Retinal Laser Photocoagulation Research Articles

Современные алгоритмы терапии диабетического макулярного отека (Обзор литературы. Часть II)

This review presents up-to-date information on officially approved intravitreal angiogenesis inhibitors, provides the comparative analysis of the data obtained during large-scale randomized trials on their efficacy and safety as well as possible schemes of their administration. Special attention is paid to the problem of refractory diabetic macular edema and alternative therapies, including the use of glucocorticoids, inhibition of Rho/ROCK signaling pathway. The dynamics of the central foveal thickness according to optical coherence tomography and best-corrected visual acuity are the main criteria for evaluating the diabetic macular edema therapy effectiveness. According to current data, intravitreal injection of angiogenesis inhibitors is a first-line treatment. In diabetic macular edema, the following drugs have been registered in Russia: ranibizumab, aflibercept, brolucizumab, faricimab. Laser retinal photocoagulation is used mainly for the non-central edema treatment. Intravitreal glucocorticoids are considered as an alternative therapy, but their use is limited by the presence of side effects in the form of secondary drug-induced ophthalmic hypertension and/or glaucoma and the development of cataracts. However, the suboptimal response to standard treatment and the development of refractory forms stimulate the development of novel drugs and delivery systems, as well as the use of several types of therapy that affect different points of the pathogenesis. The review emphasizes the need to further study the trigger points of the diabetic retinopathy pathogenesis and the development of diabetic macular edema in order to find novel drugs and individualize the treatment of each patient. Key words:diabetic retinopathy, diabetic macular edema, vascular endothelial growth factor, VEGF-therapy

Aflibercept 5+PRN with retinal laser photocoagulation is more effective than retinal laser photocoagulation alone and aflibercept 3+PRN with retinal laser photocoagulation in patients with high-risk proliferative diabetic retinopathy and diabetic macular edema: a 12-month clinical trial.

This study aimed to investigate and compare the efficacy and safety of retinal laser photocoagulation (PRP) alone, PRP with aflibercept 3+PRN, and PRP with aflibercept 5+PRN in patients with both high-risk proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME). Overall, 170 patients with high-risk PDR and DME (170 eyes from 170 patients) who visited our ophthalmology clinic from December 2018 to December 2020 were divided into the PRP (n=58), aflibercept 5+PRN with PRP (n=53), and aflibercept 3+PRN with PRP (n= 59) groups. General information, such as age, sex, and eye category, was obtained. Moreover, best-corrected visual acuity (BCVA), baseline central macular foveal thickness (CFT), microaneurysm (MA), area of neovascularization (NV), area of hard exudate (HE), and cytokine levels in atrial fluid before and after treatment, were assessed. The χ2 test was used for comparison between groups for statistical data. Analysis of variance was used for the statistical description of measurement data, independent samples were analyzed using Student's t-test, and Student-Newman-Keuls test was used for group comparisons. Differences were considered statistically significant at P < 0.05. After treatment, no significant improvement in the BCVA (logMAR) of patients in the PRP group was observed. The BCVA (log MAR) decreased from 0.72 ± 0.17 and 0.74 ± 0.17 to 0.50 ± 0.13 and 0.53 ± 0.17 in PRP with aflibercept 5+PRN and PRP with aflibercept 3+PRN groups, respectively, with a statistically significant difference compared to those in the PRP group (P<0.05 in all cases). However, no statistically significant difference was observed between the combined treatment groups (P>0.05). The CFT in the PRP-only group decreased slightly from 361.80 ± 36.70 μm to 353.86 ± 40.88 μm, with no statistically significant difference (P>0.05), whereas the CFT in the aflibercept 5+PRN with PRP and aflibercept 3+PRN with PRP groups decreased from 356.57 ± 37.57 μm and 358.17 ± 44.66 μm to 284.87 ± 31.52 μm and 303.19 ± 37.00 μm, respectively, with statistically significant differences before and after treatment (P<0.05 for both groups). Statistically significant differences were observed in CFT between the three groups after treatment (P<0.05 in all cases). The number of MA (pcs) in the PRP, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups decreased from 118.34 ± 27.96, 118.60 ± 33.34, and 116.59 ± 28.95 to 92.95 ± 29.04, 44.60 ± 20.73, and 54.26 ± 25.43, respectively. The two-way comparison of the three groups revealed statistically significant differences in MA (P<0.05 in all cases). In the three groups, NV decreased from 1.00 ± 0.21 mm², 1.01 ± 0.18 mm², and 0.98 ± 0.20 mm² before treatment to 0.49 ± 0.17 mm², 0.31 ± 0.16 mm², and 0.38 ± 0.14 mm², respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, 13, 18, and 18 patients had reduced HE area in the PRP-only, aflibercept 5+PRN with PRP, and aflibercept 3+PRN with PRP groups, respectively, with statistically significant differences (P<0.05 in all cases). After 12 months of treatment, vascular endothelial growth factor, monocyte chemoattractant protein-1, and glial fibrilliary acidic protein levels (pg/mL) in the aqueous humor decreased in both combined treatment groups compared with that at baseline, with statistically significant differences; however, no significant difference was observed between the two combined treatment groups (P>0.05). Aflibercept 5+PRN combined with PRP was safe and effective in treating patients with high-risk PDR and DME, and was more effective than PRP-only and aflibercept 3+PRN with PRP in improving CFT and MA.

