Междисциплинарный подход в диагностике и лечении макулярного отека, обусловленного тромбозом центральной вены сетчатки или ее ветвей

Abstract

Purpose. To present clinical cases of macular edema associated with central retinal vein thrombosis (CRVT) of various etiologies. Material and methods. A prospective study of patients with macular edema associated with thrombosis of the central retinal vein or its branches in real clinical practice was conducted. All patients underwent a standard ophthalmological examination, as well as optical coherence tomography (OCT), and a biochemical blood test was performed on a patient with suspected macroglobulinemia. Results. In the first clinical case, macular edema was associated with retinovasculitis. The patient was consulted by a rheumatologist, diagnosed with idiopathic dermatomyositis, polymyositis, confirmed seropositive form. A long-term regimen of glucocorticosteroid drugs (Prednisone), courses of lymphosorption was prescribed. Treatment was carried out for macular edema, occlusion of the central nervous system on the background of retinovasculitis: anti-VEGF therapy, retinal laser coagulation. In the second clinical case, macular edema on the background of CRV thrombosis associated with Waldenstrom's disease. It is recommended to monitor and treat the underlying disease with a hematologist. Conclusion. Thus, macular edema occurring against the background of thrombosis of the central nervous system and its branches, having atypical symptoms in the form of exudative retinal detachment, the presence of a bilateral process, young age and the absence of risk factors for the development of retinal vein occlusion, as well as resistance to anti-VEGF therapy requires careful collection of anamnesis taking into account the patient's somatic condition and the presence of other ophthalmological vascular pathology. Keywords: macular edema, retinovasculitis, Waldenstrom macroglobulinemia