Retinal Pigment Epithelial Detachment Research Articles

Dynamics of rheological and biochemical blood parameters of patients with an intermediate stage of the dry form of age-related macular degeneration before and after serum cascade filtration

BACKGROUND: One of the socially significant ophthalmic diseases is the dry form of the age-related macular degeneration, the key feature of which consists in a slowly progressing damage to the pigment epithelium and the formation of drusen. However, the basic mechanisms of pathogenesis are still not completely clear nowadays. AIM: The aim is, using the data of OCT, OCT-angiography and visometry, to study the dynamics of structural and functional parameters of the macular area, as well as the dynamics of rheological and biochemical blood parameters in patients with an intermediate stage of the dry form of age-related macular degeneration before and after the use of serum cascade filtration. MATERIALS AND METHODS: The study included 63 patients (94 eyes) with an intermediate stage of the dry form of age-related macular degeneration. Patients were randomly separated into two groups. The first (main) group consisted of 34 patients (52 eyes), in whom serum cascade filtration was performed; the second group (control) group included 29 patients (42 eyes) who did not receive any specific treatment. In patients of the main group, before and after the serum cascade filtration course (1 month after the start of follow-up), in 6 and 12 months, in addition to standard ophthalmological examination, as an indicator of the efficacy of performed serum cascade filtration, the ultrasound triplex scanning in color Doppler mapping mode with an assessment of blood flow velocity in the posterior short ciliary arteries, Fourier IR spectroscopy, and the testing of the serum and blood viscosity were performed. Patients in the control group also underwent a similar examination at 1, 6, 12 months after the start of follow-up. RESULTS: According to optical coherence tomography, optical coherence tomography-angiography and visometry data, we found a positive dynamics of structural and functional parameters of the macular retina and an improvement in blood rheological parameters with an increase in microcirculation indices against the background of the serum cascade filtration use in treatment of patients with an intermediate stage of the dry form of age-related macular degeneration. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, being an evidence of the stabilization of the pathological process. CONCLUSIONS: This study showed that after the serum cascade filtration in patients with an intermediate stage of the dry form of age-related macular degeneration, against the background of an improvement in blood rheological and biochemical parameters, there was an improvement in structural and functional parameters of the macular area, which consisted in a decrease of the volume of the drusenoid retinal pigment epithelium detachment and in a visual acuity amelioration.

Dynamics of rheological and biochemical blood parameters of patients with an intermediate stage of the dry form of age-related macular degeneration before and after serum cascade filtration

BACKGROUND: One of the socially significant ophthalmic diseases is the dry form of the age-related macular degeneration, the key feature of which consists in a slowly progressing damage to the pigment epithelium and the formation of drusen. However, the basic mechanisms of pathogenesis are still not completely clear nowadays. AIM: The aim is, using the data of OCT, OCT-angiography and visometry, to study the dynamics of structural and functional parameters of the macular area, as well as the dynamics of rheological and biochemical blood parameters in patients with an intermediate stage of the dry form of age-related macular degeneration before and after the use of serum cascade filtration. MATERIALS AND METHODS: The study included 63 patients (94 eyes) with an intermediate stage of the dry form of age-related macular degeneration. Patients were randomly separated into two groups. The first (main) group consisted of 34 patients (52 eyes), in whom serum cascade filtration was performed; the second group (control) group included 29 patients (42 eyes) who did not receive any specific treatment. In patients of the main group, before and after the serum cascade filtration course (1 month after the start of follow-up), in 6 and 12 months, in addition to standard ophthalmological examination, as an indicator of the efficacy of performed serum cascade filtration, the ultrasound triplex scanning in color Doppler mapping mode with an assessment of blood flow velocity in the posterior short ciliary arteries, Fourier IR spectroscopy, and the testing of the serum and blood viscosity were performed. Patients in the control group also underwent a similar examination at 1, 6, 12 months after the start of follow-up. RESULTS: According to optical coherence tomography, optical coherence tomography-angiography and visometry data, we found a positive dynamics of structural and functional parameters of the macular retina and an improvement in blood rheological parameters with an increase in microcirculation indices against the background of the serum cascade filtration use in treatment of patients with an intermediate stage of the dry form of age-related macular degeneration. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, being an evidence of the stabilization of the pathological process. CONCLUSIONS: This study showed that after the serum cascade filtration in patients with an intermediate stage of the dry form of age-related macular degeneration, against the background of an improvement in blood rheological and biochemical parameters, there was an improvement in structural and functional parameters of the macular area, which consisted in a decrease of the volume of the drusenoid retinal pigment epithelium detachment and in a visual acuity amelioration.

