Purpose. To analyze current literature data on the topic of thrombotic and vasoocclusive lesions of retinal vessels in conditions of thrombophilia and endotheliopathy to determine the tactics of management of patients with this pathology. Material and methods. A search and analysis of current research published in the databases PubMed, eLibrary, Springer, ScienceDirect and Google Scholar has been performed. A clinical case of bilateral postthrombotic retinopathy with the phenomena of vasculitis and fibrovascular proliferation, which developed against the background of thrombophilia in a 34-year-old woman, is also described. Results. Retinal vasoocclusion occurred in conditions of thrombophilia due to hyperproduction of factor VIII and von Willebrand factor (vWF), in the presence of genetic markers of thrombogenic risk and a history of pulmonary embolism. Mutations F13, PAI-1, FBG, ITGA2 and ITGB3 demonstrate a moderate association with vasoocclusive retinal damage, while the genes of the folate complex enzymes MTRR and MTHFR are associated with thrombophilia due to hyperhomocysteinemia, endotheliopathy and the development of heart defects that increase the risk of occlusion of the CRV and its branches. Dynamic assessment of the condition of retinal vessels according to optical coherence tomography in angiography mode allowed us to confirm the effectiveness of antiVEGF therapy in combination with panretinal laser coagulation, which was accompanied by the restoration of lost visual functions. Conclusion. In order to prevent retinal vascular catastrophes for patients with a similar comorbid background, it is preferable to use multi-stage transpuppillary retinal laser coagulation and anti-VEGF therapy, thereby avoiding vitreoretinal surgical interventions to limit intraoperative and postoperative complications. Key words: postthrombotic retinopathy, neoangiogenesis, thrombophy
Read full abstract