Active ROP Research Articles

Эволюция транспупиллярной лазерной коагуляции сетчатки в лечении активной ретинопатии недоношенных: от режима одиночного импульса до навигационного сопровождения

Abstract Evolution of transpupillary laser coagulation of the retina in the treatment of active retinopathy of prematurity: from single pulse mode to navigational support A.V. Tereshchenko, I.G. Trifanenkova, Yu.A. Sidorova, V.V. Firsova, V.V. Shaulov S. Fyodorov Eye Microsurgery Federal State Institution, Kaluga branch, Kaluga, Russian Federation K.E. Tsiolkovski Kaluga State University, Kaluga, Russian Federation Purpose. To present the development stages and results of 18 years of experience in laser technologies application for the treatment of premature infants with active ROP in the Kaluga branch of S. Fyodorov Eye Microsurgery Federal State Institution. Material and methods. Transpupillary laser coagulation of the retina (LCR) was performed in 1583 children (2537 eyes) with active ROP for the period from 2004 to 2021. LCR was carried out with various stationary laser ophthalmocoagulators. Stages 2 and 3 of active ROP with an unfavorable disease course, stage of early clinical manifestations, manifestation of aggressive posterior ROP were indications for laser treatment. Results. Transpupillary LCR began to be performed for children with active ROP with a stationary ophthalmic coagulator for the first time in Kaluga branch of the S. Fyodorov Eye Microsurgery in 2004. The technology of patterned LCR in active ROP was applied for the first time at domestic and international clinical practice, in the Kaluga branch of Eye Microsurgery in 2009. Pattern LCR began to be performed on the Integre Pro Scan device in 2016. Pattern with the most dense and uniform arrangement of laser applications – hexagonal – was identified. In 2021 transpupillary LCR of the avascular zone of the retina was performed in automatic mode with navigation support on the Navilas 577s laser system. It was possible to perform LCR of the avascular zone of the retina up to the dentate line in all cases. Regression of disease was achieved in 100% of cases. Conclusion. Evolution of laser technologies and the experience of their use demonstrate the high efficacy, safety and predictability of the results of laser treatment of active ROP. Modern pattern laser techniques are highly effective, safe, dosed and tissue-saving, which can serve as the basis for standardization of retinal laser coagulation technology in the treatment of active ROP. Key words: retinopathy of prematurity, unfavorable type of course, laser coagulation of the retina, hexagonal pattern, navigation system

Suppressing a mitochondrial calcium uniporter activates the calcium signaling pathway and promotes cell elongation in cotton

Mitochondrial calcium uniporter (MCU) is a conserved calcium ion (Ca2+) transporter in the mitochondrial inner membrane of eukaryotic cells. How MCU proteins regulate Ca2+ flow and modulate plant cell development remain largely unclear. Here, we identified the gene GhMCU4 encoding a MCU protein that negatively regulates plant development and fiber elongation in cotton (Gossypium hirsutum). GhMCU4 expressed constitutively in various tissues with the higher transcripts in elongating fiber cells. Knockdown of GhMCU4 in cotton significantly elevated the plant height and root length. The calcium signaling pathway was significantly activated and calcium sensor genes, including Ca2+ dependent modulator of interactor of constitutively active ROP (GhCMI1), calmodulin like protein (GhCML46), calcium-dependent protein kinases (GhCPKs), calcineurin B-like protein (GhCBLs), and CBL-interacting protein kinases (GhCIPKs), were dramatically upregulated in GhMCU4-silenced plants. Metabolic processes were preferentially enriched, and genes related to regulation of transcription were upregulated in GhMCU4-silenced plants. The contents of Ca2+ and H2O2 were significantly increased in roots and leaves of GhMCU4-silenced plants. Fiber length and Ca2+ and H2O2 contents in fibers were significantly increased in GhMCU4-silenced plants. This study indicated that GhMCU4 plays a negative role in regulating cell elongation in cotton, thus expanding understanding in the role of MCU proteins in plant growth and development.