Clinical, functional and aberrometric parallels in the treatment of the neovascular form of age-related macular degeneration

Purpose: to analyze clinico-functional and aberrometric parameters of patients with the neovascular form of age–related macular degeneration (nAMD) treated by the anti-VEGF drug brolucizumab. Material and methods. The study involved 59 patients (59 eyes) aged 55 to 75 years, divided into two groups depending on the type of treatment. Group 1 consisted of 25 patients (25 eyes) who had previously received no anti-VEGF therapy and Group 2 had 34 patients (34 eyes) with an active nAMD form, who had previously been given anti-angiogenic therapy with aflibercept. All patients averagely received 5.48±1.5 brolucizumab injections in the “treat and extend” mode: 3 loading injections with monthly checkups followed by elongated intervals reaching 8 weeks. The treatment effectiveness was estimated by the change in maximum corrected visual acuity (MCVA) as measured by precision visometry, the aberrations parameters of the optical system of the eye, and the thickness of the central retinal zone (CRZ). In addition, the height of retinal pigment epithelium (RPE) detachment, the presence of intraretinal fluid (IRF), subretinal fluid (SRF), and fluid under RPE. Results. In group 1, BCVA whose initial value was 0.37 ± 0.16 reached 0.78 ± 0.25 (p = 0.02) by the end of treatment, while in group 2, the value rose from 0.35 ± 0.18 to 0.62 ± 0.22 (p = 0.02). After the 5th injection, Group 1 showed a statistically significant decrease in TCZV (ave. by 270.17 ± 92.37 μm, p=0.05), while Group 2 showed a less pronounced morphological result (a decrease from 480.54 ± 174.22 to 320.32 ± 109.53, p < 0.05). Both groups also showed, after the 5th injection, a decrease in the cumulative frequency of occurrence of various types of fluid (p < 0.02). A decrease in all components of higher order aberrations was also noted after the first 3 injections; this result remained stable until the end of the observation period (p = 0.04). Conclusion. In Group 1 patients, we succeeded in achieving high morphological and functional results and maintaining them at a stable level until the end of the observation period. Group 2, patients with an active nAMD, previously treated with other anti-VEGF preparations, showed a less pronounced, though stable improvement in morphofunctional parameters.

Improvement in Central Serous Chorioretinopathy Following Multiwavelength Photobiomodulation Treatment - Case Report.

Central serous chorioretinopathy (CSCR) is a condition where fluid build-up accumulates underneath the retina, resulting in retinal pigment epithelium (RPE) detachment and vision loss. Irreversible retinal functional and anatomical changes are possible consequences. Research into novel strategies to aid in recovery are of interest. Photobiomodulation (PBM) uses light wavelengths to improve cellular function and shows positive effects in several conditions including those with edema. This prospective case report details a 39-year-old woman with CSCR. Multiwavelength PBM treatment was initiated with the Valeda® Light Delivery System. A series of treatment included nine sessions delivered over 3-5weeks. Follow-up treatments were conducted. Optical coherence tomography (OCT) imaging and best-corrected visual acuity (BCVA) measures were taken. The patient has been followed for approximately 1year. The patient presented with blurred vision and a BCVA score of 65 letters in the left eye. After 3weeks of observation, the patient's vision had further declined two lines on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart to 55 letters. Fluorescein angiography was performed, confirming CSCR diagnosis, and PBM was initiated. PBM treatment improved BCVA and fluid build-up in the RPE within 1week of treatment (three treatment sessions). Following the full series of treatment (nine PBM treatment sessions), fluid was completely resolved and BCVA scored at 80 letters. The patient had a repeat PBM treatmentseries ~ 6months later and has shown stable vision and no fluid present on OCT scan. The patient was seen again ~ 1year later with continued stable vision and no fluid detection. PBM is a non-invasive treatment option that may provide benefit in CSCR to resolve fluid build-up, macular change, and vision loss. Research into PBM as an immediate treatment option for CSCR, especially those with chronic presentations or those posed to have irreversible damage, is warranted to confirm effectiveness.