Diabetic corneal neuropathy and its relation to the severity of retinopathy in patients with type 2 diabetes mellitus: an in vivo confocal microscopy study.

To investigate corneal neuropathy and corneal nerve alterations in type 2 diabetes mellitus (DM) patients with different diabetic retinopathy (DR) status. A total of 87 eyes of 87 patients with DM and 28 eyes of 28 healthy control subjects were included in the study. DM patients were further classified into 3 groups: patients without DR (NDR), patients with non-proliferative DR (NPDR), and patients with proliferative DR (PDR). PDR patients were classified into 2 groups regarding having undergone retinal argon laser photocoagulation treatment (ALP). Ocular surface disease index score (OSDI), average tear break-up time (A-BUT), corneal sensitivity and cornea nerve fiber length (CNFL), cornea nerve fiber density (CNFD), and cornea nerve branch density (CNBD) of the cornea subbasal nerve plexus (SBNP) were measured using in vivo confocal microscopy (IVCM). OSDI scores increased and A-BUT decreased in DM patients compared to the control group, but no significant difference was found between DM patient groups. Corneal sensitivity decreased in DM patients who developed DR, compared to both the controls and the NDR group. CNFD and CNFL decreased in NPDR and PDR patients compared to controls. CNFD and CNBD decreased in patients who had developed PDR, compared to all three groups. All IVCM parameters decreased with DR progression. IVCM can detect early structural corneal nerve changes in diabetic patients. The presence of DM affects ocular surface parameters, especially in long-term DM patients. Corneal sensitivity loss is increased with the presence of DR. All IVCM parameters decrease with DR development and its progression.

Rhegmatogenous retinal detachment in highly myopic eyes with implantable collamer lens.

To investigate the clinical characteristics, treatment methods and outcomes of rhegmatogenous retinal detachment (RRD) in highly myopic eyes with implantable collamer lens (ICL). High myopia patients who received treatment for nontraumatic RRD after ICL implantation surgery at the Retinal Department of Zhongshan Ophthalmic Center from Jan 2018 to Dec 2022 were reviewed. Comprehensive ophthalmologic examinations including visual acuity measurement and digital fundus photography were performed in each patient. A total of nine RRD eyes from nine patients who received V4c-ICL implantation were included. The mean time from ICL implantation surgery to the diagnosis of RRD was 32.44±22.56mo (range, 1-60mo). At the initial visit for RRD, giant retinal tear (GRT), horseshoe tear, simple round hole, and horseshoe tear combined with round hole were detected in 3, 3, 2, and 1 eye(s), respectively, with macula-off in eyes. Eight patients received surgical treatment, and one patient was treated by retinal laser photocoagulation alone. The ICL was preserved in 7 eyes. At the last follow-up, the mean best corrected visual acuity (BCVA) improved significantly from 1.76±1.06 logMAR at presentation to 0.81±1.01 logMAR (P=0.035), and no case of recurrent retinal detachment was found. The morphological presentation of retinal breaks is diverse in this study. The ICL can be preserved in most cases during the course of retinal detachment repair surgery in our data, companied with acceptable visual and anatomical outcomes.

