aqueous humor of the anterior chamber in patients with myopic choroidal neovascularization (mCNV) and to compare the results to their ophthalmic status. MATERIAL AND METHODS: A total of 19 patients (19 eyes) with mCNV treated with intravitreal ranibizumab were included in the study. The control group consisted of 15 patients (15 eyes) with myopia who had cataract surgery. Age, sex, and refractive error distribution were similar to that in the study group. All patients underwent a detailed ophthalmic examination as well as immunological study of the aqueous humor for cytokines concentrations using flow fluorometry (Bio-Plex Pro Human Cytokine Panel, 27-Plex, Bio-Rad Laboratories, USA). RESULTS: Significant differences in concentrations of 10 cytokines were found between the mCNV and study groups. Vascular endothelial growth factor (VEGF) level was twice as low in patients with mCNV as that in the controls (191.15±142.3 pg/ml and 320.06±170.05 pg/ml, respectively) (p<0.05). The other 9 cytokines were higher in mCNV, namely, platelet-derived growth factor (PDGF-BB), inflammatory and anti-inflammatory cytokines (IL-2, IL-15, IL-17А and IL-5, IL-13, respectively), tumor necrosis factor (TNFα), and chemokines (IL-8, RANTES). The degree of myopia as well as morphological and functional changes in the macular zone were shown to be in close correlation with cytokines involved in inflammation and VEGF. VEGF level appeared to be negatively related to axial eye length, refractive error, and three cytokines: IL-13, INF-γ, and RANTES. At the same time, numerous (6, 8 and more) close correlations were established between inflammatory and anti-inflammatory cytokines, chemokines, and growth factors. CONCLUSION: Patients with mCNV have been found to have higher than usual levels of inflammatory and anti-inflammatory cytokines, chemokines, and growth factors as well as a significantly decreased VEGF concentration. Immunological status of these patients differs from that in other ocular neovascular diseases suggesting possible involvement of alternative pathogenetic mechanisms.

[Intraocular cytokines imbalance in retinal vein occlusion and its impact on the efficacy of anti-angiogenic therapy].

AIM: To study the concentrations of intraocular cytokines in patients with retinal vein occlusion (RVO) before and after intravitreal ranibizumab injection and to compare the results with clinical activity of the disease and treatment efficacy. MATERIAL AND METHODS: A comprehensive ophthalmological examination of 44 patients with RVO and macular edema was performed. Intraocular fluid was first collected before the intravitreal injection. Cytokines concentrations were measured using Bio-Plex Pro Human Cytokine 27-plex Panel (Bio-Rad Laboratories, USA) for flow cytometry. The test was repeated 1 month after the injection. RESULTS: A total of 11 cytokines were reliably detected. After ranibizumab injections certain angiogenic (VEGF) and proinflammatory (IL-6, IL-8, IL-13, IL-15, MCP-1) factors appeared to be significantly suppressed. Clinical efficacy of the therapy correlated with the degree of cytokines suppression, which in turn depended on the severity of ocular involvement at baseline. CONCLUSIONS: Retinal vein occlusion pathogenesis involves a cascade of immune and inflammatory processes, including activation of not only VEGF but also quite a few inflammatory and chemotactic factors, whose activity depends on the extent of ischemic damage in the retina.

[Comprehensive assessment of risk factors for retinal vein occlusion and derivation of classification criteria for retinal ischemia].

OBJECTIVE: to perform a complex ophthalmological and general examination of patients with retinal vein occlusion (RVO) and to derive classification criteria for retinal ischemia. MATERIALS AND METHODS: A total of 44 patients with RVO and macular edema and 20 controls were enrolled. All patients underwent a thorough ophthalmological and general examination and clinical laboratory testing. RESULTS: Cardinal risk factors of RVO development were derived from among somatic illnesses and laboratory results. Regional hemodynamics assessment helped identify the most significant systolic and diastolic blood flow disturbances in the central retinal vein and central retinal artery circulation systems. Profound changes in electrophysiological parameters were found. Statistical analysis of the collected data allowed to identify 3 stages of retinal ischemia. CONCLUSION: The established risk factors of RVO development, regional blood flow impairment and original classification criteria for retinal ischemia make it possible to predict the course of the disease and treatment effect.

