Macular Zone Research Articles

Evaluation of the Quality of Visual Function and Life of Patients with Diabetic Macular Edema with Vitrectomized and Non-Vitrectomized Eyes on Steroid Therapy

Objectives: to evaluate the dynamics of changes in quality of life in patients with diabetic macular edema (DME) with vitrectomized and non-vitrectomized eyes after intravitreal injection of dexamethasone implant (IVD). Material and methods. 60 patients (60 eyes) were examined, divided into two groups with a diagnosis of diabetic retinopathy, DME and with different vitreous conditions. Group 1 — patients with non-vitrectomized eyes, group 2 — with vitrectomized eyes. Both objective and subjective methods of ophthalmological examination were used, followed by an assessment of the quality of life and visual functions based on the results of a questionnaire conducted to patients using VFQ-25 (visual function questionnaire — 25). Also, all patients of both groups were assessed for best corrected visual acuity (BCVA) before, 1, 3 and 6 months after IVD. Results. In both groups, an increase in the average BCVA after IVD was observed up to 3 months of monitoring (p < 0.01). In addition, the quality of life parameters increased after 1 month of steroid therapy in both groups (p < 0.05), and by 3 and 6 months this trend persisted mainly only for the group with vitrectomized eyes (p < 0.05). Conclusion. IVD in patients with DME can significantly improve the morphofunctional parameters of the macular zone in the eyes with both vitrectomized and non-vitrectomized eyes. The maximum effect of the drug according to the quality of visual functions assessment was observed in 1 month of monitoring in the group with non-vitrectomized eyes. At the same time, the longest increase in quality of visual functions parameters from 3 to 6 months was observed in the group with vitrectomized eyes.

Subfoveal and Parafoveal Choroidal Thickening in Patients with Keratoconus Using the ETDRS Grid on Swept-Source OCT.

There is growing evidence that confirms morphological changes in the posterior structures in patients with keratoconus (KC); however, isolated alterations could have been missed. This study assesses choroidal thickness (CT) in the fovea and beyond in KC eyes. This prospective case-control and non-randomized study enrolled 107 eyes, 62 eyes of 62 patients with KC, and 45 age-matched eyes of 45 control subjects with axial length in the range of 22-26mm. Swept-source optical coherence tomography (SS-OCT) was performed to manually measure the subfoveal choroidal thickness (SCT) using a single-line scan. CT was obtained automatically from the Early Treatment Diabetic Retinopathy Study (ETDRS) grid using the 12-lines radial scan pattern. A two-way repeated-measures analysis of variance (ANOVA) was conducted to evaluate CT variations among macular eccentricity, parafoveal area, and the interaction between both factors. CT was compared in all parafoveal areas between groups and subgroups of KC. SCT was significantly thicker in KC eyes (357 ± 57µm) than in healthy eyes (325 ± 63µm) (p < 0.001). Significant choroidal thickening was observed in the central ring and outer and inner rings of the temporal, superior, and inferior parafoveal macular areas (p < 0.001), except in the outer ring of the nasal macular zone (p > 0.05) of KC compared to healthy eyes. The CT significantly decreased from the center to the outer ring regardless of the presence of KC (p < 0.001). The choroid in the nasal macular zone was significantly thinner than that in the temporal, superior, and inferior parafoveal areas (p < 0.001). The choroidal structure increased its thickness not only in the subfoveal area, but also in eight parafoveal areas of the ETDRS grid encompassing a wider area of macular examination. These findings demonstrate and corroborate that keratoconus is not a purely corneal disease. Furthermore, it confirms the role that the choroidal structure has in the pathophysiology of keratoconus.