The factors associated with retinal pigment epithelium tear development in the early phase after treatment initiation for age-related macular degeneration.

This study aimed to evaluate the factors associated with retinal pigment epithelium (RPE) tear development in the early phase after anti-vascular endothelial growth factor (VEGF) drug initiation in eyes with neovascular age-related macular degeneration (nAMD) and retinal pigment epithelial detachment (PED). Treatment-naive eyes with nAMD and PED for which anti-VEGF drug injections had been initiated and followed up for at least 3months after the 1st anti-VEGF drug injection, were retrospectively investigated. Baseline characteristics of the PEDs, including type, height, and area, were evaluated using fundus photographs, fluorescein angiography, and optical coherence tomography images. The association between patient age, sex, medical history, PED characteristics, and the development of RPE tears within 3months of starting anti-VEGF therapy was examined. This study included 244 eyes (230 patients; mean age 75.0years, 159 males and 71 females). RPE tears occurred in 13 eyes (5.3%) within 3months of the start of anti-VEGF therapy. Multivariate analysis showed an association of the development of RPE tears with PED height (every 100µm, odds ratio [OR]: 1.50, 95% confidence interval [CI]: 1.07-2.12, p = 0.019), PED area (every 10 mm2, OR: 3.02, CI: 1.22-7.46, p = 0.016), and the presence of fibrovascular PED (OR: 59.22, CI: 4.12-850.59, p = 0.002). Eyes with cleft (the hypo-reflective space beneath the fibrovascular PED) were more likely to develop an RPE tear (p = 0.01, χ-square test). Fibrovascular PED, large PED area, high PED height, and the cleft finding are independent risk factors for the development of RPE tears early after the administration of anti-VEGF drugs.

Giant retinal pigment epithelium tears with membranous nephropathy: a case report and literature review

BackgroundKidney and eye diseases may be closely linked. Tears of the retinal pigment epithelium (RPE) have been reported to be related to kidney diseases, such as IgA nephropathy and light-chain deposition disease. However, pigment epithelium tears associated with membranous nephropathy have not been reported or systematically analysed.Case presentationA 68-year-old man presented with decreased right eye visual acuity. Optical coherence tomography (OCT) revealed cystic macular edema, localized serous detachment of the retina and loss of the outer retinal structure in the right eye and retinal pigment epithelium detachment (PED) combined with serous detachment of the retina in the left eye. Fundus fluorescein angiography (FFA) and indocyanine green angiography (ICGA) revealed giant RPE tears in the right eye and exudative age-related macular degeneration in the left eye. The patient also suffered from severe membranous nephropathy-autoimmune glomerulonephritis. Renal biopsy immunofluorescence revealed a roughly granular pattern, with immunoglobulin G (IgA), immunoglobulin G (IgG), IgM, complement C3(Components 3), λ light chain and κ light chain subepithelial staining.ConclusionsIt is hypothesized that severe membranous nephropathy caused immune complex deposition on the surface of Bruch membrane, resulting in weakened adhesion between the RPE and Bruch membrane and impaired RPE pump function, combined with age-related macular degeneration, leading to giant RPE tears in the right eye. Close attention should be given to the ocular condition of patients with membranous nephropathy to facilitate timely treatment and avoid serious consequences.

Predicting central choroidal thickness from colour fundus photographs using deep learning.

The estimation of central choroidal thickness from colour fundus images can improve disease detection. We developed a deep learning method to estimate central choroidal thickness from colour fundus images at a single institution, using independent datasets from other institutions for validation. A total of 2,548 images from patients who underwent same-day optical coherence tomography examination and colour fundus imaging at the outpatient clinic of Jichi Medical University Hospital were retrospectively analysed. For validation, 393 images from three institutions were used. Patients with signs of subretinal haemorrhage, central serous detachment, retinal pigment epithelial detachment, and/or macular oedema were excluded. All other fundus photographs with a visible pigment epithelium were included. The main outcome measure was the standard deviation of 10-fold cross-validation. Validation was performed using the original algorithm and the algorithm after learning based on images from all institutions. The standard deviation of 10-fold cross-validation was 73 μm. The standard deviation for other institutions was reduced by re-learning. We describe the first application and validation of a deep learning approach for the estimation of central choroidal thickness from fundus images. This algorithm is expected to help graders judge choroidal thickening and thinning.

