[Current view on the issue of insufficient effectiveness of anti-VEGF therapy for age-related macular degeneration]. / Sovremennyi vzglyad na problemu nedostatochnoi effektivnosti antiangiogennoi terapii vozrastnoi makulyarnoi degeneratsii.

Due to the significant medical and social importance of neovascular (wet) age-related macular degeneration (wAMD), increasing the effectiveness of anti-VEGF therapy used to treat this disease is one of the high-priority problems in modern retinology. This article focuses on pathobiological aspects and clinical manifestations of incomplete responses to anti-VEGF therapy of wAMD, considers the proposed ways to improve the terminology and classification of responses to therapy, as well as the assessment of its correctness and effectiveness of the treatment. It also discusses the available ways to optimize anti-VEGF therapy and define the criteria of its termination in cases when the treatment proves to be futile.

[Anti-VEGF therapy for neovascular age-related macular degeneration: causes of incomplete response]. / Anti-VEGF-terapiya neovaskulyarnoi vozrastnoi makulyarnoi degeneratsii: prichiny nedostatochnoi effektivnosti.

Neovascular age-related macular degeneration (nAMD) is one of the leading causes of decreased vision in the elderly population in many countries, including Russia. Anti-VEGF therapy is undoubtedly the «gold standard¼ of treatment for the disease, but its use in different patients is known to produce results with significant interindividual differences. This article reviews modern ideas about the clinical assessment of the degree of response to anti-VEGF therapy, possible reasons for its insufficient effectiveness (clinical, pharmacological, or related to nAMD pathogenesis), discusses the potential applications of the existing therapeutic strategies, and considers the prospects for the emergence of new strategies that could be used for solving that problem.

[Anti-VEGF therapy of wet age-related macular degeneration: analysis of patients lost to follow-up]. / Antiangiogennaya terapiya «vlazhnoi¼ vozrastnoi makulyarnoi degeneratsii: analiz prichin otkaza patsientov ot posleduyushchego nablyudeniya.

Patients lost to follow-up (LTFU) are a well-recognized challenge, both in clinical trials and in real clinical practice. PURPOSE: To study the reasons for patients receiving anti-VEGF therapy for «wet¼ age-related macular degeneration (wAMD) in clinical environment to cease monitoring in the clinic. MATERIAL AND METHODS: This retrospective cohort study included patients with wAMD which received anti-VEGF therapy (ranibizumab, aflibercept) in the Ural State Medical University clinic from 2011 to 2019 (n=241). A subgroup of patients continuing treatment (n=90) was compared with a subgroup of lost to follow up patients (LTFU, n=151, 62.7%). Observation lasting less than 12 months was an exclusion criterion. Statistical analysis included a comparison of demographic and clinical data. The reasons for treatment discontinuation were determined using a phone survey. RESULTS: Characteristic for the LTFU subgroup were shorter duration of the follow-up (p<0.0001), lower number of intravitreal injections (p<0.0001), lower baseline (p<0.0001) and final best corrected visual acuity (p<0.0053) as well as higher values of therapy intensity coefficient (the ratio of the number of intravitreal injections to the duration of the follow-up, p<0.0001). According to the results of the phone survey, the following categories of LTFU were identified: ceased regular monitoring/treatment - 83 (55.0% of the LTFU subgroup), continued treatment in another clinic - 14 (9.3%), deceased - 18 (11.9%), status unknown - 36 (23.8%). The most common causes of LTFU were dissatisfaction with treatment results, financial burden and general comorbidities, which were named by 50, 27 and 17 respondents, respectively. CONCLUSION: In accordance with identified reasons for LTFU, we determined the directions for increasing the effectiveness of wAMD treatment: early diagnosis and start of treatment; using the most effective drugs and therapeutic regimens; increasing the availability of anti-VEGF therapy.

[Protocol of intravitreal drug delivery. Consensus of the Expert Counsil of Retina and Optic Nerve Diseases of the All-Russian Public Organasation «Association of Ophthalmologists¼]. / Protokol vypolneniya intravitreal'nogo vvedeniya lekarstvennykh preparatov. Konsensus Ekspertnogo soveta po zabolevaniyam setchatki i zritel'nogo nerva Obshcherossiiskoi obshchestvennoi organizatsii «Assotsiatsiya vrachei-oftal'mologov¼.

