Epiretinal Fibrosis Research Articles

Прогнозируемая интраоперационная индукция задней отслойки стекловидного тела

Purpose. To develop a technique for predictive intraoperative induction of posterior vitreous detachment as the first stage of surgical treatment of various vitreoretinal pathologies based on data of preoperative spectral optical coherence tomography (SOCT) and to evaluate its clinical effectiveness. Material and methods. 30 patients were performed surgery, 15 of them (15 eyes) with epiretinal fibrosis and 15 (15 eyes) with macular hole. Preoperatively, SOCT was used to determine the place of the retina in the parapapillary area, which is the most optimal for induction of posterior vitreous detachment during the operation. For this, a vitreoretinal interface was used on a Solix device (Optovue, USA) with a Full Range Retina protocol with a scan length of 16 mm, according to which the degree of vitreomacular and vitreopapillary adhesion was assessed. In the optimal zone of the posterior hyaloid membrane, microperforations were applied with a parapapillary vitreotom. At maximum vacuum (650 mm Hg), the vitreous body fibers were aspirated into the hole of the vitreotom until a characteristic “wave” or “meniscus” (“crescentic fold”) appeared along the edge of the optic disc. At the final stage, in the “vacuum mode”, movements from the optic nerve head to the periphery by the aspiration method raised the cortical layers of the vitreous body and torn off the posterior hyaloid membrane from the edge of the optic nerve head, separating the vitreous body from the center to the periphery of the retina. Results. In all 30 cases, it was possible to initiate intraoperatively posterior vitreous detachment without the use of dyes. There were no intraoperative complications. Conclusion. The proposed technique makes it possible to perform a predictable intraoperative induction of detachment of the posterior cortical layers of the vitreous from the retina, which is a necessary step for subsequent vitreoretinal surgery. Keywords: intraoperative induction of posterior vitreous detachment, posterior hyaloid membrane, posterior cortical layers.

Возможности двухпортовой витрэктомии в лечении пациентов с эпиретинальным фиброзом

Aim: to evaluate the efficacy and safety of two-port vitrectomy in the treatment of patients with epiretinal fibrosis. Patients and Methods: surgical treatment using a two-port vitrectomy technique was performed in 25 patients (25 eyes) with epiretinal fibrosis. Patients with concomitant retinal pathology (e.g. diabetic or post-thrombotic retinopathy) and glaucoma were not included in the study. Of the total number of patients, 64% (n=16) were women and 36% (n=9) were men. The mean age of the patients was 61±6,4 years. The surgical procedure was based on the developed technology and conducted by the same surgeon in the same clinical setting. The surgical technique included the installation of two ports in the opposite quadrants: in the upper hemisphere for the vitreotome and instruments, and in the lower hemisphere — for the infusion cannula with a built-in endo-illuminator-chandelier as a single light source. Then, vitrectomy was performed according to the classical technique — the vitreous body was removed centrally, followed by membrane staining and membrane peeling, and partial tamponade with an air mixture. Patients were examined on day 1, one and three months after the surgical procedure. They underwent the basic ophthalmic examination, including visometry and tonometry. Optical coherence tomography with retinal image analysis was used to assess the recovery of anatomical parameters. Results: intra- or postoperative adverse events were not reported. All patients had stable anatomical results: the absence of horizontal tractions in the foveal zone and a retinal height reduction to 297±32 μm. The maximum functional effect — a decrease in metamorphopsia expression and an increase in best-corrected visual acuity by 0.48±0.1 vs. that at the baseline was observed 3 months after the surgery. Conclusion: in addition to the classical three-port vitrectomy with xenon focal illuminator, it is possible to use the two-port vitrectomy with a mercury vapor chandelier illuminator. The advantage of this method is the reduction of surgical trauma. Keywords: epiretinal fibrosis, two-port vitrectomy, phototoxicity, tyndallometry. For citation: Borisova D.V., Frolychev I.A., Pozdeeva N.A. Prospects of two-port vitrectomy in the treatment of patients with epiretinal fibrosis. Russian Journal of Clinical Ophthalmology. 2022;22(4):224–227 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-224-227.