Интраоперационная индукция задней отслойки стекловидного тела без окрашивания задней гиалоидной мембраны как этап хирургического лечения витреоретинальной патологии

Purpose. To develop a technology for intraoperative induction of posterior vitreous detachment without staining the posterior hyaloid membrane and evaluate its clinical effectiveness. Material and methods. The study included 10 premature infants (18 eyes) with stages 3 (8 eyes) and 4a (10 eyes) of active ROP and 70 adult patients (70 eyes) with primary penetrating macular holes, 48 of them with medium (diameter 250–400 µm) and 22 large holes (more than 400 µm in diameter). According to the indications, all patients underwent vitreoretinal surgery using the technique of intraoperative induction of posterior vitreous detachment (PVD) developed in the Kaluga branch of the S. Fyodorov Eye Microsurgery Federal State Institution. A vitreotome is used, while dyes are not used during vitreoretinal surgery. Results. It was possible to initiate the posterior vitreous detachment intraoperatively without the use of dyes and additional instruments for all patients included in the study. There were no complications at this stage of the operation in any case. In children with active ROP, posterior vitreous detachment was induced using the tip of a vitreotome, the posterior hyaloid membrane was separated from the adjacent retina almost along its entire length, and the maximum removal of the vitreum was performed. This was achieved in all 18 eyes. In adult patients with macular rupture after successful induction of posterior vitreous detachment, in all 70 cases it was possible to perform the operation completely, with the formation of the inner limiting membrane flap and the closure of the macular rupture. Conclusion. The developed technique for intraoperative induction of posterior vitreous detachment is effective in separating the posterior hyaloid membrane and posterior cortical layers of the vitreous body from the retina, reduces the duration and trauma of the operation, does not require special instruments or dyes, and can be successfully used as the initial stage of vitreoretinal operations to create access to the subsequent stages of surgery treatment. Key words: induction of posterior vitreous detachment, retinopathy of prematurity, macular rapture

Ophthalmological follow-up of premature children in St. Petersburg

Premature newborns have a high risk of developing visual impairments. This study presents the experience of an organization dispensary ophthalmological observation as a stage of providing medical care to premature children in St. Petersburg and the prospects for its development.
 AIM: To analyze the effectiveness of the organizational model of dispensary ophthalmological observation of premature children in St. Petersburg for 20202022.
 MATERIAL AND METHODS: Reporting forms of the activities of interdistrict ophthalmological cabinet and reporting forms of medical and social expertise of Rosstat No. 7D were used.
 RESULTS: In 2010, a system of specialized ophthalmological care for premature infants at the hospital stage was organized in St. Petersburg (screening and laser treatment of active ROP using telemedicine technologies; surgical treatment of late disease stages). In 2018, for the subsequent dispensary observation of premature children aged up to 3 years, six inter-district ophthalmological cabinets of follow-up were organized. A developed routing scheme for children at risk and with active and cicatricial ROP in St. Petersburg and preliminary results of ROP incidence were presented.
 CONCLUSION: The activities of specialized inter-district follow-up cabinets primarily ensure continuity between hospital and outpatient services in the dynamic monitoring of children at risk and children with active ROP. In addition, professional competencies allow ophthalmologists to avoid mistakes in diagnosing the stage, monitoring the ROP course, and promptly referring patients for emergency treatment (laser or anti-VEGF therapy).

Features of the Foveal Avascular Zone in Children with Active Retinopathy of Prematurity According to Optical Coherence Tomography in Angio Mode

