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Features of a well-timed macular hole closure related retinal regmatogenous detachment complicated by macular hole. OPHTHALMOLOGY JOURNAL 2023. [DOI: 10.17816/ov109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
The literature review deals with the analysis of the timing and surgical techniques of macular hole closure in patients with retinal detachment complicated by macular hole. Modern concepts of treatment tactics for this disease, its efficacy are analyzed. Benefits and drawbacks of each of the discussed surgical treatment methods are specified.
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Fayzrakhmanov RR, Bosov ED, Shishkin MM, Voropaev VY, Sukhanova AV, Chekhonin ES, Mironov AV. [Modern aspects of the treatment of submacular hemorrhages secondary to macular degeneration]. Vestn Oftalmol 2022; 138:87-93. [PMID: 35488566 DOI: 10.17116/oftalma202213802187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Age-related macular degeneration complicated by submacular hemorrhage if not treated timely leads to permanent loss of central vision. The basis of effective therapy is its early start, dislocation of blood from central parts of the retina and blockage of neovascularization. This review examines the current methods of treatment of submacular hemorrhages, anatomical and functional outcomes, risks of postoperative complications, as well as trends in the use of combined methods of surgical intervention.
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Affiliation(s)
| | - E D Bosov
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - M M Shishkin
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | | | - A V Sukhanova
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - E S Chekhonin
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - A V Mironov
- Svyatoslav Fedorov Foundation for the Promotion of Advanced Medical Technologies, Moscow, Russia
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Kovalevskaya MA, Pererva OA, Roldugin AA, Kartamyshev EG. [Potential pitfalls of anti-VEGF therapy of neovascular age-related macular degeneration]. Vestn Oftalmol 2021; 137:149-156. [PMID: 34965081 DOI: 10.17116/oftalma2021137061149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
When administering anti-VEGF therapy for neovascular age-related macular degeneration (nAMD), it is necessary to take into account the fact that treatment outcomes - in addition to factors associated with the disease itself - may be affected by progressive concomitant conditions (for example, macular atrophy) and possible adverse events (AEs). The latter can be divided into two large groups: non-inflammatory and inflammatory. Intraocular inflammation (IOI) is a rare but potentially dangerous AE of anti-VEGF therapy, which can include endophthalmitis, early sterile inflammation and retinal vasculitis. Raising awareness about inflammatory AEs is becoming even more important due to the sheer number of intravitreal injections performed, as well as the frequency of cases of IOI when using new anti-VEGF drugs. The new anti-VEGF drug Brolucizumab is associated with the development of retinal vasculitis, which is considered a type III and IV hypersensitivity reaction (involving cellular and humoral immune responses, respectively). The article presents an overview of publications on the mechanisms, clinical manifestations, differentiation, and methods of treatment of various types of IOI.
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Affiliation(s)
- M A Kovalevskaya
- Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
| | - O A Pererva
- Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
| | - A A Roldugin
- Voronezh Regional Clinical Ophthalmological Hospital, Voronezh, Russia
| | - E G Kartamyshev
- Voronezh State Medical University named after N.N. Burdenko, Voronezh, Russia
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Bobykin EV, Korotkih SA, Krokhalev VY, Buslaev RV, Beresneva NS, Morozova OV. [Anti-VEGF therapy of wet age-related macular degeneration: analysis of patients lost to follow-up]. Vestn Oftalmol 2021; 137:66-74. [PMID: 33881265 DOI: 10.17116/oftalma202113702166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients lost to follow-up (LTFU) are a well-recognized challenge, both in clinical trials and in real clinical practice. PURPOSE To study the reasons for patients receiving anti-VEGF therapy for «wet» age-related macular degeneration (wAMD) in clinical environment to cease monitoring in the clinic. MATERIAL AND METHODS This retrospective cohort study included patients with wAMD which received anti-VEGF therapy (ranibizumab, aflibercept) in the Ural State Medical University clinic from 2011 to 2019 (n=241). A subgroup of patients continuing treatment (n=90) was compared with a subgroup of lost to follow up patients (LTFU, n=151, 62.7%). Observation lasting less than 12 months was an exclusion criterion. Statistical analysis included a comparison of demographic and clinical data. The reasons for treatment discontinuation were determined using a phone survey. RESULTS Characteristic for the LTFU subgroup were shorter duration of the follow-up (p<0.0001), lower number of intravitreal injections (p<0.0001), lower baseline (p<0.0001) and final best corrected visual acuity (p<0.0053) as well as higher values of therapy intensity coefficient (the ratio of the number of intravitreal injections to the duration of the follow-up, p<0.0001). According to the results of the phone survey, the following categories of LTFU were identified: ceased regular monitoring/treatment - 83 (55.0% of the LTFU subgroup), continued treatment in another clinic - 14 (9.3%), deceased - 18 (11.9%), status unknown - 36 (23.8%). The most common causes of LTFU were dissatisfaction with treatment results, financial burden and general comorbidities, which were named by 50, 27 and 17 respondents, respectively. CONCLUSION In accordance with identified reasons for LTFU, we determined the directions for increasing the effectiveness of wAMD treatment: early diagnosis and start of treatment; using the most effective drugs and therapeutic regimens; increasing the availability of anti-VEGF therapy.