Результаты применения усовершенствованного витреоретинального вмешательства при пролиферативной диабетической ретинопатии

Purpose. To improve the technology of combined vitreoretinal intervention, including preliminary intravitreal injection of angiogenesis inhibitors followed by vitrectomy and a differentiated approach to internal limiting membrane peeling in patients with proliferative diabetic retinopathy (PDR). Material and methods. The research based on analysis of morpho-functional parameters 134 patient's eyes with PDR during type II diabetes mellitus. The patients were divided into 2 groups. The first group consisted of 30 patients (30 eyes), who were determined optimal period for vitrectomy. That patients underwent fundus photography and optical coherence tomography during 1 month after intravitreal injection of ranibizumab. Vitrectomy was performed within 1-3 months (38.4 ± 5.6 days). The second group consisted of 104 patients (104 eyes) who underwent vitrectomy with a differentiated approach to internal limiting membrane peeling and tamponade of the vitreous cavity. Results. The optimal period for vitrectomy in patients with PDR is 10-14 days after preliminary ranibizumab injection, which is due to the maximal regression of neovascularization and minimal traction on the retina (the risk of developing local traction retinal detachment decreases by 36.6%). Carrying out vitrectomy in optimal period helped to reduce the risk of intraoperative hemorrhagic complications by 4.2 times, the frequency of using perfluorocarbons by 3.7 times. At postoperative period, in patients without internal limiting membrane peeling on the silicone oil tamponade, the risk of epiretinal fibrosis increased 2.7 times compared with the data before treatment, and 1.8 times on air-gas mixture tamponade. Conclusion. The optimal surgical tactic for patients with PDR is preliminary intravitreal injection of angiogenesis inhibitors before vitrectomy, internal limiting membrane peeling at silicone oil tamponade (frequency of epiretinal fibrosis 96%) and individual approach to surgical correction of macular area at gas-air mixture tamponade (frequency of epiretinal fibrosis 36%), which allows to achieve a progressive improvement in morphological and functional results. Key words: proliferative diabetic retinopathy, preliminary anti-VEGF therapy, vitrectomy, internal limiting membrane peeling.

Устранение витреомакулярного тракционного синдрома на глазах, ранее оперированных по поводу отслойки сетчатки

Aims. Evaluate the efficiency of ILM peeling in the treatment of VMTS on eyes previously treated for retinal detachment. Materials and methods. 4 participants diagnosed with VMTS were enrolled in this study. There were 2 male and 2 female patients aged 30-64 y.o. who were previously surgically treated for their retinal detachment. 3 patients had rhegmatogenous and 1 patient had traumatic tractional retinal detachment with the mean duration of 5.75 years. 3 eyes undergone scleral buckling following subretinal fluid drainage, 1 eye underwent cataract phacoemulsification with an implantation of IOL + closed vitrectomy + pneumatic retinopexy + endolaser retinal photocoagulation + silicone oil, insertion following silicone oil removal from the vitreous cavity. All patients had some degree of myopia as well as peripheral retinal degenerations. 2 patients were diagnosed with epiretinal fibrosis and 2 other with stage 2 small full-thickness macular hole. Mean BCVA before surgery was 0.078, mean central retinal thickness was 390,25 um, small full-thickness macular hole diameter was about 320 um. Before the surgery, all patients undergone cycloscopy, where there were no indications for the additional laser photocoagulation. 3 patients underwent posterior vitrectomy 25G and 1 patient had 25G ports placed on his eye with the peeling of ILM and usage of pneumatic retinopexy, 2 eyes underwent cataract phacoemulsification with IOL implantation. Results and discussion. All surgical interventions were done without any complications. Since there were conjunctival scars left after the previous surgeries, conjunctiva did not show any displacement during the sclerotomy procedures, which led to the formation of post-sclerotomy holes. This fact forced us to make knot sutures, which resulted in foreign body sensations in our patients during the post-op period. Intraoperatively, all patients had their ILM removed, which was proved by OCT in the post-op period. Mean BCVA after operations was 0.3. Mean Central retinal thickness was 314 um based on OCT data in the post-op period. Patients were recommended to undergo cycloscopy 1 month after the surgery and then twice every year. There were no retinal detachment relapse observed in the post-op period. Conclusion: 1. Removal of ILM in patients, that were previously operated due to retinal detachment, is considered as an effective method in the treatment of VMTS. It is clinically manifested as visual acuity improvement, retinal thickness reduction, lamellar hole closure and the absence of full thickness macular hole formation risk in the early and late post-op periods. No retinal detachment relapses were observed. 2. Presence of conjunctival scars following previous retinal detachment surgical interventions leads to the hole formation following sclerotomy procedures, which causes foreign body sensations in patients during the post-op period. 3. Endovitreal surgical intervention for the retinal detachment should include ILM peeling to prevent formation of VMTS in the post-op period. Key words: vitreomacular traction syndrome (VMTS), Internal limiting membrane (ILM), rhegmatogenous retinal detachment ( RRD), optic coherence tomography (OCT).