Short-term outcomes of treatment switch to faricimab in patients with aflibercept-resistant neovascular age-related macular degeneration

PurposeTo report short-term outcomes of treatment switch to faricimab in real-world patients with aflibercept-resistant neovascular age-related macular degeneration (AMD).MethodsSingle-center, retrospective cohort study with chart-review using electronic injection database, electronic medical records, and optical coherence tomography (OCT) data from May to September 2023.ResultsA total of 50 eyes of 46 patients were analyzed. Faricimab treatment led to absence of fluid in 32% of the eyes and a reduction of fluid in 84% of the eyes. There was a statistically significant decrease in central retinal thickness (CRT) and pigment epithelial detachment (PED) height in those that responded to the switch (median difference: − 31 μm, IQR: 55, p < 0.0001 and median difference: − 21 μm, IQR: 36, p < 0.0001, respectively) and a statistically significant increase in CRT (median difference: + 19 μm, IQR: 20, p = 0.0143) and no change in PED height (median difference: + 22 μm, IQR: 64, p = 0.1508) in those that did not.Best-corrected visual acuity (BCVA) showed marginal decrease with low statistical significance. No ocular or systemic safety events were observed.ConclusionsOur findings suggest that switching to faricimab is generally safe and effective in patients with neovascular AMD who are otherwise difficult to treat and have residual fluid despite frequent injections with aflibercept. We observed a high rate of morphological response to the treatment switch, improvement of anatomical parameters with about one-third of patients having dry macula following a single injection, and a marginal change in BCVA. Sustainability of these results requires further investigation.Study registrationClinicalTrials.gov registration number: NCT06124677. Date of registration: 09/11/2023, retrospectively registered.

Double Layer Sign and Pigment Epithelial Detachment in Patients Treated with Subthreshold Laser for Central Serous Chorioretinopathy

Background and Objective Central serous chorioretinopathy (CSCR) is characterized by serous detachments of the central neurosensory retina. Besides, other alterations of the retinal pigment epithelium (RPE) of the focal detachment of the RPE can occur. We explored the frequency of RPE detachment and double layer sign in OCT in our patient population, the influence of subthreshold photocoagulation (ST-LP) on these parameters and the possibility of correlations with visual acuity. Materials and Methods We conducted a retrospective analysis of all patients who underwent ST-LP based on the diagnosis of CSCR in a German university eye clinic from 2009 to 2014. Measurements in OCT were performed regarding pigment epithelial detachment (PED) and double layer sign (DLS). Results 54 eyes of 49 patients were included in the study. The frequency of PEDs dropped from 66% of cases at baseline to 50% after 3 months. No significant differences in calculated areas of lift-off volume of PED were identified. The frequency of a DLS was significantly lower 8 weeks after ST-LP compared to baseline (63%, p&lt;0.05), but not after 12 weeks. Conclusion We conclude that PEDs and DLS are common in CSCR. In this study, no convincing correlation can be identified between BCVA before ST-LP or at the last visit and different characteristics of PED as well as DLS. While the area of PED becomes smaller after ST-LP, the extent of the DLS seems to increase. Further prospective studies are required, and DLS with respect to the occurrence of CNV should also be given attention.