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Affiliation(s)
- E V Bobykin
- Ural State Medical University, Yekaterinburg, Russia
| | - S A Korotkih
- Ural State Medical University, Yekaterinburg, Russia
| | | | - R V Buslaev
- Ural State Medical University, Yekaterinburg, Russia
| | - N S Beresneva
- Ural State Medical University, Yekaterinburg, Russia
| | - O V Morozova
- Ural State Medical University, Yekaterinburg, Russia
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Ivakhnenko OI, Neroyev VV, Zaytseva OV. [Age-related macular degeneration and diabetic eye lesion. Socio-economic aspects]. Vestn Oftalmol 2021; 137:123-129. [PMID: 33610160 DOI: 10.17116/oftalma2021137011123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Diabetic retinopathy (DR) and age-related macular degeneration (AMD) comprise a significant socio-medical problem for Russia. The article presents an analysis aimed at identifying the prerequisites for further research on the socio-economic consequences of retinal pathology. Studying the epidemiological aspects of DR and AMD, as well as the conditions for receiving medical aid helped define the main approaches to assessing the economic burden of retinal diseases in Russia. It also revealed the problems associated with completeness of registration and accounting of patients, the disparity between the volume of medical aid required and funding, and between the required and provided assistance for patients with these pathologies in clinical practice. Analysis of the disease cost will allow not only to determine the socio-economic consequences of retinal diseases, but also to find further directions for improving the quality of medical care for patients with DR and AMD in order to reduce its economic cost for the state and society. Evidently, there is a need for comprehensive assessment of the total burden of retinal diseases in Russia that would serve as a basis for subsequent assessment of the economic effectiveness of prevention and treatment measures.
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Affiliation(s)
- O I Ivakhnenko
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.,National Centre for Assessment of Health Technologies, Moscow, Russia
| | - V V Neroyev
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - O V Zaytseva
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia.,A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
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Fayzrakhmanov RR, Voropaev VY, Sukhanova AV, Shatalova EO. [Antiangiogenic therapy of neovascular age-related macular degeneration]. Vestn Oftalmol 2021; 137:83-93. [PMID: 33610155 DOI: 10.17116/oftalma202113701183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The problem associated with the prevalence of retinal diseases, and age-related macular degeneration (AMD) in particular, is undoubtedly relevant. This aspect is based on steadily growing statistics on morbidity, a high number of randomized controlled trials (RCT) and published real world data (RWD). The analysis of RCT results being published by researchers on 15.05.19 showed 2915 studies were registered on the subject of retinal diseases; that exceeds the number of studies on glaucoma by approximately 1.38 times (2118 studies) and conjunctival lesions by 2.37 times (1230 studies). AMD is one of the leading causes of irreversible vision loss and blindness; its neovascular form leads to blindness in 80-90% of all cases. Even though the topic of nAMD therapy is widely highlighted in modern ophthalmology, today there are many aspects that require targeted solutions. The main controversial issues that determine the complexity of therapy and patient management include discrepancies in determination of reference points (disease activity criteria) for implementation of anti-VEGF dosing regimens, patients' compliance, prioritization issues in treatment, its continuity with potential for the increase of intervals between injections and monitoring visits.
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Affiliation(s)
| | | | - A V Sukhanova
- N.I. Pirogov National Medical and Surgical Center, Moscow, Russia
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Abstract
Diabetic retinopathy (DR) is one of the most severe complications of diabetes mellitus, its treatment involves specialists of different areas - endocrinologists, diabetes specialists, therapists, cardiologists, surgeons, anesthesiologists etc. For ophthalmologists the objective is to diagnose ocular pathological changes associated with diabetes mellitus, and to prescribe required treatment in a timely manner. Treatment methods used in DR can be divided into three main groups: laser coagulation of the retina, intravitreal injection of medications - inhibitors of the vascular endothelial growth factor (VEGF) and glucocorticoids, as well as surgical treatment. The present literature review addresses the use of anti-VEGF drugs in the therapy of DR, specifically the latest medications, the most important studies on the treatment of DR and diabetic macular edema (DME), as well as post hoc analysis of such studies, the role of these medications in the therapy of refractory DME and proliferative stage DR. The review also addresses the upcoming strategies for therapy, as well as the importance of medications in prevention of DR and DME.