The purpose — to study the features of the foveal avascular zone (FAZ) in children with active retinopathy of prematurity according to the data of optical coherence tomography in angio-mode.Patients and methods. OCT-A was performed on 37 premature infants (37 eyes) with active ROP: at stages 1–2 — in 14 eyes (8 — with a favorable current type, 6 — with an unfavorable current), at stage 3 — in 16 eyes (6 — with a favorable type, 10 — with unfavorable), with aggressive posterior ROP — in 7 eyes (4 — at the stage of early clinical manifestations, 3 — at the stage of manifestation). Patients with stages 1 and 2 of active ROP were combined into one group due to similar findings. The control was the data of OCT-A performed on 10 premature infants without signs of ROP.Results. At 1–2 stages with a favorable type in children with a somatic state of moderate severity in the FAZ area, statistically significant differences in comparison with the control parameters were not determined. In children with a severe condition, FAZ was significantly expanded, which was accompanied by a significant decrease in the density of capillaries in the fovea. With an unfavorable type, a significant decrease in the size of the FAZ was noted, as well as a slight decrease in the density of the capillaries of the superficial plexus in the fovea. At stage 3 with a favorable type, an expansion of the FAZ, a decrease in the density of capillaries in the fovea in the superficial and deep plexus were recorded, and the values of the density of capillaries in the parafovea were slightly increased. At 3 stages with an unfavorable course in children born at a gestational age of 29–32 weeks, the FAZ was expanded. In children born at a gestational age of 25–28 weeks, a significant decrease in the size of the FAZ was recorded in comparison with children with a long gestation period, as well as those with a favorable course of stage 3. At the stage of early clinical manifestations of the posterior aggressive ROP, the FAZ was absent; vessels grew into it, which formed shunts and zones of intraretinal neovascularization in the form of “tangles”. At the stage of manifestation of the posterior aggressive ROP, a gross violation of the architectonics of the microvasculature was determined. As at the stage of early clinical manifestations, FAZ was absent; shunt vessels grew into it.Conclusion. The OCT method in angio-mode has showed high information content in studying the features of the foveal avascular zone in children with various forms, stages and types of active ROP. The characteristics of FAZ with an unfavorable type of the disease are of the greatest value for clinical practice. Their identification at the early stages of the pathological process will make it possible to timely determine the correct tactics and carry out the necessary treatment.

Навигационная лазерная коагуляция сетчатки при активной ретинопатии недоношенных: новый взгляд на старую проблему

Purpose.To demonstrate the possibilities and determine the specific features of navigational transpupillary laser coagulation of the retina in children with active stages of retinopathy of prematurity. Material and methods. Navigational transpupillary laser coagulation of the retinal avascular zones (LC) was performed in 9 premature infants in the active ROP with an unfavorable type in 18 eyes, of which 2nd stage of the disease was diagnosed in 10 eyes, 3rd stage with epiretinal neovascularization in the projection of the extraretinal proliferation ridge – in 8 eyes. Laser treatment in all cases was carried out transpupillary on the NAVILAS 577s laser system (OD-OS, Germany) using a pediatric corneal contact panfundus lens. Results. In result of the navigation LC in children with active ROP stages regression of the disease was achieved in all cases, the required amount of laser coagulation was performed in one session, in the avascular zone of the retina, regardless to the localization of the pathological process, while the implemented treatment plan fully corresponded to preoperative planning. Conclusion. The presence of navigation support for laser interventions allows for effective, safe and dosed treatment for patients with active ROP. Keywords: retinopathy of prematurity, retinal laser coagulation, automated navigation laser system

Microtubule-associated ROP interactors affect microtubule dynamics and modulate cell wall patterning and root hair growth.

Rho of plant (ROP) proteins and the interactor of constitutively active ROP (ICR) family member ICR5/MIDD1 have been implicated to function as signaling modules that regulate metaxylem secondary cell wall patterning. Yet, loss-of-function mutants of ICR5 and its closest homologs have not been studied and, hence, the functions of these ICR family members are not fully established. Here, we studied the functions of ICR2 and its homolog ICR5. We show that ICR2 is a microtubule-associated protein that affects microtubule dynamics. Secondary cell wall pits in the metaxylem of Arabidopsis icr2 and icr5 single mutants and icr2 icr5 double mutants are smaller than those in wild-type Col-0 seedlings; however, they are remarkably denser, implying a complex function of ICRs in secondary cell wall patterning. ICR5 has a unique function in protoxylem secondary cell wall patterning, whereas icr2, but not icr5, mutants develop split root hairs, demonstrating functional diversification. Taken together, our results show that ICR2 and ICR5 have unique and cooperative functions as microtubule-associated proteins and as ROP effectors.