Bilateral Ocular Ischaemic Syndrome due to Carotid Artery and Cardiovascular Disease: A Case Report

Introduction : Ocular ischemic syndrome (OIS) is a rare but potentially blinding and fatal condition caused by carotid artery disease or other systemic condition results in ocular hypoperfusion.&#x0D; Case Illustration : A 62-year-old male with sudden bilateral vision loss, swelling, redness and pain of both eye for 7 days. There were dilated conjunctival and episcleral vessels, visual acuity of the right eye was hand movement and 0.05 for left eye, intraocular pressure (IOP) was 33 mmHg in right eye and 37 mmHgfor left eye. Anterior segment evaluation revealed rubeosis iris, mild anterior chamber reaction, and temporal angle neovascularization on gonioscopy. Both direct and consensual light reflexes were sluggish. Fundus examination showed normal optic disc, minimal hemorrhages at mid-periphery, narrowed arterioles, and minimal cotton wool spot. Macular OCT demonstrated discrete hyperreflectivity of inner retinal layers. From Macular Angiography OCT, ETDRS Central vessel density were 11.2% and 17.6% for the right eye and left eye, respectively. In both eyes, paracentesisof anterior chamber, intravitreal and intracameral injections of anti-VEGF were performed. Brain Magnetic Resonance Angiography Imaging revealed moderate stenosis of both distal carotid artery circulation. Percutaneous Coronary Angiography showed extensive stenosis in coronary artery, with low Ejection Fraction.&#x0D; Discussion : For the cardiovascular management, a pacemaker was implanted. One week after procedure, BCVA were 1/60 and 0.15, and IOPs of 17 and 18 mmHg, for the right and left eye, respectively. The patient was scheduled to have laser retinal photocoagulation.&#x0D; Conclusion : Quick clinical diagnosis, targeted workup for systemic associations, and prompt treatment might preserve life and sight in OIS.

Prevalence of strabismus in premature infants in an age-related perspective.

was to investigate the prevalence of strabismus in premature infants; to identify diagnostic indicators for predicting strabismus at the age of 3-8 years. The material was the data of 84 premature infants who underwent ophthalmological examination at the age of 6 months - 3 years and again - at 3-8 years. All children underwent ophthalmic examination for retinopathy of prematurity (ROP) in infancy. An increase in the frequency of strabismus occurrence among preterm infants was observed in 3-8 years compared to the data from 6 months - 3 years - from 13.3% to 20.0% in children without ROP, from 5.9% to 23.5% in children with self-resolving ROP, from 22.7% to 45.5% in children with ROP after laser retinal photocoagulation. The presence of strabismus and structural changes of eye at ages 6 months - 3 years increase the risk of strabismus at ages 3-8 years, OR = 6.5 (95% CI 3.8-11.3), (p < 0.001); OR = 4.2 (95% CI 2.8-6.2), (p = 0.005). The increase in the risk of developing strabismus at ages 3-8 years is associated with the presence of anisometropia, (p = 0.047), amblyopia, (p < 0.05). Children with higher visual acuity at ages 3-8 years have a decreased risk of strabismus, (p < 0.05). The frequency of strabismus occurrence among preterm infants has increased by ages 3-8 years. Strabismus, structural changes of eye at ages 6 months - 3 years increases the risk of strabismus at ages 3-8 years. Anisometropia and amblyopia increase in the risk of strabismus, higher visual acuity decreases risk of strabismus.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion.