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Affiliation(s)
- E S Chekhonin
- National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia
| | - R R Fayzrakhmanov
- National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia
| | - A V Sukhanova
- National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia
| | - E D Bosov
- National Medical and Surgical Center named after N.I. Pirogov, Moscow, Russia
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Fayzrakhmanov RR, Sukhanova AV, Shishkin MM, Krupina EA, Pavlovsky OA, Larina EA, Karpov GO. [Changes in perfusional and morphological parameters of the macular area after silicone oil tamponade of the vitreous cavity]. Vestn Oftalmol 2020; 136:46-51. [PMID: 33056963 DOI: 10.17116/oftalma202013605146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the changes of the macular morphological and functional parameters in the postoperative period in patients with silicone oil tamponade after successful surgery of the macula-on rhegmatogenous retinal detachment (RRD). MATERIAL AND METHODS The study included 20 eyes operated on for macula-on RRD, which made up the first group, and the control group (20 eyes) for comparison. All patients of the study group underwent vitrectomy using silicone oil tamponade. Standard ophthalmological examination was performed on the 3rd day (early postoperative period) and the 14th day (late postoperative period), including OCT and OCT-A that were used to assess morphological and functional changes. RESULTS A significant decrease in visual acuity was seen on the 3rd day after surgery involving the use of silicone oil tamponade, in comparison with the 14th day (p=0.0237) and the control group (p=0.0001). A decrease in the FD parameter (p=0.045), a decrease in vascular density in the fovea (p=0.020) and parafovea (p=0.024) in SCP were found on the 3rd day in comparison with control. On the 14th day of postoperative observation, a tendency was detected for choroidal perfusion to restore, as well as significant increase in FD (p=0.016), and an increase in vascular density in parafovea (p=0.01) compared with the early postoperative period. No statistically significant changes were seen in the FAZ area and vessel density DCP (p>0.05).
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Affiliation(s)
| | - A V Sukhanova
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - M M Shishkin
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - E A Krupina
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - O A Pavlovsky
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - E A Larina
- Pirogov National Medical and Surgical Center, Moscow, Russia
| | - G O Karpov
- Pirogov National Medical and Surgical Center, Moscow, Russia
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Comparative analysis of morphological and functional methods of studying the condition of the central parts of the retina with relapse of macular rupture. КЛИНИЧЕСКАЯ ПРАКТИКА 2020. [DOI: 10.17816/clinpract25831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
in 8-10% of cases after surgical treatment, macular ruptures dont close. Objective: to assess the morphological and functional parameters of the macular area using the surgical method of closing previously operated macular ruptures using a free flap of the internal limiting membrane and silicone oil tamponade. This study involved 31 patients, all patients underwent surgical treatment according to the method using a free ILM flap and silicone tamponade, also the standard diagnostic procedures and optical coherence tomography and microperimetry were used (before the operation, on 14th and 30th day after the operation). A change of the morphological parameters of the retina has a direct correlation with a change of the functional parameters of the macular zone, and a peak of the increase in photosensitivity of the retina occurs in the early postoperative period with a slight increase in this indicator in the long-term postoperative period.
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Kamenskih TG. [A differentiated approach to analysis of retinal fluid and assessment of its effect on anti-VEGF therapy of neovascular age-related macular degeneration]. Vestn Oftalmol 2020; 135:134-140. [PMID: 32015318 DOI: 10.17116/oftalma2019135061134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neovascular age-related macular degeneration (nAMD) causes rapid irreversible vision loss presenting a serious socio-economic problem. The recommended approach to the treatment of this pathology is the use of angiogenesis inhibitors (anti-VEGF drugs). Following the proactive principles when conducting anti-VEGF treatment helps achieve the maximum therapeutic efficacy. The evolution of diagnostic capabilities and the rising awareness of the pathogenetic features of nAMD have contributed to implementation of a more personalized approach of conducting intravitreal injections, bringing to light the necessity of determining the diagnostic criteria for repeated anti-VEGF injections. Currently, the discourse looks at the subject of OCT criteria that could act as sufficiently reliable biomarkers to help decide the change in frequency of intravitreal injections. A differentiated approach to defining the role of retinal fluid as a marker of disease activity depending on the compartment of its localization on the OCT images has not been fully determined and is of particular scientific and practical interest. The importance of correct interpretation and understanding of differences in the effects of various types of retinal fluid on the frequency of anti-VEGF injections will be discussed in this review.
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Affiliation(s)
- T G Kamenskih
- Saratov State Medical University named after V.I. Razumovsky, 112 Bolshaya Kazachia St., Saratov, Russian Federation, 410012
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