The occurrence of age-related macular degeneration in the presence of a transferred, confirmed COVID-19

BACKGROUND: COVID-19 can affect the eyes and both the anterior and posterior segments of the eye. Retinal complications associated with COVID-19 have been reported.&#x0D; CLINICAL CASE DESCRIPTION: We present a clinical case of age-related macular degeneration that developed during the acute period of coronavirus infection. A patient with COVID-19 and pneumonia (CT-1) experienced sudden decrease in visual acuity within 1 month. A dark spot appeared in front of the left eye, which did not disappear despite eye movements, and distortion of objects was observed. The disease was manifested acutely. A complete ophthalmological examination revealed a sharp decrease in visual acuity and a positive Amsler test (distortion of lines at a distance of 30 cm). In the field of view, scotomas were noted in the center. Ophthalmoscopy revealed light and dark foci in the central macular zone of the retina. Cptical coherence tomography with an angiographic mode detected severe changes at the level of the neuroepithelium and retinal pigment epithelium with the formation of gray tissue. Aflibercept (approved for use in the Russian Federation, No. LP-003544) was intravitreally prescribed according to the clinical guidelines for treating age-related macular degeneration. After treatment with positive dynamics, visual acuity increased to 1.0, and the thickness of the retina decreased by 102 microns.&#x0D; CONCLUSION: The key objective in making a correct diagnosis was the use of optical coherence tomography with an angiographic mode. This method allows the visualization of the retinal layers without invasion The angiography mode allows the assessment of the state of the foveolar avascular zone and the density and perfusion of blood vessels, which enable the diagnosis of age-related macular degeneration and choroidal neovascularization. Timely antiangiogenic treatment, that is, a single intraocular injection, completely restored the visual acuity and visual field and normalized the state of the retina according to objective data of optical coherence tomography with angiography mode.

Determination of modes for safe application of selective micro-pulse individual retinal therapy of the macular zone using the modeling based on the theory of activated complex

Purpose: to make modeling of various modes of laser radiation, to assess the degree of damage to the retinal pigment epithelium and adjacent structures, and to determine modes and safety conditions of selective micro-pulse individual retinal therapy based on the theory of activated complex. Materials and methods. The authors have modeled the degree of damage to the chorioretinal complex and adjacent structures using the activated complex theory with the Eyring equation. The following definitions were used to determine the regime quality and safety conditions: micro-pulse mode is a mode with fixed values of micro-pulse duration, duty cycle and the number of pulses in the packet; power is a variable parameter. Efficiency is the ratio of the amount of denatured protein inside the retinal pigment epithelium layer to the total amount of protein in it. Selectivity is the ratio of the amount of denatured protein inside the retinal pigment epithelium layer to the total amount of denatured protein. Relative harmfulness is the ratio of denatured protein volume outside the retinal pigment epithelium to the volume of protein in it. Results and discussion. The quality of micro-pulse mode was found as depending on the selectivity value with efficiency equal to 90 %. With the efficiency value less than 50 %, the mode is non-selective, with more than 67 % – selective. Safety conditions for selective micro-pulse modes have been established, taking into account safety of the neurosensory retina and choroid in terms of relative harmfulness which should not exceed 1. Parameters at which micro-pulse modes have high values (more than 90 – 99) of efficiency and selectivity at the same time have been determined as well. It requires single pulse mode, micro pulse duration of 25 microseconds and power from 6 to 8 W. To expand the combination of parameters, it is necessary to be able to freely change them in increments of 1 pulse, 5 microseconds, 100 mW, with long interval and short duty cycle. These technical capabilities can be realized and implemented into clinical practice by manufacturers of laser devices. Conclusion. For selective micro-pulse individual retinal therapy of the macular zone with existing lasers, the following recommendation are to be observed: micro-pulse modes with pulse duration no more than 200 microseconds, short duty cycle less than 5 % and number of pulses in an envelope no more than 5; relative harmfulness less than one, radiation power selection, personalized patient’s characteristics.