To assess the long-term outcomes of treating macular edema (ME) associated with central retinal vein occlusion (CRVO) with a regimen of "5+pro re nata (PRN)". This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO (non-iCRVO group, n=15) and ischemic CRVO (iCRVO group, n=12). The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab, followed by reinjections as needed or PRN. Retinal laser photocoagulation or intravitreal dexamethasone implants (DEX) were implemented in both groups when necessary. The best-corrected visual acuity (BCVA, logMAR) and central retinal thickness (CRT) were recorded at baseline, at 1, 2, 3, 4, 5, 6, and 12mo, and at the final visit. The efficacy rates of BCVA and CRT before and after treatment were calculated. The number of injections at each visit and the incidence of adverse events were also recorded. The patients, aged 59.4±15.1y, were followed up for 24.7±8.8mo (range: 15-42mo). After treatment, BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR (P=0.038) at the final visit in all patients. Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points, but there was no statistical significance (P=0.197 and 0.33, respectively). The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups (all P<0.001). The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection, 48.15% for BCVA and 62.96% for CRT after 5 consecutive injections, and 74.08% for BCVA and 100% for CRT at the end of follow up. The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups (P>0.05). Laser treatment was applied to all eyes in the iCRVO group, while only 5 patients in the non-iCRVO group. Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch. DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group. The 5+PRN anti-vascular endothelial growth factor (VEGF) regimen is found to be safe and effective for both iCRVO and non-iCRVO, especially in the iCRVO group. The best regimen for such patients needs to be further investigated. Adjuvant laser therapy and DEX are necessary in some cases.

Prospects Using of Colour Doppler Imaging to Study Ocular Hemodynamics in Pregnant Women with Diabetic Retinopathy. Review

Color Doppler imaging became widespread for study hemodynamics in patients with vascular eyes pathologies. A number of studies have shown changes in ocular blood flow velocity and Doppler indices in patients with diabetes mellitus in both the absence and presence of diabetic retinopathy. With the progression of diabetic retinopathy, an increase in parameters’ changes was revealed, variations in ocular blood flow were studied after conservative treatment, retinal laser photocoagulation, against the background of anti-VEGF therapy. Due to its non-invasiveness, color Doppler imaging is used to assess orbital blood flow in pregnant patients at any gestational age. The works of this direction concern the assessment the changes in orbital blood flow during the physiological course of pregnancy and preeclampsia. However, there is still no information on the state of ocular blood flow in pregnant women with diabetes mellitus, which can serve as a basis for further research.

Visual outcome of treating proliferative sickle cell retinopathy in 108 eyes.

To report treatment methods and visual outcome of treating proliferative sickle cell retinopathy (PSCR). Retrospective interventional. Review of PSCR eyes treated between 2017 to 2022. Patient demographics, fundus findings at presentation, genotype, PSCR stage, treatment used, and visual outcome were assessed. 108 eyes of 88 consecutive patients were studied. Male: Female 48:40. Mean age: 38.91 (SD:12.52) years. Genotype: sickle cell haemoglobin C (SC) 83 eyes (76.9%), sickle cell haemoglobin S (SS) 19 eyes (17.6%), and sickle cell trait (AS) 6 eyes (5.5%). PSCR stages: 3: 15 eyes (11.0%), 4: 74 eyes (67.0%), and 5: 19 eyes (22.0%). Treatment methods: Intravitreal Injection (IVI) of anti-vascular endothelial growth factor (VEGF) only (27 eyes,25%), scatter retinal laser photocoagulation (SRLP) only (7 eyes, 6.5%), Vitrectomy + SRLP (29 eyes, 26.9%), IVI + SRLP (25 eyes, 23.1%), and Vitrectomy + IVI + SRLP (20 eyes, 18.5%). The treatment used correlated with PSCR stage (p = 0.000). IVI only was mostly used to treat stage 4 (81.4%), and SRLP only was used for stages 3 (42.9%) and 5 (57.1%). IVI + SRLP treated eyes had the best pre- and post-treatment vision. Vitrectomy + SRLP treated eyes had the most improved vision. SRLP only had least visual improvement. Fundus findings correlated with visual outcome (p = 0.003); but stage of PSCR, genotype and treatment used had no correlation (P > 0.05). Several options effectively treat PSCR. Visual outcome improved or remained same in 90.7% of treated eyes. Randomized controlled trials will determine the optimum treatment for each distinct presentation of PSCR. Treatment guidelines and a disease classification system of prognostic value are unmet needs.

An Artificial Intelligence System for Screening and Recommending the Treatment Modalities for Retinopathy of Prematurity.