Исследование эффективности антиангиогенной терапии диабетического макулярного отека на авитреальных глазах в условиях реальной клинической практики

Despite the vitrectomy performed for diabetic macular edema (DME), some patients still have symptoms of the disease due to overproduction of VEGF by the ischemic retina, which requires regular administration of an antiangiogenic drug. Studies of the pharmacokinetics of antiangiogenic drugs after vitrectomy in humans have not been carried out. Data from the DRCR.net (Post-Hawk Protocol I) study and real-life clinical practice studies show similar results for anti-VEGF DMO therapy in vitreous eyes and after vitrectomy (2, 7). Purpose. To assess the effectiveness of antiangiogenic therapy with aflibercept for DMO in avitreal eyes in real clinical practice. Methods. The initial and after vitrectomy best corrected visual acuity (BCVA) and central retinal thickness (CRT) were determined according to OCT data, then these parameters were monitored by 1, 3, 6 and 12 months after the start of antiangiogenic therapy with aflibercept. 14 patients (14 eyes) with persistent DME underwent vitrectomy with removal of the internal limiting membrane, in 5 of them the epiretinal fibrosis was removed and 3 of them with a traction retinal detachment that was also removed with air tamponade. Results. Aflibercept intravitreal injections were started with 5 loading doses by 1-11 months after vitrectomy. On average, after 12 months, patients received 7.2 injections, while there was no need for laser surgery of the macular zone. By the end of the study, the CRT decreased by 255 ±86 µm, the BCVA was 0.35 ± 0.2 in comparison with the initial 0.07±0.03 (on a decimal scale). Conclusions. The effectiveness of the anti-VEGF therapy with aflibercept for DME in avitreal eyes was confirmed by an increase in functional (BCVA) and normalization of morphological (CRT on OCT) parameters after the first injections during the period of loading doses. Previous vitrectomies in patients with DMO do not affect the long-term favorable clinical outcomes of anti-VEGF therapy with aflibercept. Key words: vitrectomy, diabetic macular edema, aflibercept, anti-VEGF, OCT, best corrected visual acuity, central retinal thickness.

Тактика лечения пациентов с сочетанной витреоретинальной патологией: наличием влажной формы возрастной макулярной дегенерации и эпиретинального фиброза. Клинические случаи

Introduction. Age-related macular degeneration (AMD) is one of the leading causes of irreversible vision loss among older patients. Since the introduction of anti-VEGF therapy, retinal specialists have been able to maintain or improve vision in patients with AMD. However, anti-VEGF therapy is ineffective in a certain percentage of patients. In 25-35% of cases of wet AMD, secondary epiretinal membranes (ERM) in the macular region are found. Anti-VEGF therapy has been found to be less effective in the treatment of wet AMD with ERM. Optimal treatment tactics for this combined pathology remains a matter of debate. Purpose. To evaluate the efficacy of different combined treatment approaches to patients with wet AMD and ERM. Methods. Study was performed on 2 eyes of 2 patients with ERM and AMD, wet form. Patients were divided in two groups. First patient received one loading dose of anti-VEGF drug (ranibizumab) and after that underwent standart pars plana vitrectomy (PPV) with removal of epiretinal and inner limiting membrane (ILM). Anti-VEGF therapy than was continued according to pro re nata regimen. Second patient underwent standart PPV with removal of ERM and ILM first. After the surgery, loading dose of anti-VEGF drug was injected. Anti-VEGF therapy than was continued according to pro re nata regimen. Results. After treatment, there was a decrease in central retinal thickness in both patients, but an increase in maximum corrected visual acuity was observed only in first patient. Conclusions. Based on the results of the performed study, the most optimal treatment approach to patients with wet AMD and ERM consisted of a single loading dose of anti-VEGF drug injection followed by PPV with removal of ERM and ILM and further continuation of anti-VEGF therapy for wet AMD. However, further research is needed to form a final conclusion about the effectiveness of the chosen treatment tactic. Key words: epiretinal fibrosis, AMD, CNVM, anti-VEGF

Підвищення клінічної ефективності хірургічного лікування регматогенного відшарування сітківки шляхом оцінювання імунологічних та анатомо-морфологічних показників: огляд літератури