State of the Retina and Optic Nerve in 21-Day Head-Down Tilt Bed Rest

Studies in conditions of head-down tilt bed rest are widely used experiments which imitate redistribution of body fluids similar to the redistribution of fluid media in microgravity. To study the mechanism of development of spaceflight-associated neuro-ocular syndrome (SANS) in head-down tilt bed rest studies scientists have evaluated, among other things, participants’ visual system parameters. The main symptom of SANS is an edema of an optic disc and a retina. To date, the results describing the influence of head-down tilt bed rest on the visual system are ambiguous, which determines the relevance of further research. The aim of the study is to analyze retinal morphometry in the optic disc area and macular area in participants before and after 21-day head-down tilt bed rest. The study was performed using an optical coherence tomography with angiography function (Optovue RTVue XR Avanti System) before and after 21-days of head-down tilt bed rest. In 4 participants (8 eyes) (men, mean age ± standard deviation: 29.3 ± 3.9 years) the macular zone and optic disc area were evaluated according to standard scanning modes. To analyze the values obtained, we used mean tendency scores, mean comparison criteria, and graphical analysis. The results of the retinal thickness in the optic disc zone were consistent with those of other researchers, indicating a possible increase in retinal thickness, but our results did not reach the level of statistical significance. A statistically significant thickening of the retina in the macular zone was shown for the first time, but the increase is significantly less in amplitude than the thickening of the nerve fiber layer in the optic disc zone. Analysis of vascular density under head-down tilt bed rest conditions was performed for the first time both for the optic disc zone and the macula zone, but additional studies are required to obtain steady conclusions. For the first time, an increase in retinal thickness in the macula zone in participants of head-down tilt bed rest experiments was shown; for the optic disc zone, data consistent with the results of other researchers were obtained. For the first time, angiographic data were obtained for the macula and optic disk areas, but the obtained differences in vascular density did not reach the level of statistical significance.

Chronic Pediatric Retinal Detachment with Multiple Macrocysts.

To describe a case of chronic pediatric retinal detachment with multiple macrocysts, its surgical management, and a review of the literature. Case report with fundus photography and optical coherence tomography. We describe a case of an asymptomatic, 11-year-old male with a chronic rhegmatogenous retinal detachment with multiple peripheral macrocysts. The patient had count fingers visual acuity upon presentation. The detachment was successfully surgically repaired with scleral buckling, subretinal fluid drainage, cryotherapy, with a SF6 tamponade. At the 12-month follow-up, the retina remained attached with improvement of visual acuity to 20/100 with resolution of the cysts. Optical coherence tomography revealed loss of macular ellipsoid zone. Genetic testing revealed a heterozygous dominant COL11A1 mutation. To the authors' knowledge, this is the first reported case of chronic retinal detachment presenting with multiple peripheral macrocysts in a pediatric patient with Stickler's Syndrome. More research is needed into the cause and significance of retinal macrocysts, particularly in the pediatric population.

Our experience of surgical treatment of peripheral retinoschisis without capturing the macular zone using scleral buckling

Purpose: to present our experience of surgical treatment of peripheral retinoschisis without macular involvement using a scleral buckle.Material and methods. 31 patients (31 eyes) with peripheral retinoschisis (PR) without macular involvement, including 19 cases complicated by retinal detachment, underwent scleral buckling with cryoretinopexy of rupture zones and vitreoretinal degeneration and transscleral drainage of subretinal fluid.Results. In 12 (39 %) cases, the retina reattached within 24 hours after the operation, in 11 (35 %) cases, it reattached within 1 week, while in 8 (26 %) cases complete resorption of the subretinal fluid and retinal reattachment occurred 1 to 6 months after the operation. By the end of the 6-month follow-up period, retinal reattachment was achieved in all cases.Conclusion. The surgical treatment tactics of PR without macular involvement by scleral buckling is effective and pathogenetically validated, especially in the case of progressing lretinoschisis.

Состояние сетчатки у пациентов, перенесших COVID-19 с поражением легких

Microvascular lesions are one of the main factors of lung and other organ damage in COVID-19. We hypothesized that patients with post-COVID lung dysfunction may also retain signs of systemic micro-vascular damage, in particular of the retina. Aim. To evaluate vascular and macular retinal area status in COVID-19 patients with pulmonary damage. Methods. 61 patient, average age 60.5 years, after in-patient COVID-19 treatment was examined. The volume of lung lesions according to high resolution computed tomography (HRCT) data ranged from 12 to 90 %. Decrease of diffusion capacity for carbon monoxide (DLCO) was observed in all patients after recovery: in 3 months in 18 patients (29.5 %) with severe COVID-19 DLCO was 58.4 % and in moderate COVID-19 – 73.2 % of the proper one. Optical coherence tomography (iVue-100, Optovue, USA) using Linear Scan and Nerve Fiber 3D Disc map was performed after 1 and 3 months. The control group included 20 patients comparable by sex, age, and comorbidity. Results. All patients showed typical signs of micro-circulatory disturbances in the posterior pole of the eye, increased caliber of arteries and first-order veins. In patients with severe COVID-19 an increase of arterial caliber by 22.5 μm and veins caliber by 35.04 μm, a decrease of retinal thickness in the macular region (by 8.78 μm in the fovea and by 6.6 μm in parafovea) compared to control group were revealed. After 6 months no significant dynamics of these parameters was revealed. Retinal changes in patients with moderate COVID-19 were similar but less pronounced. Conclusion.The revealed changes of retinal vessels and macular zone may indicate microcirculation disturbances and blood flow retardation in the posterior pole of the eye. The severity of the disturbances is comparable with the severity of the disease and the degree of DLCO reduction. Key words: COVID-19 with lung damage; retina; caliber of retinal vessels.