The purpose of this study was to develop an artificial intelligence (AI) system for the identification of disease status and recommending treatment modalities for retinopathy of prematurity (ROP). This retrospective cohort study included a total of 24,495 RetCam images from 1075 eyes of 651 preterm infants who received RetCam examination at the Shenzhen Eye Hospital in Shenzhen, China, from January 2003 to August 2021. Three tasks included ROP identification, severe ROP identification, and treatment modalities identification (retinal laser photocoagulation or intravitreal injections). The AI system was developed to identify the 3 tasks, especially the treatment modalities of ROP. The performance between the AI system and ophthalmologists was compared using extra 200 RetCam images. The AI system exhibited favorable performance in the 3 tasks, including ROP identification [area under the receiver operating characteristic curve (AUC), 0.9531], severe ROP identification (AUC, 0.9132), and treatment modalities identification with laser photocoagulation or intravitreal injections (AUC, 0.9360). The AI system achieved an accuracy of 0.8627, a sensitivity of 0.7059, and a specificity of 0.9412 for identifying the treatment modalities of ROP. External validation results confirmed the good performance of the AI system with an accuracy of 92.0% in all 3 tasks, which was better than 4 experienced ophthalmologists who scored 56%, 65%, 71%, and 76%, respectively. The described AI system achieved promising outcomes in the automated identification of ROP severity and treatment modalities. Using such algorithmic approaches as accessory tools in the clinic may improve ROP screening in the future.

Radiation Retinopathy: Pathogenesis, Diagnosis, and Treatment

Radiation retinopathy is chronic retinopathy that usually after radiotherapy with delayed onset (6 months-3 years) and slow progression. The primary vascular event is endothelial cell loss. Clinically affected individuals may be asymptomatic or may describe decreased visual acuity. Combining anamnesis, complete ophthalmologic examination, and multimodal imaging is essential for diagnosis. The ophthalmological examination may reveal signs of retinal vascular disease such as microaneurysms (the first structural change detected ophthalmoscopically), cotton wool spots, retinal hemorrhages, perivascular sheathing, capillary telangiectasia, macular edema, and optic nerve head edema. Optical coherence tomography can detect macular edema, intraretinal hyperreflective spots that may develop secondary to ischemia, disorganization in the inner retinal layers, and deterioration in the outer retina. Fundus fluorescein angiography helps detect capillary perfusion anomalies and other signs of vascular disease. Diabetic retinopathy, retinal vein occlusion, ocular ischemic syndrome, hypertensive retinopathy, Coats' disease, and parafoveal telangiectasia should be considered in the differential diagnosis, and sometimes these diseases may accompany radiation retinopathy. Currently, there is still no standard treatment for radiation retinopathy. Anti-vascular endothelial growth factors (anti-VEGF) and steroid therapy are among the effective treatment options. Retinal laser photocoagulation can be applied for neovascular complications. For macular edema, focal laser photocoagulation was less effective than anti-VEGF and steroid therapy in terms of functional gain.

Is diabetic retinopathy screening worthwhile among people first diagnosed with diabetes at older ages? A cohort study of Norfolk diabetic retinopathy screening programme.

England's Diabetic Eye Disease Screening Programme offers screening to every resident over age 12 with diabetes, starting as soon as possible after diagnosis and repeated annually. People first diagnosed with diabetes at older ages have shorter life expectancy and therefore may be less likely to benefit from screening and treatment. To inform decisions about whether diabetic eye screening policy should be stratified by age, we investigated the probability of receiving treatment according to age at first screening episode. This was a cohort study of participants in the Norfolk Diabetic Retinopathy Screening Programme from 2006 to 2017, with individuals' programme data linked to hospital treatment and death data recorded up to 2021. We estimated and compared the probability, annual incidence and screening costs of receiving retinal laser photocoagulation or intravitreal injection and of death, in age groups defined by age at first screening episode. The probability of death increased with increasing age at diagnosis, while the probability of receiving either treatment decreased with increasing age. The estimated cost of screening per person who received either or both treatments was £18,608 among all participants, increasing with age up to £21,721 in those aged 70-79 and £26,214 in those aged 80-89. Diabetic retinopathy screening is less effective and less cost-effective with increasing age at diagnosis of diabetes, because of the increasing probability of death before participants develop sight-threatening diabetic retinopathy and can benefit from treatment. Upper age limits on entry into screening programmes or risk stratification in older age groups may, therefore, be justifiable.