Longitudinal Characteristics of Choroidal Neovascular Membrane in Pediatric Patients

To report the clinical and imaging characteristics, including optical coherence tomography angiography (OCTA), and treatment outcomes of choroidal neovascular membranes (CNVMs) in children. Retrospective clinical cohort study. Thirty eyes from 25 children (56% girls) with CNVM from 2 centers were examined from 2005 to 2022. Clinical features, imaging findings, treatment regimens, and outcomes are described. The most common causes of CNVM were idiopathic (48%) and inflammatory (20%). At diagnosis, most CNVMs were unilateral (80%), active (83.3%), and juxtafoveal (46.7%). Twenty-five eyes (83.3%) of 21 patients (84%) were treated. The most common first-line treatment was intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) (92%), with a retreatment rate of 52.2% at an average of 237 days. The average number of total injections per eye was 2.3. Injections were safely administered in the clinic (52.2%). A gain of 3 lines or 15 ETDRS (Early Treatment Diabetic Retinopathy Study) letters was observed at final visit. The average duration of follow-up was 56.46 ± 42.51 months. No ocular or systemic complication related to treatment was reported. Sixteen eyes (64%) had OCTA images at both presentation and final visit, which showed a decrease in CNVM vessel density and vessel-length density, and in the height of retinal pigment epithelium detachment (RPED). There are a variety of underlying etiologies for pediatric CNVMs, which are most often unilateral. Treatment with intravitreal anti-VEGF can be beneficial and does not often require frequent or chronic dosing. OCTA demonstrated a decrease in the CNVM vessel density and vessel-length density as well as in the height of RPED.

Early and late chorioretinal complications of preeclampsia

Preeclampsia remains a serious problem of obstetric practice, the growth of severe forms of this complication of pregnancy is predicted in the future, which determines the scientific interest of specialists in the search for new markers of preeclampsia to prevent the progression of preeclampsia and maternal mortality. The ocular fundus is an area where vessels can be observed in real time, in addition, the structure of the retina predisposes to the development of edema, up to retinal detachment in severe preeclampsia. In the last decade, new diagnostic equipment has become available to study chorioretinal changes at the stage of preclinical manifestations. In order to study early and late complications of pre-eclampsia from the retina and vasculature, we analyzed domestic and foreign scientific sources published in the last five years. According to a number of authors, changes in the visual organ of varying degrees of severity in preeclampsia occur in 100% of cases. It is established that the key role in the pathogenesis of vascular disorders in preeclampsia belongs to endothelial dysfunction. Preeclampsia may be accompanied by hemorrhagic and ischemic retinal infarcts, retinal pigment epithelium detachment, corkscrew-shaped tortuosity of arterioles in the periphery of the retina, retinal detachment, optic disc edema, less frequently vitreous hemorrhages, lesions of the optic nerve, conjunctiva and cerebral cortex in the area of visual centers, which may resolve against the background of therapy when the patient's general condition improves. However, in some women endothelial dysfunction may persist for many years, the most frequent late complications of preeclampsia are retinal detachment and diabetic retinopathy. Along with traditional methods of ophthalmoscopy of the eye fundus for diagnostics of chorioretinal complications OCT for determination of serous retinal detachment, subretinal deposits and other pathologies of the vasculature, USDG of the central retinal artery, posterior short ciliary arteries, ocular artery for diagnostics of ophthalmologic complications of preeclampsia can be used. As a result of the analysis of scientific data, conclusions are drawn about the association of preeclampsia with the development of certain early and distant chorioretinal complications. The search for new, earlier changes on the ocular fundus may serve for early diagnosis of preeclampsia, prevention of severe complications of pregnancy.

Comparative efficacy of aflibercept and ranibizumab in the treatment of age-related macular degeneration with retinal pigment epithelial detachment: a systematic review and network meta-analysis

ObjectivesTo evaluate the efficacy of anti-vascular endothelial growth factor (VEGF) in treatment of age-related macular degeneration (AMD) with retinal pigment epithelial detachment (PED).MethodsSystematic review identifying studies comparing intravitreal ranibizumab (IVR), intravitreal aflibercept (IVA) and intravitreal conbercept (IVC) published before Mar 2022.ResultsOne randomized controlled trial and 6 observational studies were selected for meta-analysis (1,069 patients). The change of best corrected visual acuity (BCVA) in IVA 2.0 mg group was better than IVR 0.5 mg (average difference 0.07) and IVR 2.0 mg (average difference 0.10), the differences were statistically significant. The change of the height of PED in IVA 2.0 group was better than IVR 0.5 group (average difference 45.30), the difference was statistically significant. The proportion of patients without PED at last visit in IVA 2.0 group were better than those in IVR 2.0 group (hazard ratio 1.91), the difference was statistically significant. There was no significant difference compared with IVR 0.5 group (hazard ratio 1.45). IVA required fewer injections than IVR, with a mean difference of -1.58.ConclusionsIVA appears to be superior to IVR in improvement of BCVA, height decrease of PED and regression of PED with less injections in nAMD with PED.