Ключевые флюоресцентно-ангиографические признаки благоприятного и неблагоприятного типов течения активной ретинопатии недоношенных

Purpose. To determine the crucial fluorescence-angiographic features of favorable and unfavorable types of active retinopathy of prematurity and evaluate their prognostic informational value. Material and methods. Fundus fluorescence angiography (FFA) was performed by 180 premature infants (180 eyes). The children had 1st–3rd stage of active ROP. The age of gestation of the children was 24–34 weeks. A birth weight of the children was 560–2150 g. By the time of the study the age of the children was 3–14 weeks. This age corresponded to 30–38 weeks of postconceptual age (PCA). The stage and type of the pathological process was determined by using a comprehensive ophthalmological examination, which included reverse ophthalmoscopy, digital retinoscopy and morphometry. Children were admitted to FFA procedure in a stable somatic state, without pathology of renal and hepatic metabolism, after setting a test to determine the sensitivity to the drug. The evaluation of the prognostic information content of the revealed features of FFA in relation to the type of disease course was performed. Statistical processing of the research results was carried out by using the Statistica 13.3 program (Tibco Software Inc., USA). Results. During of the study, pathological fluorescence-angiographic features were identified and studied. These features were conditionally divided into 3 groups depending on the location on the fundus: near the border with the avascular retina, in the avascular retina, in the vascularized retina. It has been shown that the unfavorable course of the 1st–3rd stage of active ROP is distinguished by a much wider variety of fluorescence-angiographic phenomena and their more pronounced intensity (frequency of occurrence) in comparison with the favorable course of active ROP. On the basis of a comprehensive statistical analysis, the most informative fluorescence-angiographic features for the prognosis of the type of active ROP were determined: increased vascular tortuosity near the border with the avascular retina, zones of capillary nonperfusion in the vascularized retina, multiple foci of local neovascularization in the vascularized retina. Conclusion. Clinical use of a fluorescence angiographic study of the fundus of patients with ROP with the determination of crucial prognostic features of favorable and unfavorable types in the early stages of the disease will contribute to early treatment of this severe retinal pathology in premature infants and consequently, its favorable outcome. Key words: fluorescence angiography, retinopathy of prematurity, prognosis

Magnesium Promoted Active and Isoselective ROP of rac‐Lactide and ϵ‐Caprolactone Under Mild Conditions

AbstractA novel amidophosphine sulfur‐supported magnesium complex, [Ph2P(S)NCH2CH2N−(CH2CH2)O]Mg(C4H9)(THF)] (2) enabling efficient ring‐opening polymerization of rac‐lactide (LA) and ϵ‐caprolactone (CL) is disclosed. Achieved incredible selectivity for ROP of rac‐lactide for the first time using a magnesium catalyst affording isoselective PLA with a Pi value of 0.77. The polymerization of rac‐LA as well as ϵ‐CL proceeded under mild reaction conditions in absence of any external initiator, to yield corresponding polyesters with a great control over the molecular weight. The kinetic studies reveal that both sulfur and magnesium centers simultaneously work together to drive high yield and selectivity.

Показания к первичной витрэктомии в лечении 3-й активной стадии ретинопатии недоношенных

Purpose is to determine the indications and evaluate the results of primary vitrectomy at 3rd stage of active ROP with an unfavorable type. Material and methods. A retrospective analysis of multimodal diagnostics was carried out in 16 premature infants from 2016 to 2019 who were treated with a diagnosis of 3rd active stage ROP, in which, due to the progression of the pathological process after transpupillary laser coagulation of the retina, vitreoretinal surgery was required during the period. In 2021, 3 patients (5 eyes) with an unfavorable type of 3rd active stages of ROP and confirmed extraretinal retinovitreal neovascularization underwent primary vitrectomy. Results. According to the results of a retrospective analysis, it was revealed that extraretinal retinovitreal neovascularization is a predictor of the development of retinal detachment. It is this clinical sign that indicates that transpupillary laser coagulation of the retina will be ineffective and will not lead to stabilization of the process, therefore, primary vitrectomy will be a pathogenetically justified treatment in such cases. Based on the data obtained in the type of a retrospective study in 2021, 3 patients with an unfavorable type of 3rd active stage ROP and confirmed extraretinal retinovitreal neovascularization underwent primary vitrectomy. After 3–6 months after the operation, the pathological process stabilized, the retina was completely attached, continued growth of vessels into the previously avascular zone of the retina was observed. Conclusion. To date, the search for a clear correspondence between a pathogenetically substantiated method of treatment and the timing of its implementation of the stage of the pathological process of ROP remains relevant. Extraretinal retinovitreal neovascularization according to multimodal preoperative diagnostics indicates the need for vitreretinal surgery as a pathogenetically substantiated method of treatment for 3rd active stage ROP. Keywords: retinopathy of prematurity, active stage, primary vitrectomy, transpupillary laser coagulation of the retina, early vitreous surgery.