Introduction. Closed subtotal vitrectomy (CSV) is used to treat rhegmatogenous retinal detachment (RRD), but even with successful surgery performed at a relatively early stage, some patients still have low visual acuity and persistent color perception defects. Therefore, the combination of CVS with the internal limiting membrane (ILM) peeling in RRD can improve clinical outcomes in the postoperative period. The aim. To determine the role of ILM peeling and its influence on the functional and morphological state of the macula after RRD surgery in order to maximize the results of visual acuity after retinal detachment and clarify the indications for ILM removal in RRD. Materials and methods. Analysis of the literature shows that in many cases, despite the full ft of the detached retina, visual acuity is not restored in full. There are almost no data comparing the effect on visual acuity of ILM removal during vitrectomy in the remote period, hemodynamic disorders in the macular area according to optical coherence tomography (OCT) angiography in patients with RRD. Results. Despite the fact that ILM peeling in RRD significantly reduces the incidence of epiretinal fibrosis the anatomical and morphological changes of the retina after ILM peeling and their impact on postoperative clinical outcomes should be taken into account. The determination of blood biomarkers has the potential to better predict the risk of proliferative vitreoretinopathy (PVR) after surgery to inhibit the pathological reaction that causes the formation of fibrous films on the retina, which in turn significantly worsen the clinical outcomes in the postoperative period. Conclusions. Thus, a combination of appropriate surgical techniques and new diagnostic markers, both clinical and immunological, can help to improve the diagnosis and prognosis of RRD.

Структура клинической разновидности макулярной патологии среди пациентов диагностического отделения

Purpose. To study the frequency and nosological structure of concomitant macular pathology in patients admitted for ophthalmic surgery. Material and methods. A study of the state of the macula was carried out in 337 eyes of 170 patients who underwent a diagnostic examination in the Khabarovsk Branch the S. Fyodorov Eye Microsurgery Federal State Institution in 2020. The patients' age was 58±15.2 years. The selection criterion was sufficient transparency of the optical media for viewing the macular zone. An in-depth examination of the macular zone was carried out using a forehead binocular reflex-free ophthalmoscope (Heine OMEGA500, Germany) and a non-contact lens (VOLK Double Aspheric 20D, USA), as well as optical coherence tomography (Cirrus HD-OCT 5000, «Carl Zeiss», Germany). The proportion of macular pathology among the patients who applied, the frequency and severity of its individual nosological forms were evaluated. Results. Various macular pathologies occurred in 28.2% of cases. Age-related macular degeneration (AMD) (47.9%) and epiretinal fibrosis (27.1%) accounted for a significant share in the structure of macular pathology. The frequency and structure of macular pathology in patients with age-related cataracts was analyzed. The incidence of macular pathology in them was 45.1%, of which AMD was detected in 65.2% of cases, epiretinal fibrosis – 7.8%. Conclusion. Among the group of patients selected by the method of continuous sampling with various ophthalmic surgical pathologies, 28.2% had various pathologies of the macular zone. The most common macular pathology occurred in the age group from 45 to 59 years old, accounting for 56.2% of cases. In the nosological structure of macular pathology, the share of AMD and epiretinal fibrosis prevailed. Key words: macular pathology, age-related macular degeneration, epiretinal fibrosis.

The Role of Intravitreal Anti-VEGF Agents in Rabbit Eye Model of Open-Globe Injury.

Purpose To evaluate the effects of intravitreal anti-VEGF agents in a rabbit model of open-globe injury (OGI). Methods OGI was induced in the right eyes of 75 Belgian rabbits by making 5 mm circumferential incision placed 6 mm behind the limbus. The rabbits were divided into 4 groups: control (n = 5), OGI group (n = 40), and intravitreal Ranibizumab and Conbercept (n = 15 each). Ranibizumab or Conbercept was injected into the vitreous at 0.5 hours, 3 days, or 7 days. Vitreous fluid was collected, and levels of growth factors and cytokines were measured by enzyme-linked immunosorbent assay (ELISA). On day 28 after OGI, B scan examination and histological examination were performed to evaluate intravitreal proliferation and formation of epiretinal fibrosis. Results Vitreous levels of vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and plasminogen activator inhibitor-1 (PAI-1) were significantly increased in rabbit eyes after OGI. Compared to eyes in OGI group, anti-VEGF treatments significantly reduced these growth factors and cytokines. Among the 7 eyes examined from each group for intravitreal proliferative changes, they were found in 7 of 7 (100%) in OGI group and were decreased by Ranibizumab and Conbercept to 5 of 7 (71.4%) and 4 of 7 (57.1%), respectively. Both Ranibizumab and Conbercept inhibited epiretinal scar formation at the wound site, with Conbercept showing the greatest effect (maximal length of scar (L), LOGI = 503 ± 82.44 μm, LRanibizumab = 355 ± 43.66 μm, and LConbercept = 250.33 ± 36.02 μm). Conclusion Anti-VEGF treatments after OGI significantly attenuated the upregulation of growth factors and cytokines in the vitreous and prevented intravitreal proliferation and epiretinal scar formation and thus may protect against the development of posttraumatic complications such as proliferative vitreoretinopathy (PVR).