Spontaneous Separation of Secondary Epiretinal Membrane (ERM) with Retinal Tear After Retinal Laser Photocoagulation

Introduction: Reporting a case of spontaneous separation epiretinal membrane (ERM) with retinal break and investigation of various dimensions and influencing factors. Case Presentation: The article presents a rare 44-years-old female clinical case spontaneous separation of secondary ERM. The patient had secondary ERM and Retinal tear in the right eye after complaining of losing vision. the patient had undergone 1 sessions of barrier laser photocoagulation for Retinal tear in the right eye. A method of cautious waiting was chosen. There was no surgical treatment. The spontaneous secondary ERM separation with the improvement in visual acuity, residual parapapillary fixation, and the diminution in retinal thickness were discovered during the subsequent visit. Conclusions: As spontaneous secondary ERM separation and improvement in visual symptoms is a possibility. Regular structural assessment and monitoring of the macular anatomy with OCT for spontaneous resolution of the ERM may help defer surgical intervention until the patient experiences significant and persistent reduction in vision or associated visual symptoms.

Aflibercept monotherapy versus aflibercept with targeted retinal laser to peripheral retinal ischemia for diabetic macular oedema (LADAMO)

ObjectiveWe tested the hypothesis that targeted retinal laser photocoagulation (TPRP) to peripheral retinal ischaemia reduces the overall burden of aflibercept injections when treating diabetic macular oedema (DMO) over a 24-month period.MethodsProspective, double-masked, multicentre, randomised controlled trial in Australia comparing aflibercept monotherapy, following a treat-and-extend protocol, or combination therapy of aflibercept and TPRP for DMO. The aflibercept monotherapy group received placebo laser. The primary outcome measure was the mean number of intravitreal aflibercept injections for each group at 24 months. Secondary outcome included: mean change in central macular thickness (CMT) and vision at trial completion, the proportion of eyes whose DMO resolved and the mean injection treatment interval. Ocular and systemic adverse events were recorded.ResultsWe enrolled 48 eyes of 47 patients; 27 eyes were randomised to combination therapy (aflibercept and TPRP) and 21 to aflibercept monotherapy. Thirty-two eyes (67%) completed the 2-year study. The number of intravitreal treatments given were similar for combination therapy (10.5 (SD 5.8) and monotherapy (11.8 (SD5.6)) (P = 0.44). The mean visual improvement (+4.0 (−1.8, 9.8) and +7.8 (2.6, 12.9) letters, P = 0.32), mean decrease in CMT (−154 (−222,−87) µm and −152 (−218,−86) µm, P = 0.96), proportion of eyes with CMT < 300 µm (48% and 67%; P = 0.50) and safety outcomes were similar in both the combination and monotherapy treatment groups (respectively).ConclusionsLaser to areas of ischaemic peripheral retina does not reduce the burden of intravitreal aflibercept injections when treating diabetic macular oedema.

Уникальный патологический и физиологический ангиогенез ретинопатии недоношенных в аспектах безопасности селективной анти-VEGF терапии

ROP in the developing retina of premature infants is unique because of the coexistence of physiological and pathological angiogenesis. The type of structure of the vascular nodes is the way to understand the selective treatment of ROP. Purpose. Identification of criteria for the selective ROP treatment choice using the type of pathological vasculogenesis. Material and methods. The study included 279 patients with ROP – 1 group (stage I), 152 (304 eyes); group 2 (stage II) – 45 (90 eyes); 3 group (III stage) – 8 (12 eyes); group 4 (IVA stage) –7 (8 eyes); 5 group (posterior aggressive ROP) – 7 (14 eyes); group 6 (immature retina) 60 (120 eyes) – control; 231 (188 eyes) patients with ROP referred for surgical treatment, divided into subgroups before and after lasercoagulation of the retina. Fractal dimension (Df) and complexity of vascular system (СVS) on wide-field images were assessed. Results. In the group before treatment Df 1.4374 ± 0.03, CVS 2.8 ± 0.14, in the group after treatment Df 1.3756 ± 0.03, CVS 2.3 ± 0.21. According to the morphometric data of 12 images, Df (p = 0.004) and CCC (p = 0.02) values were statistically different in subgroups before and after treatment. Low values of Df (&lt; 1.34) may indicate a more pronounced shift of angiogenesis towards pathological, since normally Df of the formed vasculature is 1.7. In this case, it is preferable to use anti-VEGF therapy. Conclusion. The Df and CVS are indicators are relevant parameters for evaluating the effectiveness of laser treatment in patients with ROP. Vascular patterns are unique for each post-conceptual age, CVS and Df are potential markers of the balance between pathological and physiological angiogenesis for the selective choice of ROP therapy. Keywords: retinopathy of prematurity, retinal laser photocoagulation, retinal vascular system, antiVEGF