Optical coherence tomography angiography analysis of changes in the retina and the choroid after hemodialysis for end stage kidney disease.

To study effects of hemodialysis (HD) on retinal and choroidal vasculature in patients with end-stage kidney disease (ESKD) using optical coherence tomography angiography (OCTA). In this prospective study, we investigated eyes of patients undergoing hemodialysis for ESKD from Mondor University Hospital. Only one eye/patient was considered. Subfoveal choroidal thickness (SCT) was measured on enhanced-depth imaging optical coherence tomography (EDI-OCT) before and after the hemodialysis session. OCTA was used to extract retinal vascular density (superficial and deep capillary plexus, SCP, DCP) and choriocapillaris non-perfusion. Clinical, demographic and biological parameters (Blood B-Nitric Peptid rate prior to HD session) were reviewed. Twenty patients (mean age 53.2 ± 13.6years, 10 males and 10 females) were included in this prospective study. SCT significantly decreased after the HD session (234.3 ± 56.14µm before HD to 211.9 ± 60.79µm after hemodialysis (Wilcoxon signed-rank test, p = 0.003)). Non-perfusion in the choriocapillaris significantly increased after HD (41.65 ± 3.58 before HD, 42.95 ± 3.19 after HD, p = 0.036) while no significant modification of the vascular density was observed in the retinal vasculature (SCP, DCP) around the macular zone or the optic nerve. An increased plasma B-Nitric Peptide (BNP) level prior to the onset of the HD session was significantly correlated with the decrease of the SCT (r = 0.45, p = 0.043). Hemodialysis in patients with ESKD is associated with a significant decrease in SCT and an increase in non-perfusion in the choriocapillaris on OCTA. A High BNP level prior to the onset of the hemodialysis appears to be correlated with the decrease in SCT.

Etiopathogensis of Macular Diseases in Terms of Glymphatic Fluid Circulation

This article is an analysis of theoretical aspects of etiopathogenesis of the macular zone of the eye in terms of glymphatic circulation of tissue fluid. To date, a lot of data has been accumulated on functional and structural changes of the macular zone in normal and in various pathologies. The genesis of macular edemas along with subretinal and choroidal neovascularisation could be highlighted and understood from a different point of view if assuming the presence of the glymphatic para- and perivascular fluid flow within the retina, channels in the vitreous body and the choroid. Clinical features of the various eye diseases including hereditary, highlight the paravascular glymphatic outflow routes. As a result of the data analysis, a new theory of disease development in the macular region has been developed for the first time, which explains the pathogenetic mechanisms of occurrence and progression of macular pathology based on the principles of glymphatic current.

Girate atrophy: clinical and functional features

Gyrate atrophy is a rare genetic metabolic disease with an autosomal recessive inheritance that causes progressive chorioretinal atrophy, fundus manifestations, and decreased visual function. The prognosis of the disease largely depends on the development and progression of complications (macular changes and cataracts) as well as concomitant neurological and somatic pathology.&#x0D; AIM: To describe three clinical cases of hypertension.&#x0D; MATERIAL AND METHODS: We examined three children with gyrate atrophy at 4, 10, and 15 years old. All patients underwent a comprehensive ophthalmological examination, including modern diagnostics, visualization, and electrophysiological studies.&#x0D; RESULTS: Although older patients have more pronounced changes in the fundus with involvement of the macular zone in the pathological process, a 4-year-old child has pronounced functional retinal disorders detected during electroretinogram registration, indicating an earlier manifestation of the pathological process. Gyrate atrophy was combined with foveoschisis and ornithinemia in older patients (10 and 15 years old).&#x0D; The differential diagnosis of gyrate atrophy should be carried out with high myopia with areas of dystrophy of the cobblestone pavement type on the periphery of the fundus, resembling foci of chorioretinal changes in hypertension.&#x0D; CONCLUSION: Patients with gyrate atrophy require an interdisciplinary approach that includes not only ophthalmologists but also pediatricians, medical geneticists, and other specialists with comorbidities.