When Eagle Stares into The Eye

Retinal pigment epithelial detachment (PED) is the separation of the retinal pigment epithelium(RPE) from the Bruch’s membrane(BM). Eagle syndrome(ES) is characterized by an abnormally elongated styloid process with/without abnormal direction and/or ossification of the styloid ligament. Presence of both the above entities together is a rarest of rare sight. It may be a coincidence, or the diseases may have an association. Hence, further studies are warranted.

Multimodal Imaging of Bilateral Idiopathic Multifocal Retinal Pigment Epithelial Detachments in Young Patients.

To describe two cases of multiple epithelial detachments (PEDs) occurring in otherwise young, healthy patients. The medical and imaging records of two cases were reviewed retrospectively. Multiple serous non-vascularized pigment epithelial detachments (PEDs) were present in two young, healthy patients who underwent multimodal imaging. The first patient, a 38 year old woman, was incidentally found to have a visual acuity of 20/20 in both eyes and multiple bilateral PEDs. Imaging and a systemic work up was negative for secondary causes, and at 36 months vision remained stable although some of the PEDs had coalesced. The second patient, a 32 year old female, presented with distortion and perceived scotomas in both eyes progressive over the course of two years. Visual acuity was 20/20 and multimodal imaging confirmed the presence of bilateral PEDs. Bilateral idiopathic multifocal retinal PEDs in otherwise healthy young adults is a rare condition. Longer term follow up is needed to evaluate secondary complications and visual outcomes.

Retinal Pigment Epithelial Detachments Devoid of Retinal Pigment Epithelium.

To describe two patients with chronic central serous chorioretinopathy (CSC) showing what appeared to be retinal pigment epithelium detachments (PED) lacking imaging findings consistent with retinal pigment epithelium (RPE) over the elevation. The patients underwent comprehensive ophthalmic examination, including multicolor fundus photography, fundus autofluorescence (FAF), and spectral-domain optical coherence tomography (SD-OCT). A 70-year-old male and a 58-year-old male, both diagnosed with chronic CSC, showed PED-like lesions that were hypoautofluorescent, suggesting an absence of RPE. SD-OCT B-scans showed serous, dome-shaped elevations composed of a narrow, mildly hyperreflective band (9-10 μm thick) that demonstrated hypertransmission of light. The material that constituted the elevation was contiguous with the outer portion of the RPE band at the lesion borders. Based on the multimodal imaging findings we hypothesize that these elevations of the retina have lost their overlying RPE. A thin layer of material that could represent a residual layer of basal laminar deposit produced by the RPE remains overlying the detachments, possibly accounting for their dome shape and structural stability.

Diagnostic value of 3D Optical Coherence Tomography Multimode Images in the Diagnosis of Acute Central Serous Chorioretinopathy.

Spectral-Domain Optical Coherence Tomography (SD-OCT) provides non-invasive, high-speed, high-resolution, three-dimensional cross-section imaging of the macula. This study aimed to investigate the diagnostic value of the multimodal imaging technique of three-dimension (3D) optical coherence tomography (OCT) (3D-OCT) for the diagnosis and characterization of acute central serous chorioretinopathy (CSC). In this prospective clinical study 3D-OCT examinations of 82 cases with acute CSC were performed on the macular area, and the image characteristics were analyzed. Our study included a total of 87 eyes from 82 cases of CSC patients, 67 males and 15 females (mean age ± standard deviation (SD): 42.89 ±7.80 years old; age range: 27 to 56 years old. The 3D-OCT images were evaluated for the presence of subretinal fluid, subretinal space, fluctuation of the internal limiting membrane (ILM), folds of retinal pigment epithelial (RPE), retinal pigment epithelium detachment (PED), and flat irregular PED. The foveal thickness was measured using the manual caliper of OCT software. The OCT B-scan images showed 87 (100%) eyes had exudative retinal detachment (ERD), 38 (44%) had flat irregular PED, 36 (41%) had PED, 8 (9%) had subretinal turbidity structure, 2 (2%) had subretinal dot-like precipitates, 1 (1%) had focal choroidal excavation (FCE), and 1 (1%) eye had fluctuation of internal limiting membrane (FI). In the ILM-RPE thickness map, all eyes had a round or round like regular uniform domes. Fifty-seven (66%) domes were limited in the examination area and 30 (44%) domes were beyond the scope of this examination and only a partial section of the dome could be observed. In the en-face image, all eyes had a round or round-like black figure that corresponded with domes in the ILM-RPE thickness map. In RPE surface, 76 (87%) eyes had a shallow plate depression, 71(82%) had small focal uplift, and 1 (1%) eye had a focal concave feature. In the OCT ILM-RPE thickness, en-face image, and RPE surface maps, acute CSC exhibited specific imaging characteristics that can be helpful for reliable diagnosis and differential diagnosis of CSC.