Поэтапный подход в лечении комбинированной гамартомы сетчатки и ретинального пигментного эпителия

Combined hamartoma of the retina and retinal pigment epithelium (RPE) is a rare congenital benign lesion. It is most often detected in young adults and adolescents. The disorder is mostly asymptomatic, however, in 24% of patients the loss of visual function results from complications, such as epiretinal fibrosis associated with tractional distortion of the fovea, hemophthalmos, choroidal neovascularization, exudative retinal detachment, macular edema, and combined tractional/rhegmatogenous retinal detachment. Currently, there is no consensus on the combined hamartoma complications management. The reported clinical case demonstrates the feasibility of staged approach to treatment of combined hamartoma of the retina and RPE complicated by epiretinal fibrosis and partial hemophthalmos using the advanced diagnosis (optical coherence tomography) and treatment methods.

A rare case of eye complications of gastric stromal tumor treatment using imatinib mesylate

Purpose: to describe a clinical case of ocular complications of gastric stromal tumor treatment with imatinib mesylate. Material and methods . A patient aged 78 was examined by general ophthalmologic and instrumental methods, including ultrasound and spectral optical coherence tomography (SOCT). Results. Ophthalmoscopy helped diagnose a blunted foveal reflex of the right eye. In the left eye, fuzzy boundaries of the optic disc edema and the macular reflex, the presence of gray-yellow foci of an irregular shape with even distinct boundaries in the paramacular zone were revealed. In the lower part of the left eye fundus, a weakly pigmented gray-yellow focus with uneven indistinct boundaries and an uneven surface was to be seen. SOCT showed in the right eye a retinal edema in the macula and paramacular zones and an epiretinal membrane. In the left eye, SOCT showed vitreoretinal tractions and retinal edema on the edges of the optic nerve; in the paramacular zone and in the inner parts of the fundus, vitreoretinal tractions, epiretinal fibrosis, retinal edema was observed whilst in the lower parts of the fundus complete destruction of all retinal layers due to the hyperreflective focus with a small-shaped inner contour, an even choroidal profile with thinning of the choroid, vitreoretinal tractions, and epiretinal membrane in the left eye could be seen. Conclusions. The clinical case of eye complications of imatinib mesylate in the treatment of gastric stromal tumor necessitates an interdisciplinary integrated approach (involving an oncologist and an ocular oncologist) in the diagnosis and treatment of eye tumors. A complex of instrumental methods of diagnostics of eye fundus diseases involving additional refinement methods (SOCT) ensures differential diagnosis of retinopathy during the chemotherapy, secondary metastatic involvement, and vitreoretinal pathology of a different pathogenetic etiology. Early diagnosis facilitates providing adequate treatment aimed at preserving the patient’s vision, the eye, and life.

Optical Coherence Tomography with Angiography in the Analysis of Vitrectomy Effectiveness in Patients with Vitreomacular Traction Syndrome

Micro incision vitrectomy surgery with removal of epiretinal and internal limiting membranes is used for treating various forms of vitreomacular traction syndrome.Objective: to study the condition of retinal microcirculation using the OCTA method in the patients with traction maculopathy and macular ruptures before and after vitrectomy.Patients and Methods. The study included 160 patients, of which 55 had epiretinal fibrosis (Treatment 1), 60 had macular ruptures (Treatment 2), and 45 with no ophthalmic pathology (Control). Treatment 2 group included two subgroups: 2a — patients with large-diameter ruptures (over 800 μm) subject to inverted internal limiting membrane flap technique (n = 12), and 2b — patients with 430–800 μm ruptures subject to rapprochement of the rupture edges with a platelet mass technique. All patients underwent conventional ophthalmology examinations and optical coherence tomography angiography (OCTA) using Sirrus HD-OCT 5000, Carl Zeiss, Germany.Results. In the postoperative period, there was an improvement in retinal microcirculation in the Treatment 1 patients, and the values of both perfusion and vascular densities increased. A month later, an additional improvement of these indicators was recorded against the background of a decrease in retinal thickness and restoration of the vitreoretinal interface configuration. In the early postoperative period, Treatment 2 patients showed significant difference in the capillary density of the superficial vascular complex from the control group. A month later, the density of blood vessels in the Treatment 2 patients achieved control group values. Despite an immediate increase in perfusion measurements after surgical treatment, their values in a month were still lower than in the control group.Conclusions. In the patients with epiretinal membrane and macular ruptures, a statistically significant decrease in both vascular and perfusion densities of the surface capillary complex was revealed by OCTA. The effects of vitreoretinal surgery performed on Treatment 1 and 2 patients with macula traction pathology included increased visual acuity, decreased retinal thickness, and restoration of the proper vitreoretinal profile. Based on OCTA results, we discovered a gradual increase in vascular density of the macula in Treatment 1 and 2 patients after surgical treatment of VMT syndrome. Retinal perfusion in the macular region of Treatment 1 patients achieved the values of the control group within a month, while in Treatment 2 patients they increased, but remained lower than in control group. OCTA is a highly informative method for the diagnostics and monitoring of the eye posterior segment condition in the patients with VMT syndrome.