[Changes of intraocular cytokine level in patients with vascular and neovascular retinal pathology depending on pathologic process activity].

Cytokine and growth factors levels were estimated in anterior chamber humor of patients with different diseases manifesting with vascular and neovascular retinal changes and various pathologic process activity. 40 patients with macula edema, retinal and choroid neovascularization were examined. Process activity was determined based on data obtained using high-resolution optical coherence tomography and fluorescent angiography. Quantitative concentration of interleukine 6, 8, vascular endothelium growth factor and monocyte chemoattractive protein-1 in anterior chamber aqueous humor was measured using enzyme immunoassay. Increased level of cytokines studied was found in all forms of the diseases.

[Regularities of structural and functional visual system changes in patients with myopic refraction and presbyopia].

Two age groups of 57 patients with noncomplicated low or moderate myopia were examined to reveal the regularities of structural and functional visual system changes in patients with myopic refraction and presbyopia. Characteristics of visual impression, anatomic and physiologic parameters were studied. Presbyopia development in patients with myopic refraction was found to occur on the background of significant changes in anatomic proportions and optic parameters of the eye, decrease of functional capability of visual system and development of abnormal functional system of visual perception. The key mechanisms of presbyopia development in myopia besides the accommodation decrease are pupil dysfunction and binocular interactions disintegration i. e. all the near vision reflex components.

[Recovery of visual functions after multifocal intraocular lens implantation].

In order to study the features of visual system (VS) recovery after multifocal correction we examined in dynamics visual functions and subjective satisfaction with sight quality in 64 patients (mean age 52 +/- 2.5 years) at different time after binocular implantation of apodized refractive-diffractive intraocular lens (IOL) Acrysof Restor. These patients before surgery and 30 healthy subjects (60 eyes, mean age 48 +/- 4.5 years) served as controls. Over 6 months after surgery progressive improvement of mean visual acuity in the main distances (40, 70-80 cm and 5 m), contrast sensitivity and subjective satisfaction were observed. Gradual increasing of VS resolution suggests the need of search of postoperative rehabilitation methods that would provide faster adaptation to new optical conditions.

[Intravitreal ranibizumab for diabetic macula edema].

25 patients with diabetic macula edema (DME) treated with 0,5 mg intravitreal ranibizumab (Lucentis) were studied. Mean number of intravitreal injections was 1.7 (1-5 injections). Visual acuity improved from 0.29 +/- 0.03 to 0.36 +/- 0.04 after the 1st injection and to 0.38 +/- 0.04 after the last one (p < 0.001). Central retinal thickness reduced from 469 +/- 36.3 to 353 +/- 31.5 microm in a month after the 1st injection and was 346 +/- 30.3 microm after the last one (p < 0.05). No systemic or ocular adverse effects were observed. Intravitreal ranibitumab (Lucentis) leads to stabilization and improvement of visual acuity and reduction of DME. The procedure is a safe treatment option for DME.

[Regularities and mechanisms of visual perception transformation in presbyopia development].

66 healthy subjects were divided into 2 groups (mean age in the 1st group 18,6+/-0,4 years and 51,7+/-6,5 years in the 2nd group) to study regularities and mechanisms of presbyopia development. Visual pattern characteristics and anatomico-physiological parameters were studied using ultrasound biomicroscopy, electroretinography, ISCEV and visual evoked potentials. The most informative parameters for division of 2 groups are near visual point, fusion capacity in convergence, range of relative accommodation, binocular visual acuity, intraocular pressure, astigmatism, ciliary body thickness, A-wave amplitude on maximal ERG. Presbyopia development is accompanied with significant reorganization of visual analyzer activity, including binocular interaction. Surgical treatment of presbyopia should be supplemented with methods aimed to recover binocular interaction.

[Classification signs of end-stage pigmented retinitis].