Case report of sclerochoroidal calcification

Background. Sclerochoroidal calcification is an idiopathic rare benign lesion of the sclera or choroid characterized by histological deposition of calcium pyrophosphate. Taking into consideration its similar clinical manifestations with other diseases of the sclera, the most dangerous of which are malignant, timely verification of the diagnosis with the appointment of a further observation period is important.The aim. The description of a clinical case of sclerochoroidal calcification to improve the efficiency of disease detection through the use of multimodal diagnostics.Material and methods. A 62-year-old patient with complaints of “bright flashes” in her left eye for the past few months, who underwent a standard complex of ophthalmological examinations, supplemented according to indications by optical coherence tomography of peripapillary nerve fibers, macular zone, B-scan, Dopplerography in color Doppler mapping mode. Auxiliary diagnostic methods were magnetic resonance imaging of the orbits and extraocular muscles, computed tomography of the orbits and a biochemical blood test.Results. Considering the anamnesis, the absence of progression of complaints, the data of instrumental diagnostic methods, the absence of pathological blood flow in the area of both eyes formations, the correct diagnosis is most likely to be sclerochoroidal calcification of both eyes, despite the difficulties of the diagnostic process, which consisted in the absence of visualization of foci during ophthalmoscopy. Conclusion. Sclerochoroidal calcification is of interest to practicing ophthalmologists due to the difficulties of diagnostic search and differential diagnosis with malignant neoplasms. Modern medicine has a sufficient set of instrumental and laboratory research methods for making an accurate diagnosis.

Intraocular complement activation is related to retinal vascular and neuronal degeneration in myopic retinopathy.

To investigate the relationship between the intraocular levels of complement proteins and myopia-related retinal neuronal and vascular degeneration. Aqueous humour from 147 myopic patients, including 60 low-myopia and 87 high-myopia were collected during Implantable Collamer Lens implantation surgery. All participants received comprehensive ophthalmic examinations, including logMAR best corrected visual acuity, axial length measurement, fundus photography and ocular B-scan ultrasonography. The myopic eyes were further classified into simple myopia (SM, n = 78), myopic posterior staphyloma (PS, n = 39) and PS with myopic chorioretinal atrophy (PS + CA, n = 30). Retinal thickness and vascular density in the macula (6 mm × 6 mm) and optic nerve head (4.5 mm × 4.5 mm) were measured using Optical Coherence Tomography (OCT) and OCT angiography (OCTA). The levels of complement proteins including C1q, C3, C3b/iC3b, C4, CFB, CFH, C2, C4b, C5, C5a, CFD, MBL and CFI in the aqueous humour were measured using the Luminex Multiplexing system. The real-time RT-PCR was conducted to examine the expression of complement genes (C1q, C2, C3, C4, CFI and CFD) in the guinea pig model of long-term form deprivation-induced myopic retinal degeneration. OCTA showed that retinal neuronal thickness and vascular density in superficial and deep layers of the macular zone as well as vascular density in the optic nerve head were progressively decreased from SM to PS and PS + CA (p < 0.05). The aqueous humour levels of C1q, C3, C3b/iC3b, C4, CFB, CFH, C2, C4b, C5 and CFI were significantly higher in high-myopic eyes compared to those in low-myopic eyes. Further subgroup analysis revealed the highest levels of complement components/fragments in the PS + CA group. The intraocular levels of complement factors particularly C3b/iC3b and C4 were negatively correlated with macular zone deep layer retinal thickness and vascular density and optic nerve head vascular density. The expression of C2, C3 and C4 genes was significantly higher in guinea pig eyes with myopic retinal degeneration compared to control eyes. The intraocular classical pathway and alternative pathway of the complement system are partially activated in pathological myopia. Their activation is related to the degeneration of retinal neurons and the vasculature in the macula and the vasculature in the optic nerve head.