Патофизиологические механизмы эпителиально-мезенхимальной трансформации при идиопатическом эпиретинальном фиброзе

Эпителиально-мезенхимальная трансформация (ЭМТ) может лежать в основе перестройки дифференцированных клеток при репарации тканей и формировании фиброза. В основе патогенеза идиопатического эпиретинального фиброза (иЭРФ) могут также быть задействованы процессы дифференцировки и трансформации различных типов клеток. Цель исследования - выявление признаков мезенхимального фенотипа в клетках эпиретинальных мембран удаленных с поверхности сетчатки у пациентов с иЭРФ и различной остротой зрения. Методика. В исследование включено 60 пациентов (60 глаз) с диагнозом иЭРФ. Все пациенты были разделены на 3 группы по 20 пациентов в каждой, в зависимости от исходной максимально корригированной остроты зрения (МКОЗ): 1- я группа имела МКОЗ 0,9 -0,7 н/к; 2-я - 0,6-0,3 н/к; 3-я - от 0,2 до 0,05. У всех пациентов удаляли эпиретинальную и внутреннюю пограничную мембраны (ЭРМ и ВПМ). ЭРМ и ВПМ удаляли послойно или единым блоком. Проводили иммуногистохимическое окрашивание образцов мембран, с целью выявления и визуализации следующих антигенов: виментина, α-гладкомышечного актиа (α-SMА), и коллагенов IV и VI типов. Результаты. У пациентов 1-й группы во всех случаях ЭРМ удалялись отдельно от ВПМ. В образцах выявлялись единичные клетки экспрессирующие виментин, α-SMA, коллагены IV и VI типов. У пациентов 2-й группы в 16 случаях (80%) ЭРМ с поверхности сетчатки удалялись единым блоком с ВПМ. В образцах выявлено увеличение числа клеток экспрессирующих α-SMА и виментин, при этом имело место статистически значимое увеличение экспрессии коллагенов IV и VI типов. Во всех образцах 3-й группы ЭРМ и ВПМ в 100% случаях удалялись с поверхности сетчатки единым блоком. В 17 (85%) случаях мембраны имели один или несколько участков сращения с сетчаткой, в клетках превалировала экспрессия коллагенов VI и VI типов. Маркеры виментин, α-SMA, коллагены VI и VI типов обнаруживали статистически значимую корреляционную связь с МКОЗ до операции. Причем, виментин имел сильную обратную корреляционную связь (r=-0,788, p=0,004), факторы α-SMA и коллагены IV, VI типов - очень сильную обратную корреляционную связь (r<-0,9, p<0,001). Заключение. На примере прогрессирования идиопатического эпиретинального фиброза выявлена ЭМТ мембран. Данный феномен характеризуется приобретением клетками мембраны мезенхимального фенотипа: появлением экспрессии виментина и α-SM актина а также и приобретением способности к продуцированию компонентов внеклеточного матрикса (коллагены IV и VI типов). Ключевым моментом в процессе формирования и прогрессирования ЭРФ является трансформация клеточного состава в миофибробластоподобные клетки. Повышенная экспрессия α-SM актина непосредственно связана с сокращением мембраны и «натяжением» сетчатки миофибробластами, что в свою очередь приводит к прогрессирующему снижению остроты зрения и увеличению метаморфопсий у пациентов (r<-0,9, p<0,001).Epithelial-mesenchymal transition may underlie reorganization of mature differentiated cells and tissues during their repair and fibrosis. The pathogenesis of idiopathic epiretinal fibrosis may also involve processes of differentiation and transformation of different cell types. Aim. To identify signs of the mesenchymal phenotype in cells of idiopathic epiretinal membranes removed from the surface of the retina in patients with different visual acuity. Methods. Sixty eyes of 60 patients with idiopathic epiretinal fibrosis were divided into three groups: Group 1 included patients with best-corrected visual acuity (BCVA) 0.7-0.9; group 2 consisted of patients with BCVA 0.3-0.6; and group 3 consisted of patients with BCVA 0.1-0.3. In all patients, the internal limiting membrane (ILM) was peeled for idiopathic epiretinal membrane (IERM). Idiopathic ERM/ILM samples from vitrectomy were analyzed for vimentin, α-smooth muscle actin (α-SMA), and type IV and VI collagens using flat-mount immunohistochemistry. Results. In patients of group 1, single cells expressing vimentin, α-SMA, and type VI and VI collagens were found. In patients of group 2, the number of cells expressing α-SMA and vimentin was increased with a statistically significant increase in the expression of type IV and VI collagens (p <0.05). Type VI and IV collagens prevailed (p <0.05) in all samples of group 3. Sometimes membranes had sites of rough fusion with extracellular matrix components. These membranes strongly adhered to ILM and were removed as a single block during vitrectomy. Conclusion. Using the example of progressive idiopathic epiretinal fibrosis this study found the epithelial-mesenchymal transition. This phenomenon was characterized by membrane cells that have acquired the mesenchymal phenotype due to appearance of vimentin and α-SM actin expression (p <0.05) as well as the ability to produce components of extracellular matrix (type IV and VI collagens) (p <0.05). The key point in the process of ERM formation and progression was the transformation of the cellular composition into myofibroblast-like cells. The increased expression of α-SM actin was associated with membrane contraction and tensioning of the retina by myofibroblasts, which resulted in impaired visual acuity and increased metamorphopsia (r <-0.9, p <0.001).