Исходы самопроизвольного регресса благоприятного типа течения ретинопатии недоношенных

Purpose. To analyze the structural changes in the fundus of the eye of children as a result of spontaneous regression of a favorable course of stages 1, 2 and 3 of active retinopathy of prematurity. Material and methods. There were 38 children with a favorable course of active ROP. The first stage of the disease was detected in 26 eyes, the second in 39, and the third stage in 11 eyes. All children underwent a comprehensive ophthalmological examination upon reaching the age of 6 months. Twenty-six of these children (22 cases at the outcome of stage 1, 23 at stage 2, 4 at stage 3) underwent annual follow-up examinations when they reached the age of 1 to 4 years. At the age of 6 months, incomplete retinal vascularization was detected at any stage of the disease: in patients who underwent stage 1 ROP in 46.1 % of cases, stage 2 – in 79.5 % of cases. At the 3rd stage of ROP, the completion of complete vascularization of the retina up to the dentate line occurred only in 2 cases (18.2 %). Results. In the children who were observed in the age period of 1–4 years, the previously identified avascular zone was preserved on the periphery of the fundus. According to SOCT data of the peripheral parts of the retina in the first and second stages of ROP, areas of local compaction of the inner limiting membrane were detected in 9.1 % and 8.7 % of cases, respectively. At the end of the 3rd stage, areas of local epi- and preretinal fibrosis were determined in 42.8 % of cases. Conclusion. All children with retinopathy of prematurity, regardless of the type of course, should undergo regular ophthalmological examination, paying special attention to the condition of the peripheral parts of the retina in order to timely detect distant vitreoretinal complications. Keywords: retinopathy of prematurity, spontaneous regression.

Changes in the microvasculature with active retinopathy of prematurity as evidenced by OCT angiography

Purpose: to evaluate the degree of structural lesions of the microvasculature, depending on the stage and type of active ROP with optical coherence tomography (OCT) in angio-mode (OCTA). Material and methods. 63 premature infants (63 eyes) with active ROP were tested by OCT of the retina, of which 30 were tested by OCTA. Additionally, 10 premature infants (10 eyes) without signs of ROP were tested by OCTA. We assessed the area and perimeter of the foveal avascular zone (FAZ), the thickness of the retina in the fovea, the density of the superficialand deep plexuses in the fovea and parafovea, the presence or absence of intraretinal, epiretinal and retinovitreal neovascular complexes. Results. We revealed gross structural and microvascular retinal pathology in children with ROP, which was more pronounced in children with an unfavorable course of the disease. Of these, the most affected were children with a shorter gestational period, i. e , more immature. In children with a favorable type of ROP course, a severe general condition has a serious impact on the child’s microvasculature state. The analysis of the correlation dependences of OCTA on the gestational age, stage and type of active ROP, showed a strong direct correlation between the retinal thickness in the fovea, the density of superficial plexus vessels in the fovea, the area and perimeter of the FAZ, on the one hand, and the course of the disease, which is crucial for the correct choice of management and treatment tactics. Conclusion. The OCTA data allow an objective assessment of the severity of the changes in the retinal vasculature, including its microcirculatory component. The data effectively supplement the clinical picture and help identifying the progressive course o f active ROP at the earliest stages of the pathological process, thereby contributing to timely treatment and good clinical and functional results.

The cellular function of ROP GTPase prenylation is important for multicellularity in the moss Physcomitrium patens.