Inhalation anesthesia in laser surgery of retinopathy of prematurity

Purpose: to assess the efficacy of inhalation anesthesia with laryngeal mask in extremely premature infants with low or extremely low birthweight and somatic comorbidities during the surgery of retinopathy of prematurity (ROP) in the active phase of the disease. Materials and methods. 477 infants of 25 to 32 weeks’ gestational age were treated by delimiting retinal laser photocoagulation. Inductive anesthesia with Sevoflurane (BAXTER HEALTHCARE Corp, USA) was followed by placing a laryngeal mask. The delimiting retinal laser photocoagulation was performed using laser devices with an adapter on a binocular forehead ophthalmoscope Supra (Quantel Medical, France) and LachtaMylon (Lasermedservis, Russia,). After the surgery, the recovery from sedation and return of consciousness took 7 to 10 minutes. Results. An inhalation of Sevoflurane with the adoption of a laryngeal mask airway significantly decreases complications of anesthesia in premature infants with comorbidities and reduces the length of hospital stay. The quick clearance of Sevoflurane makes it possible to begin feeding the infant one hour after the surgery. Conclusion. Inhalation anesthesia with Sevoflurane is a method ensuring that preterm infants receive adequate anesthesia in the treatment of retinopathy of prematurity in its active phase.

Topical glycerine for corneal clouding during retinal laser photocoagulation for retinopathy of prematurity.

To document the use of topical glycerine to reduce corneal edema in cases of retinopathy of prematurity (ROP) undergoing laser photocoagulation (PHC). Thirty-two eyes of 16 babies (9 males) with a mean gestational age of 30 weeks, mean gestational weight of 1242 grams underwent PHC for Type 1 (zone 1 disease) retinopathy of prematurity. All babies received a single PHC session. Twenty eyes of 10 babies received intravitreal anti-VEGF injection, 1-3 weeks before PHC session. All patients received a single drop of glycerine during the PHC session to clear the corneal clouding. All patients underwent PHC to the avascular area right up to the ora serrata. Patients were seen at one week and one month to assess the adequacy of laser PHC. We were able to complete the PHC for all babies in a single session without any ocular or systemic adverse events. We did not find any skip lesions at follow-up, and the second session of laser PHC was not required in any eyes. Topical glycerine is safe and effective to clear corneal clouding in eyes undergoing laser PHC for retinopathy of prematurity.

Retinal laser photocoagulation and intravitreal injection of anti-VEGF for hemorrhagic retinal arterial microaneurysm.

To evaluate the efficacy of retinal laser photocoagulation and intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) for hemorrhagic retinal arterial macroaneurysm (RAM). This was a retrospective clinical study. Patients with hemorrhagic RAM were divided into 4 groups defined by different treatments: a retinal laser photocoagulation therapy monotherapy group, an anti-VEGF intravitreal injection monotherapy group, a laser and anti-VEGF combination therapy group, and an observation group. Visual acuity (VA), central macular thickness (CMT), and retinal hemorrhage area (RHA) were collected. Forty-seven eyes of 47 patients were enrolled. VA improved and had a significant difference between baseline and final in each treatment group (logMAR; laser group: 1.90±0.53 vs 1.05±0.63, P<0.001; anti-VEGF group: 1.75±0.63 vs 1.12±0.54, P=0.009; combination group: 1.76±0.38 vs 1.01±0.52, P<0.001); however, VA decreased and had no significant difference in observation group (1.63±0.51 vs 1.76±0.61, P=0.660). CMT decreased and had a significant difference between baseline and final in each group (laser group: 815.16±310.83 vs 252.05±83.90 µm, P<0.001; anti-VEGF group: 725.00±290.79 vs 203.56±69.89 µm, P=0.001; combination group: 595.50±186.51 vs 253.13±55.06 µm, P=0.001; observation group: 758.88±195.65 vs 267.00±120.90 µm, P=0.001). RHA were 28.99±28.15, 25.94±11.58, 19.64±8.97, and 27.45±13.76 mm2 in laser group, anti-VEGF group, combination group and observation group, respectively. RHA was statistically correlated with final VA (P=0.032) in the observation group. Both laser and anti-VEGF treatments are effective for hemorrhagic RAM. Combination therapy reduces the number of injections of anti-VEGF. RHA is a visual prognosis predictor in the natural history of hemorrhagic RAM.