Выяснение причин отслойки нейроэпителия с целью постановки корректного диагноза у пациентов с патологией макулярной области

Purpose. To assess the difficulties of finding out true cause of detachment of neuroepithelium in patients with various retinal pathologies. Material and methods. 3 patients (3 eyes) aged 51 to 59 years with complaints of sensation of a “spot» in front of the eye, decreased vision and metamorphopsia. The best corrected visual acuity ranged from 0.4 to 0.5. Rounded local prominating lesion – zones of local detachment of neuroepithelium, zones of local atrophy or defects in retinal pigment epithelium (RPE) were determined in all 3 eyes in the posterior pole of the eye. Results. According to results of optical coherence tomography (OCT), all 3 eyes had local serous detachment of neuroepithelium from 250 to 270 µm, local inclusions characterized by hyperreflective and heterogeneous RPE layer, episodically located in its layers hyperreflective areas with point breach in the Bruch membrane (“hard» drusen). Irregular RPE elevations (“wavy pattern») with its local fibrovascular detachment were determined. According to the results of OCT angiography, hyperreflective zones of the presence of a neovascular network in the layer of choriocapillaries under the areas of fibrovascular detachment of RPE, coinciding with zones of hyperautofluorescence, were revealed in all 3 eyes. In paired eyes of all 3 patients, “hard» retinal drusen in the macular zone were detected. Conclusions. 1. All 3 eyes were diagnosed with the wet form agerelated macular degeneration due to: their belonging to the older age group, low corrected visual acuity, the presence of complaints of metamorphopsia, irregular elevation and local fibrovascular detachment of RPE, the presence of local hyperautofluorescence, and presence of drusen on the double eye. 2. The use of OCT angiography makes it possible to differentiate between central serous chorioretinopathy and age-related macular degeneration by detecting choroidal neovascularization. Keywords: central serous chorioretinopathy, wet AMD, detachment of neuroepithelium

Влияние степени адгезии внутренней пограничной мембраны на результаты хирургии тракционного диабетического макулярного отека

Internal limiting membrane (ILM) peeling is a technically complex manipulation that is performed during macular surgery. Experts'opinions vary on its necessity. Visual inspection during surgery does not always make it possible to assess the degree of ILM adhesion to the retina. The aimof the study was to evaluate the morphofunctional parameters of the macular zone after ILM peeling with different degree of adhesion in the long-term postoperative period. Material and methods. A study was conducted that included 119 patients with type 1 (65 (55%) and type 2 (54 (45%) diabetes mellitus with proliferative stage of diabetic retinopathy (PDR) and tractional diabetic macular edema (tDME). All patients underwent a standard three-port 25G vitrectomy with the use of an additional endo-luminaire «chandelier» and bimanual membrane peeling technique. During ILM peeling, all patients underwent intraoperative optical coherence tomography (I-OCT) in order to assess the degree of ILM adhesion to the retina. Before, 1 and 12 months after the operation, the determination of the maximum corrected visual acuity (MCVA), OCT of the macular zone with the measurement of the central retinal thickness (CRT) was performed. Results and discussion. 3 degrees of adhesion of ILM to the retina were identified with I-OCT during ILM peeling. The degree of ILM adhesion in fovea significantly correlated with the development of a retinal defect in its central area. The development of retinal central zone atrophy showed a significant correlation with a decrease in MCVA 12 months after surgery and with the degree of ILM adhesion to the retina in patients with both types of DM. Conclusions. According to the results of this study, a significant correlation was shown between the degree of ILM adhesion to the retina determined by I-OCT and the risk of macular atrophy, which in turn is associated with low visual functions of patients after tDME surgery with ILM peeling. The resulting principle can be used in surgery of other vitreomacular interface pathologies. Keywords: vitreomacular interface, epiretinal membrane, diabetic macular edema, tractional diabetic macular edema, intraoperative optical coherence tomography, vitreoretinal surgery, proliferative diabetic retinopathy

Частота и клинические характеристики эпиретинальных мембран при диабетической ретинопатии