A complete picture of how signaling pathways lead to multicellularity is largely unknown. Previously, we generated mutations in a protein prenylation enzyme, GGB, and showed that it is essential for maintaining multicellularity in the moss Physcomitrium patens. Here, we show that ROP GTPases act as downstream factors that are prenylated by GGB and themselves play an important role in the multicellularity of P. patens. We also show that the loss of multicellularity caused by the suppression of GGB or ROP GTPases is due to uncoordinated cell expansion, defects in cell wall integrity and the disturbance of the directional control of cell plate orientation. Expressing prenylatable ROP in the ggb mutant not only rescues multicellularity in protonemata but also results in development of gametophores. Although the prenylation of ROP is important for multicellularity, a higher threshold of active ROP is required for gametophore development. Thus, our results suggest that ROP activation via prenylation by GGB is a key process at both cell and tissue levels, facilitating the developmental transition from one dimension to two dimensions and to three dimensions in P. patens.

Лазерные методы лечения активной ретинопатии недоношенных: от режима одиночного импульса до навигации

Purposе. Тo present the stages of development of laser technologies for the treatment of active retinopathy of prematurity at the S. Fyodorov Eye Microsurgery Federal State Institution, the Kaluga Branch. Material and methods. Transpupillary laser photocoagulation of the retina was performed in 1546 children (2523 eyes) with active ROP from 2004 to 2021. Laser coagulation of the retina was carried out on various stationary laser ophthalmocoagulators acting in green and yellow spectra with a wavelength of 532 nm, 561 nm and 577 nm. Indications for laser treatment were the 2 nd and the 3 rd stage of the disease with an unfavorable course, the stage of early clinical manifestations, and the stage of manifestation of aggressive posterior ROP. Results. As the technology of retinal laser photocoagulation improved in patients with active ROP, the efficiency naturally increased and the duration of laser treatment decreased. Currently, the effectiveness of transpupillary laser coagulation of the retina using a hexagonal pattern has made it possible to achieve regression of the disease at the 2 nd stage with an unfavorable course in 100 % of cases, at the 3 rd stage with an unfavorable course type – in 97 %. The time for laser coagulation of the retina for the 2 nd stage was 6 ± 2 minutes, for the 3 rd stage it was 8 ± 3 minutes. Navigation assisted laser coagulation of the retina is the latest trend in laser treatment of active ROP. Conclusion. Permanent improvement of laser ophthalmocoagulators and the introduction of new methods of laser coagulation into clinical practice determine their continuous progress in achieving the maximum percentage of regression of active ROP with a minimum duration of the treatment session. Keywords: retinal laser photocoagulation, retinopathy of prematurity, ophthalmocoagulator.

Хирургическое лечение ретинопатии недоношенных: исторический экскурс

Purpose. Тo study the change in approaches to surgical treatment of ROP in the historical aspect. Large-scale multicenter researches have begun in the world to study the mechanism of ROP development since 1951. For decades, knowledge about the pathogenesis of ROP has been expanded, confirmed in practice, and since the 80 s of the last century, the development of various methods for the treatment of active ROP, depending on the stage of the disease, has begun. It has been proven that cryo- and laser retinopexy of the avascular peripheral retina is an effective method of stabilizing the pathological process in the active stages. With the accumulation of experience, it became obvious that if after laser treatment it was not possible to achieve regression of the disease, and objective markers of its further progression are determined, then expectant tactics does not make sense. The search for a clear correspondence between a pathogenetically substantiated method of treatment and the timing of its implementation to the stage of the pathological process of ROP remains relevant nowadays. Conclusion. The history of the surgical treatment of ROP is the way of the development of knowledge about this disease. Currently, a promising direction in the management of patients with active PH is to shift the timing of treatment to earlier stages. Keywords: retinopathy of prematurity, surgical treatment, vitrectomy.