Optical coherence tomography biomarkers as predictors of transition to chronic central serous chorioretinopathy after retinal laser photocoagulation.

To explore the optical coherence tomography (OCT) biomarkers to predict the transition to chronic central serous chorioretinopathy (cCSC) after retinal laser photocoagulation. Patients enrolled in this study were from a 12-week clinical trial comparing the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) for CSC and had extended follow-up for more than 1 year. They were divided into two groups, transited to cCSC group (cCSC group) and did not transited to cCSC group (non-cCSC group) according to fundus examination at the extended follow-up. Collect the best-corrected visual acuity (BCVA) and OCT characteristics of patients at baseline and 12 weeks after laser treatment. Twenty-seven patients were enrolled (42.6 ± 7.7 years old), and duration of follow-up was 178.9 ± 88.8 (57.0-312.0) weeks. Nine patients (33.3%) were assigned to cCSC group, and the other 18 patients (66.7%) were assigned to the non-cCSC group. Twelve weeks after the laser treatment, subretinal fluid (SRF) of 15 patients (83.3%) in non-cCSC group and 5 patients (55.6%) in cCSC group absorbed completely; the height of SRF had statistical difference between two groups (p = 0.035); rough RPE was less common in cCSC group (p = 0.030); hyper reflective mass (HRM) was more common in cCSC group (p = 0.024); more number of hyper reflective foci (HRF) in outer segment of photoreceptor layer were detected in cCSC group (p = 0.035). From baseline to 12 weeks after laser treatment, the number of HRF in outer segment photoreceptor layer did not change significantly in cCSC group (p = 0.665) but decreased significantly in non-cCSC group (p = 0.000). A total of five patients suffered binocular CSC, three of them in the non-cCSC group occurred later than the other two in the cCSC group (129.9-278.3 weeks vs 96.1-114.9 weeks after baseline). SRF, rough RPE, HRM, and number of HRF in outer segment photoreceptor layer 12 weeks after laser treatment, and change in the number of HRF in outer segment photoreceptor layer from baseline to 12 weeks after laser treatment may predict the transition to cCSC.

Gas tamponade followed by laser treatment for macular retinal detachment secondary to optic pit.

The study aimed to describe anatomic and visual outcomes associated with perfluoropropane intravitreal injection followed by laser treatment for macular retinal detachment secondary to optic disc pit. A single-center, retrospective study. Medical records of all patients treated at a tertiary retina referral center were evaluated between 2011 and 2018 for congenital optic disc pit-associated macular detachment with 0.3 ml 100% perfluoropropane intravitreal injection followed by retinal laser photocoagulation along the temporal optic disc margin as the initial treatment. Six patients with optic disc pit-associated macular detachment were identified, with postoperative follow-up ranging from 13 to 52 months (mean: 28 months). Spectral domain optical coherence tomography (SD-OCT) showed complete fluid resolution without recurrence in five of the six cases. Four cases showed complete reabsorption after Intravitreal perfluoropropane plus laser, one patient needed an extra procedure (pars plana vitrectomy with inner limiting membrane peeling and pedicle flap inversion over the temporal optic disc margin) to achieve complete fluid reabsorption, and one patient had persistent intraretinal fluid and denied additional surgeries. The time between the initial procedure and total fluid reabsorption varied from 6.5 to 41 months (mean: 19.5 months). Best-corrected visual acuity improved after surgery on the last follow-up visit in all cases. 100% perfluoropropane intravitreal injection followed by photocoagulation along temporal optic disc margin was associated with anatomic and visual improvement in most cases, representing an alternative treatment approach for optic disc pit-associated macular detachment.