Purpose. The study of the frequency and clinical varieties of epiretinal fibrosis (ERF) in the macula in diabetic retinopathy (DR). Material and methods. Clinical material: 90 patients with DR (90 eyes). 29 eyes had nonproliferative DR, 31 eyes had preproliferative DR, and 30 eyes had proliferative DR. Optical coherence tomography of the macular zone of the retina was performed using the CIRRUS HD-OCT MODEL 500 device. The presence and characteristics of ERF were assessed. Results. The presence of ERF was found in 65 eyes (72.2%). With nonproliferative DR it was found in 10 eyes (32.2%), within the parafoveal zone. At the preproliferative stage of DR – in 25 eyes (80.6%), in the macula – in 16 eyes, in 9 cases – outside the vascular arcades. In proliferative DR, ERF occurred in all 30 eyes (100%). In 15 eyes – ERF without vascularization, in 10 eyes ERF captured the macula and vascular arcades. There were both planar and traction variants (49 and 16 eyes, respectively). Its fixation was the most common in the fovea zone (7 eyes). ERF vascularization was observed in 10 eyes with a pronounced stage of proliferative DR (of these, in 7 cases vascularized ERF was localized in the macular area, in 3 eyes it was localized in the area of vascular arcades). Conclusion. The presence of ERF was detected in the majority of patients with DR of various stages (72.2%), with a traction component it was found in 16 eyes. With the aggravation of the stage of DR, an increase in the frequency of ERF was noted. ERF, as a rule, captured the foveal region, it was characterized by a different area of coverage of the parafovea in cases of accessible visualization of the ocular fundus. Keywords: epiretinal fibrosis, diabetic retinopathy, macula

Value of optical coherence tomography angiography for the assessment of visual functions in children with retinopathy of prematurity

AIM: To compare and assess morphometric, structural, and microvascular parameters of the macular zone in children with cicatricial ROP grades IIII with different visual acuity from those in healthy peers.&#x0D; MATERIAL AND METHODS: Eighteen children (36 eyes) aged 818 years with cicatricial ROP grades IIII were examined. Ten peers (20 eyes) made up the control group. All children, in addition to the standard ophthalmological examination, underwent optical coherence tomography and optical coherence tomography with angiography (OCTA). The diagnosis was carried out on a tomograph RS-3000 Advance 2 (Nidek (Japan)). In the resulting 33 mm scans with a center in the fovea, the vascular and perfusion density of the superficial retinal capillary plexus (SCP), deep retinal capillary plexus (DSP), and the foveolar avascular zone, were measured, the thickness of the retina in the fovea was evaluated, and the structure of the neuroepithelium in the macula was assessed.&#x0D; RESULTS: In children born before 27 weeks, the central retinal thickness was higher than that in more mature children (231.818.2 and 208.215.2 m, respectively), and the relationship of this parameter with visual acuity was not explored. The vascular density of SCP in children with ROP and best-corrected visual acuity (BCVA) up to 0.4 and more than 0.4 were 1.46 mm-1 and 1.35 mm-1, respectively; and in the control group, it was 1.89 mm-1.&#x0D; The perfusion densities of the SCP in these groups were 9.2%, 10.03%, and 13.3%, respectively. The vascular densities of the Deep capillary plexus (DCP) in children with ROP with BCVA up to 0.4 and more than 0.4 were 2.8 mm-1 and 3.0 mm-1, respectively; in the control group, it was 3.2 mm-1, and the perfusion density of the deep capillary plexus (DCP) in indicated groups were 25.7%, 30.9%, and 31.7%, respectively.&#x0D; CONCLUSION: The analysis of the architectonics of the retinal vascular bed in children with ROP using OCTA makes it possible to assess the relationship between microcirculation disorders in the central zone of the retina and visual acuity, which is of great scientific and practical importance.