Гемодинамические показатели в центральной артерии сетчатки при активной ретинопатии недоношенных и их соотношение с центральной веной сетчатки

Purpose. To analyze the main hemodynamic parameters in the central retinal artery, as well as their relationship with hemodynamic indicators in the central retinal vein, depending on the stage and type of active ROP with the use of color duplex scanning. Material and methods. The 63 premature babies with various stages of active ROP and no signs of ROP were included in the study. The 55 children with active ROP included in the study were distributed according to the stages and type of disease course. All children were at the same gestational age at the time of examination – 37–38 weeks of postmenstrual age or at 6–11 weeks of life. For all these children were performed color duplex scanning of the vessels of the eye and orbit in the modes of color Doppler mapping and pulsed Doppler. Results. The study of the hemodynamic features of the central retinal artery in premature infants with active ROP showed that the progression of the disease was accompanied by a significant increase in blood flow velocity (Vsyst and Vdiast) with each subsequent stage of ROP. A higher index of peripheral vascular resistance is recorded in comparison with the non-progressive favorable type for children with an unfavorable course of the disease.The analysis of the ratio of the maximum blood flow velocities in the central retinal artery and central retinal vein made it possible to determine in which of the vessels the hemodynamic changes are most pronounced, depending on the stage and form of active ROP. Conclusion. Thus, there are statistically significant changes in such large vessels of the retinal bed as the central retinal artery and central retinal vein during active ROP. Color duplex scanning, having a significant diagnostic potential in assessing hemodynamic parameters, made it possible to obtain reliable information about the linear blood flow velocity and the state of peripheral resistance in the central retinal artery and their relationship with the central retinal vein. This information opens up prospects for improving the accuracy of predicting the nature of the course of the disease, especially i n the early stages. Keywords: color duplex scanning, active retinopathy of prematurity, hemodynamic parameters, central retinal artery, central retinal vein

Application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity

AIM: To conduct a retrospective study of the application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity in Ural State children`s ophthalmological center at State Autonomic Health Institution of the Sverdlovsk Region Multiprofile Clinical Medical Center BONUM in Yekaterinburg.
 MATERIAL AND METHODS: The study included 17 patients (33 eyes). The gestation age was from 23 to 30 weeks (mean: 26.51.7 weeks), birth weight was from 600 to 1850 g (mean: 867229 g). 8 patients (47%) had APROP, and 9 patients (53%) had ROP stage III, type 1, plus disease. Laser coagulation of the avascular areas of the retina as the start in ROP therapy was performed in three patients with APROP (4 eyes, 12.1%). Intravitreal injection of the anti-VEGF ranibizumab was performed in 17 patients (33 eyes), including patients with previous laser coagulation. The age of the patients at the time of injection was from 7.7 to 15.6 weeks (10.51.9 weeks), PCA from 32.3 to 39.6 weeks (37.01.8 weeks). Patients with stage IVa ROP (5 patients, 6 eyes) underwent 25G or 27G lens sparing vitrectomy.
 RESULTS: As a result of the complex treatment of ROP, the following results were obtained: complete regression in 13 patients (28 eyes, 84.8%). Partial regression in two patients (2 eyes, 6.1%). ROP progression to stage V in two patients (3 eyes, 9.1%).
 CONCLUSION: Complex treatment of severe stages of active ROP with laser treatment, IVI injections, ranibizumab, and vitrectomy made it possible to preserve vision in 90.9% of patients.

Первый опыт применения ингибитора фактора роста эндотелия сосудов ранибизумаб в комплексной терапии ретинопатии недоношенных в УРФО в ГАУЗ СО МКМЦ «Бонум»

Material and methods. The study included 16 patients (31 eyes). Types and terms of treatment. Stage I in the treatment of ROP, laser coagulation of the avascular areas of the retina was performed in three patients with aggressive posterior ROP (4 eyes, 12.9%). In all patients, the progression of the disease was noted. Intravitreal injection of ranibizumab was performed in the period from 8 to 16 weeks (10.5±2.0 weeks), PCV from 32.3 to 39.6 weeks (37.0±1.8 weeks). Result. After laser treatment and IVI of ranibizumab, 11 patients (31 eyes, 81.6%) showed regression of the disease. In 5 patients (6 eyes, 19.4%) - progression. If the ROP progressed, a 25G or 27G lenssparing vitrectomy was performed. Complete regression of ROP was achieved in one patient (1 eye, 16.7%). Partial regression was observed in two patients (2 eyes, 33.3%). In two patients (3 eyes, 50%), the disease progressed to stage 5 with the development of total retinal detachment. Conclusion. As a result of the complex treatment of severe forms of the active stage of retinopathy of prematurity in the regional children's ophthalmological center MKMC "Bonum" in Yekaterinburg, the following data were obtained: complete regression with retinal adhesion is observed in 12 patients (26 eyes, 83.4%), of which in one patient (1 eye, 3.2%) regression was achieved after vitrectomy. Partial regression with the formation of a peripheral retinal detachment after vitrectomy was achieved in two patients (two eyes - 6.5%). Progression of retinopathy of prematurity to stage V with the development of total retinal detachment in two patients (3 eyes, 9.6%). Complex treatment of severe stages of active ROP using laser treatment, IVI and vitrectomy allows to preserve vision in 90.4% of patients. Key words: retinopathy of prematurity; intravitreal injection; laser coagulation of the retina; vitrectomy.