Сравнительный анализ эффективности антиангиогенной терапии диабетического макулярного отека при различных формах эпиретинального фиброза

Сравнительный анализ эффективности антиангиогенной терапии диабетического макулярного отека при различных формах эпиретинального фиброза

Результаты нехирургического лечения витреомакулярной тракции с применением бактериальной коллагеназы

Purpose. To study the efficacy of a developed method of non-surgical treatment of vitreomacular traction (VMT) using the bacterial collagenase. Material and methods. The study group included 65 cases of VMT with a length from 20 to 3100 μm. The VMT was isolated in 22 cases, and it was complicated in 43 cases: by macular hole (29 eyes) or epiretinal fibrosis (14 eyes). Results. In 3 cases (4.6%) within three months after the diagnosis there was a spontaneous resolution of traction with the restoration of the macular profile. In 48 cases (73.9%) an elimination of VMT after the treatment was achieved. In 14 cases (21.5%) VMT could not be eliminated. In 15 cases it was possible to achieve not only the elimination of VMT, but also the closure of macular hole. In 9 cases, it was possible to achieve the resolution of VMT and epiretinal fibrosis with the improved visual acuity. Conclusion. The obtained results showed that the developed method of non-surgical treatment of VMT can be the method of choice in the treatment of both isolated and complicated VMT of any length.

Роль воспалительного компонента на примере идиопатического эпиретинального фиброза

Роль воспалительного компонента на примере идиопатического эпиретинального фиброза

Two-port pars plana vitreomacular surgery without endoillumination

To present a two-port endovitreal surgery technique without endoillumination as a method of choice for sparing surgery of the macular area. Study group included 16 patients (16 eyes) with cataract and macular pathology (8 - with a macular hole (MH) and 8 - with epiretinal fibrosis). Preoperative mean best corrected visual acuity (BCVA) was 0.15±0.10. The maximum follow-up period lasted 6 months. All surgeries were performed by the same specialist using surgical microscope OMS-800™ ('Topcon') fitted with visualization system OFFISS (Optical Fiber-free Intravitreal Surgery System) and 3D visualization system NGENUITY (Alcon). In each case, cataract phacoemulsification with IOL implantation was performed prior to two-port 25-27G pars plana vitrectomy. One port was used for placing the irrigation cannula, the other - for injection of various tools. The light of the microscope tube was used for illumination. Light and color parameters were set up using Alcon NGENUITY 3D visualization system for the microscope light to be used at minimal required intensity that achieved adequate, clear image. The two-port surgery was successfully performed in all 16 patients of the study group. Neither intraoperative nor postoperative complications were observed. There was no rise or decrease in intraocular pressure (IOP) within the specified follow-up period. In the postoperative period, anatomical results were evaluated by optical coherent tomography (OCT). The hole was blocked successfully in all cases, and the epiretinal membrane (ERM) could not be determined. Mean BCVA increased to 0.5±0.3. The technique of two-port surgery without endoillumination allows safe and effective surgical treatment of the macular pathology.