Intravitreal drug administration is a procedure that has become widespread in modern ophthalmology. However, there is no global consensus on certain aspects of this manipulation, and practitioners feel the need for guidelines. In the Russian Federation, until now, such a document was not available. The expert council on diseases of the retina and optic nerve of All-Russian public organization «Association of Ophthalmologists¼, with participation of invited specialists, has studied and analyzed the existing foreign guidelines for performing intravitreal injections, as well as the regulatory framework in Russia. As a result, this Protocol was developed and approved for use in the healthcare system of the Russian Federation. The document regulates the requirements for specialists and organizations, the conditions for performing the procedure and the necessary material resources and presents an algorithm for performing intravitreal drug administration, a patient examination check-list for various conditions of the procedure, as well as parameters for evaluating and monitoring the quality of the procedure.

[Long-term outcomes of anti-angiogenic therapy for macular neovascular disorders]. / Antiangiogennaya terapiya neovaskulyarnykh zabolevanii makulyarnoi oblasti (otdalennye rezul'taty).

AIM: to study long-term (≥2-year) RESULTS of ranibizumab treatment in patients with macular neovascular disorders. MATERIAL AND METHODS: The study group included 27 patients (mean age±SD of 66.7±13.8 years) treated with ranibizumab for approved indications. Follow-up period ranged from 24 to 58 months (34.5±9.1 months on average). RESULTS: Optical coherence tomography showed statistically significant improvements of functional and anatomical parameters, namely, an increase in visual acuity (from 0.34±0.20 to 0.57±0.24, p≤0.01) and a decrease in both central retinal thickness (from 372.26±96.21 µm to 272.48±69.70 µm, p≤0.01) and macular volume (from 8.01±1.46 mm3 to 7.10±1.08 mm3, p≤0.01). There was also a decreasing tendency of the average annual number of intravitreal ranibizumab injections per patient: 4.56 injections were done during the 1st year, 1.93 - during the 2nd year, and only 1.6 - during the 3rd year of follow-up. A total of 29.6% of patients showed no need in resuming the treatment at year 2 and 40.0% - at year 3. Exudation from the neovascular membrane relapsed in 24 patients (88.9%) at some time during the follow-up; at that, in 74.1% of patients the injection-free intervals lasted from 6 to 36 months. None of the 231 injections was associated with any complications concerning ocular functions and morphology and requiring additional treatment. No correlation was found between the anti-angiogenic therapy and the progression of cardiovascular disease. CONCLUSION: Intravitreal ranibizumab has been proved effective and safe for the treatment of neovascular macular disorders. Moreover, flexible dosing schemes for ranibizumab contribute to rapid (during the 1st year already) and stable clinical benefits.

[The influence of patient compliance with antiangiogenic therapy on its efficacy for neovascular age-related macular degeneration].

PURPOSE: To study the level of patient compliance with Ranibizumab therapy and affecting factors. MATERIAL AND METHODS: Medical records of 76 patients aged from 50 to 86 years (mean age 70.7 +/- 9.5 years) who underwent Ranibizumab treatment for neovascular age-related macular degeneration (AMD) during 2010-2014 were used. Demographic data, visual acuity, optical coherence tomography results were analyzed. Surgical interventions, regularity of postoperative follow-up and its outcomes were also taken into consideration. RESULTS: The results showed high efficacy and safety of Ranibizumab therapy, though patient adherence varied significantly during the treatment course. More than 90% of patients demonstrated strong adherence to treatment in the phase of stabilization. During the follow-up period on a monthly basis and in the phase of maintenance therapy the level of compliance was 48.6% and 63.2% correspondingly. It is found that patient adherence depends on the duration of treatment, visual acuity of the contralateral eye, and functional results of the initial stage of the treatment (phase of stabilization). Four clinical examples are provided to illustrate the correlation between treatment efficacy and compliance. CONCLUSION: Patient compliance with Ranibizumab antiangiogenic therapy for neovascular AMD improves its efficacy, ensuring maximum increase of visual acuity in the phase of stabilization and functional stability in the phase of maintenance therapy. Monthly performed follow-up allows early detection of disease recurrence and timely recommencement of the treatment.

[Complex diagnosis of fragment injuries of the eye and orbit].

The paper presents data on the prevalence and pattern of fragment injuries of the eye and orbit in the Sverdlovsk Region in 2000-2004. It describes the authors' system for complex diagnosis of metallic foreign bodies, which is based on the wide use of electron location in combination with other clinical, instrumental, and special studies. The comparative results of treating patients with the standard and proposed system, which demonstrate the advantages of the latter in small-sized fragments in particular, are given.