Математическое обоснование паттерновой лазерной коагуляции сетчатки с использованием гексагональной формы паттерна в лечении активных стадий ретинопатии недоношенных

Purpose. To substantiate mathematically the tissue-preserving effect on the retinal hexagonal pattern during the laser treatment of active retinopathy of prematurity. Material and methods. At the first stage of the study, a mathematical rationale of the application of a hexagonal pattern was carried out to provide a tissue-sparing effect on the retina compared to the traditional laser coagulation pattern with matrix (rectangular) patterns.The second stage was performed as clinical studies in two groups of patients with an unfavorable course type II and III stages of active ROP. The main group consisted of 44 infants, which underwent hexagonal Fyodorov Journal of Ophthalmic Surgery. 2020;1: 40–46.laser coagulation (7 applications in one «honeycomb» pattern). The control group involved 41 infants who had a matrix laser coagulation (9 applications in one «rectangular» pattern). Results. At the first stage, it was proved that the hexagonal shape of the pattern is mathematically substantiated and ensures a uniform distribution of laser applicates on the spherical surface of the retina due to the equidistant location of the spots inside one pattern and optimal matching of neighboring patterns.As a result of the second stage of research in both groups, a regression after laser treatment was obtained in more than 97% of cases at the ROP stage 2 and in 94% of cases at the ROP stage 3. The total energy load in the main group was less than in the control group. The increase in the inter-spot distance in the hexagonal pattern by 0.25 of the coagulum diameter in comparison with the matrix pattern made it possible to maintain a high clinical efficacy and to ensure tissue-preserving effects on the retina. Conclusion. Optimization of the pattern laser coagulation method using a hexagonal-shaped pattern allows to shorten the duration of the intervention maintaining a high clinical efficacy in the treatment of active ROP.

Exocytosis and endocytosis: coordinating and fine-tuning the polar tip growth domain in pollen tubes.

Pollen tubes rapidly elongate, penetrate, and navigate through multiple female tissues to reach ovules for sperm delivery by utilizing a specialized form of polar growth known as tip growth. This process requires a battery of cellular activities differentially occurring at the apical growing region of the plasma membrane (PM), such as the differential cellular signaling involving calcium (Ca2+), phospholipids, and ROP-type Rho GTPases, fluctuation of ions and pH, exocytosis and endocytosis, and cell wall construction and remodeling. There is an emerging understanding of how at least some of these activities are coordinated and/or interconnected. The apical active ROP modulates exocytosis to the cell apex for PM and cell wall expansion differentially occurring at the tip. The differentiation of the cell wall involves at least the preferential distribution of deformable pectin polymers to the apex and non-deformable pectin polymers to the shank of pollen tubes, facilitating the apical cell expansion driven by high internal turgor pressure. Recent studies have generated inroads into how the ROP GTPase-based intracellular signaling is coordinated spatiotemporally with the external wall mechanics to maintain the tubular cell shape and how the apical cell wall mechanics are regulated to allow rapid tip growth while maintaining the cell wall integrity under the turgor pressure. Evidence suggests that exocytosis and endocytosis play crucial but distinct roles in this spatiotemporal coordination. In this review, we summarize recent advances in the regulation and coordination of the differential pectin distribution and the apical domain of active ROP by exocytosis and endocytosis in pollen tubes.