Dynamics of changes in morphometric parameters of the macular zone in glaucoma patients after phacoemulsification

To analyze the dynamics of morphometric changes in the macular zone using optical coherence tomography (OCT) data in patients with primary open-angle glaucoma (POAG) after phacoemulsification (PE). The study enrolled 93 patients (95 eyes) requiring PE; they were divided into 2 groups. The first (control) group consisted of 30 patients (32 eyes) without concomitant eye pathology. The second group included 63 patients (64 eyes) with POAG and IOP stabilized by eye drops. In the 2A subgroup (32 eyes) patients used prostaglandin analogues, in the 2B subgroup (31 eye) - carbonic anhydrase inhibitors. OCT was used to analyze retinal thickness and volume. OCT was performed before PE, after 1 week, after 1, 3, and 6 months. In the control group, the volume and thickness of the retina varied within the normal range. In the 2A subgroup, signs of macular edema (ME) in the early post-operative period were noted in 6.2% of patients. In the late post-operative period, changes in the macular zone were noted in 18.7% of cases. After the treatment, ME regressed completely in 4 patients (12.5% of all cases). One patient with retinal thickness of more than 500 µm required parabulbar and intravenous injections of glucocorticoids, which resulted in ME decrease. Another patient developed epiretinal fibrosis with tractions after ME. Among the patients of subgroup 2B, a trend for increase in the volume and thickness of the macular zone was observed in 3 cases; the values stayed within the normal range, and later returned to the initial level. Patients with POAG develop ME after PE in 1-3 months. The use of topical prostaglandin analogues may be the reason of ME development.

The Results of Morphometric Assessment of the Macular Zone in Congenital Cataract

Purpose:to study the morphological characteristics of the macular zone using optical coherence tomography to assess its development in congenital cataract.Patients and methods:a comprehensive ophthalmological examination was performed in 147 children (269 eyes) aged 1 to 15 years, including, along with traditional methods, optical coherence tomography on the Spectralis HRA + OCT instrument, Heidelberg Engineering. Of these, 193 eyes were with pseudophakia after the removal of congenital cataracts in children aged 2 months to 14 years, 18 eyes with aphakia after the removal of congenital cataracts in children aged 2 months to 11 years, 20 unoperated eyes with partial forms of congenital cataracts and 38 paired conditionally healthy eyes in children with unilateral congenital cataracts. Visual evaluation of linear tomograms, measurement of 5 parameters of the central zone of the fundus and calculation of the macular index were performed.Results:various features of the macular zone were revealed: changes in the macular contour, lamellar structure of the retina, thinning of the choroid, and elements of epiretinal fibrosis. Evaluation of retinal differentiation with the help of a macular index, calculated on the basis of morphometric characteristics, revealed its violations in 52.8 % of cases, which was not always revealed in the visual analysis of tomograms. The best morphometric parameters of the central zone of the fundus are noted in the eyes with pseudophakia in comparison with aphakia (p < 0.05).Conclusion:there is a variability in the state of the macula. In patients with congenital cataracts. Better indicators of the central zone of the fundus in front of the eye with pseudophakia in comparison with aphakia justify the feasibility of performing surgical treatment of congenital cataracts simultaneously with the implantation of the intraocular lens, including in infants. Thinning of the choroid in the subfoveiolar zone with congenital cataract may indicate a violation of trophism and exert additional influence on the physiological development of the macular zone.

The Effectiveness Analysis of Joint Use of Different Groups Anti-Inflammatory Drugs Treatment and Prevention of Cystoid Macular Edema in Patients after Phacoemulsification

Purpose: to analyze the results of the joint eye drops application of 0.09 % solution of bromfenac and 0.1 % solution of dexamethasone and subtenons triamcinolone injection for treatment and prevention of cystoid macular edema (CME) in patients after phacoemulsification.Patients and methods: The study included 914 patients (1147 eyes) which held phacoemulsification with IOL implantation. Depending on the postoperative treatment patients randomized into two groups. Patients of the first group received instillation of eye drops of antibiotics-fluoroquinolones and 0.1 % dexamethasone. Patients of the second group were prescribed instillation of eye drops of 0.09 % solution of bromfenac in addition to the treatment. In each group the patients diagnosed CME after phacoemulsification were divided into subgroups depending on the presence or absence of concomitant involution of retinal pathology. In cases of diagnosis of macular edema after phacoemulsification (2nd group of patients) periocular triamcinolone injections were made.Results. The efficacy of bromfenac was estimated by the number of cases of postoperative CME in the compared groups. In patients of the first group, complications occurred in 3.1 % of cases. In patients of the second group the number of complications was significantly lower (1.5 %), including a significant reduction in the incidence of CME observed in patients without concomitant of macular pathology (AMD and epiretinal fibrosis). A combination of steroid and NSAID in the treatment of CME provides the regression of macular edema in all patients, regardless of the presence of involution macular pathology. The positive effect of periocular triamcinolone injections in the treatment of anti-inflammatory eye drops was noted in 8 of 9 cases a month after the first injection.