Brolucizumab for recalcitrant macular neovascularization in age-related macular degeneration with pigment epithelial detachment.

To analyze anatomic and functional response to intravitreal brolucizumab in age-related macular degeneration recalcitrant to previous intravitreal anti-VEGF therapies. In this monocentric, one arm, retrospective study, eyes affected by neovascular age-related macular degeneration (nAMD) resistant to other intravitreally injected anti-vascular endothelial growth factor inhibitors were switched to intravitreal brolucizumab. All patients underwent ophthalmological examinations at baseline and in regular follow-up intervals. Best registered visual acuity (BRVA), Goldmann tonometry, intraocular pressure (IOP), central retinal thickness (CRT) and pigment epithelial detachment (PED) characteristics were analyzed at initiation of anti-VEGF treatment, at treatment switch, and at the end of brolucizumab loading phase. The study included 20 eyes of 18 consecutively treated patients (age: 77 ± 6 years). All eyes had macular neovascularization with PED. Previous treatments included intravitreal aflibercept, bevacizumab, and ranibizumab and had not resulted in a significant improvement in BRVA (0.5 ± 0.5 logMAR vs 0.5 ± 0.6 logMAR) or mean CRT (320 ± 60 µm vs 313 ± 83 µm) up to treatment switch to brolucizumab. At the end of the brolucizumab loading phase, there was significant improvement for both BRVA (0.3 ± 0.2 logMAR, P < 0.05) and CRT (264 ± 55 µm, P < 0.05). Under previous anti-VEGF therapy, there was a significant increase/deterioration in both PED area (2.68 mm2 to 5.18 mm2, P < 0.05) and PED volume (0.39 mm3 to 1.07 mm3, P < 0.05); however, both parameters improved after switching to brolucizumab (3.81 mm2 and 0.37 mm3, P < 0.05). Our results suggest a favourable anatomical and visual response after treatment switch to brolucizumab in patients with nAMD refractory to previous anti-VEGF agents.

Futibatinib (Lytgobi®)

Futibatinib (Lytgobi®)

Сравнительный анализ аваскулярных отслоек ретинального пигментного эпителия

Purpose. To study anatomical and functional parameters using optical coherence tomography in patients with avascular retinal pigment epithelium (RPE) detachment with age-related macular degeneration (AMD) and central serous chorioretinopathy (CSCR). Material and methods. 40 people with AMD and CSR were examined. Patients were divided depending on the type of RPE detachment: druzenoid – 10 patients, serous RPE detachment in AMD – 20 patients, serous RPE detachment in CSCR – 10 patients. Results. A comparative analysis revealed that serous avascular RPE detachment in AMD is characterized by the greatest height and width in relation to drusenoid RPE detachment and RPE detachment in CSCR. Avascular RPE detachment in CSCR are characterized by the smallest dimensions – both in height and width in relation to other avascular RPE detachments, and the greatest thickness of the choroid in relation to serous RPE detachment in AMD (p = 0.018). Conclusions. The identified features of avascular RPE detachment in AMD and CSCR allow us to choose an adequate tactics for managing patients. Key words: retinal pigment epithelium detachment, age-related macular degeneration, central serous chorioretinopathy

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