Дифференцированный подход к лечению пациентов с субретинальным кровоизлиянием на фоне возрастной макулодистрофии

Purpose. To determine the directions of a differentiated approach to the treatment of patients with subretinal hemorrhage (SRH) by of age-related macular degeneration (AMD). Material and methods. A total of 24 patients (25 eyes) with SRH by of AMD were treated. The mean duration of a hemorrhage from its onset to the start of treatment was 23.0 ± 17.9 days (range from 5 to 72 days). The size of the SRH varied from 1 DD to subtotal hemorrhagic retinal detachment. Prior to the onset of SRH, anti-VEGF therapy was performed in 11 (44 %) cases. Patients underwent the following treatment options for SRH: 1) anti-VEGF intravitreal injection (IVI) – 6 (24 %); 2) IVI anti-VEGF + IVI prourokinase + IVI ophthalmic gas (SF6, C2F6) – 4 (16 %); 3) vitrectomy (VE) + subretinal administration of prourokinase + IVI antiVEGF + IVI ophthalmic gas (C2F6, C3F8) – 13 (52 %); 4) VE + transplantation of PES – 2 (8 %). The average follow-up period for patients after treatment was 9.4 ± 5.4 months. Results and discussion. With the maximum follow-up period after the treatment, regardless of the method, it was possible to achieve hemorrhage displacement: partial – in 6 (24 %) patients, complete – in 19 (76 %) patients. At the maximum follow-up period, an improvement in BCVA in comparison with the preoperative one was observed in 15 (60 %) cases, no dynamics – in 7 (28 %) cases, and negative dynamics – in 3 (12 %) cases. In 2 (8 %) cases, after treatment for 3 and 6 months, a recurrence of SRH was observed, moreover, a larger size than the initial one. All patients underwent anti-VEGF therapy after the start of SRH treatment. Conclusions. A differentiated approach in the treatment of patients with SRH by of AMD has positive results in improving BCVA and shifting hemorrhage from the macular zone, and the choice of treatment method is determined by the size and duration of the existence of the SRH. Keywords: submacular hemorrhage, age-related macular degeneration, pneumodislocation, vitrectomy, anti-VEGF inhibitors, tissue plasminogen activator, retinal pigment transplantation

Оценка эффективности вторичной профилактики пациентов с ранней стадией возрастной макулярной дегенерации

Age-related macular degeneration (AMD) is one of the leading medical and social problems worldwide. The purpose of this study was to evaluate the effectiveness of drug prevention in patients with early-stage AMD lutein-zeaxanthin containing vitamin and mineral complex. Material and methods. The clinical study included 50 patients of the main group who took lutein-zeaxanthin containing a vitamin and mineral complex 1 capsule 1 time a day for 3 months 2 times a year, for 3 consecutive years, and 50 patients of the control group who did not receive drug therapy. Results. In the main group of patients, there was an increase in visual acuity, an improvement in indicators according to OCT data, and an improvement in the subjective perception of their own visual functions. At the same time, the patients of the control group had a deterioration in visual acuity, the progression of the disease according to OCT, which was manifested by the transition to the next stage of AMD. Conclusion. Drug therapy of early-stage AMD has a preventive effect on the progression of the pathological process in the macular zone. Keywords: age-related macular degeneration, vitamins, minerals, lutein, zeaxanthin

Влияние различных факторов на прогнозирование функционального результата при хирургии больших сквозных идиопатических макулярных разрывов

Purpose.To evaluate the effect of various factors on the prognosis of functional outcome after surgical treatment of large macular holes. Materials and methods. The results of surgical treatment of idiopathic macular holes (over 400 µm) in 47 patients (47 eyes) were analyzed. Endovitreal intervention of 25 or 27 G was performed with removal of epiretinal membrane and air tamponade. Results. Mean values of the best corrected visual acuity (BCVA) and retinal photosensitivity have been significant improved postoperatively: BCVA – from 0,12 ± 0,1 to 0,24 ± 0,18 (p&lt;0,01), photosensitivity – from 20,07 ± 3,85 dB to 21,43 ± 3,44 dB (p&lt;0,05). The mean value of the predicted BCVA according to the maximum hole diameter was 0.21 ± 0.0898. There was no dependence of BCVA on patients' age, duration of macular hole (more than 6 months) and anterior-posterior eyeball size (p&lt;0.05). Conclusion. Prediction of visual acuity after surgery is dependent by the initial retinal photosensitivity in the macular zone as well as the maximal diameter of the macular hole. Key words: idiopathic macular hole, microperimetry, vitrectomy, optical coherence tomography