Identification of objective criteria for early-stage pigmented retinitis (PR) remains urgent today. Visual system changes reflecting retinal metabolic and structural disturbances (a change in the time and amplitude parameters of ERG, an increase in dark adaptation, changes in the color palette and the thickness of layers of photoreceptors and pigment epithelium of the retina on the OST scans) were detected in 31% of the examined relatives of patients with PR. The authors show the diagnostic value of retinal optic coherent tomography in the diagnosis of PR and the expediency of its use for objective estimation of retinal structural changes along with functional studies. The statistical studies including descriptive, regression, and discriminant analyses have provided evidence that the characteristics of the visual system in patients with end-stage PR differ from those in the controls. Studies that can determine differences in the state of the visual system of the groups under study and significantly discriminate persons with the normally functioning visual system from patients with PR have been identified.

[Choice of optimal vegetotropic drug therapy in patients with chronic non-calculous cholecystitis combined with gallbladder dyskinesia]. / Vybor optimal'noi vegetotropnoi farmakoterapii u bol'nykh khornicheskim nekal'kuleznym kholetsitom v sochetanii s diskineziei zhelchnogo puzyria.

The group of 117 patients (58 male and 57 female, age from 17 to 54) with chronic non-calculous cholecystitis was examined. The control group included 54 practically healthy persons. The motor-evacuation function of gallbladder was estimated on dynamic ultrasonographic findings of biliary system sorbet. The character of the autonomic regulation was determined on the basis of variability parameters of the heart rhythm. The results of the repeated dynamic ultrasonography of biliary system with sorbet on a background of vegetotropic medications (Atropine, Propranolol, Metoclopramide) have demonstrated that the variability parameters of heart rhythm can be used for an estimation of the autonomic regulation type and can become the basis of vegetotropic pharmacotherapy choice for the patients with chronic non-calculous cholecystitis and biliary dyskinesia.

[A choice of optimal vegetotropic pharmacotherapy in patients with chronic non-calculous cholecystitis in combination with dyskinesia of the gallbladder]. / Vybor optimal'noi vegetotropnoi farmakoterapii u bol'nykh khronicheskim nekal'kuleznym kholetsistitom.

The group of 117 patients (58 male and 57 female, age from 17 to 54) with chronic non-calculous cholecystitis was examined. The control group included 54 practically healthy persons. The motor-evacuation function of gallbladder was estimated on dynamic ultrasonographic findings of biliary system sorbet. The character of the autonomic regulation was determined on the basis of variability parameters of the heart rhythm. The results of the repeated dynamic ultrasonography of biliary system with sorbet on a background of vegetotropic medications (Atropine, Propranolol, Metoclopramide) have demonstrated that the variability parameters of heart rhythm can be used for an estimation of the autonomic regulation type and can become the basis of vegetotropic pharmacotherapy choice for the patients with chronic non-calculous cholecystitis and biliary dyskinesia.

[Modern notions of regularities and mechanisms of formation of Frank-Kamenetskiy glaucoma]. / Sovremennye predstavleniia o zakonomernostiakh i mekhanizmakh formirovaniia glaukomy Frank-Kamentskogo.

Frank-Kamentsky glaucoma, a hereditary disease of the eyes, transmitted by female partners with X-linked type. It is accompanied by typical progressive lesions in the stroma and in the iridal pigment sheet at the background of goniodisgenesis. Males suffer from these diseases most frequently. Glaucoma develops in the 2-nd--3-rd decades of life. Its course resembles that of in course open-angle glaucoma. Megalocornea and goniodysgenesis are aggravating factors pre-disposing to glaucoma. Microsymptoms in the iris of female conductors can serve as a prognostic test in planning progeny.

[Formation of idiopathic macular holes]. / Zakonomernosti formirovaniia idiopaticheskikh makuliarnykh razryvov.

Sixty-eight patients (136 eyes) with idiopathic macular hole (IMH) were examined, using optic coherent tomography. 91% of these patients were women, mean age 66.6 years. Preholes were detected in 14 eyes, lamellar ruptures in 11, and perforating ruptures in 78 eyes. Specific functional and morphological changes in the retina, vitreous, and vascular membrane were detected. Three main mechanisms of IMH formation were distinguished. Conceptual scheme of the pathogenesis of this condition was developed and a new more complete pathogenetically justified classification of IMH is offered, which helps more objectively diagnose, predict the functional outcome, determine the treatment strategy, and evaluate the efficiency of surgery.