Time of vitreal surgery for active retinopathy of prematurity

Background. The anatomical and functional results of surgery for retinopathy of prematurity (ROP) are determined not only by the stage of the pathological process, but also depend on the timing of its implementation.The aim: to estimate the effectiveness of vitrectomy for severe active retinopathy of prematurity, depending on the timing of surgical treatment.Methods. Vitreoretinal surgery was performed in 138 children (198 eyes) with severe stages of ROP. All patients were divided into three groups depending on the timing of surgical treatment: group 1 – 42–48 weeks of postconceptual age (PCA), with the progression of ROP after laser coagulation of the retina (LCS), group 2 – 39–41 weeks of PCA, with the progression of ROP after LCS, group 3 – 36–39 weeks of PCA, without previous LCS. A 3-port transscleral 27-G vitrectomy was performed by all patients. At the postoperative period, the results of vitrectomy were estimated by the anatomical attachment of the retina. The follow-up period was 12 months. Results. In group 1, in 31 cases (73.8 %), the surgical intervention was completed with silicone tamponade. By the end of the follow-up period, anatomical retinal attachment was achieved in 17 eyes (40.5 %).In group 2, surgical intervention was completed with silicone tamponade in 29 eyes (42 %). By the end of the follow-up period, anatomical retinal attachment was achieved in 52 eyes (75 %).In group 3, surgical intervention was completed with silicone tamponade in 11 of 87 eyes (12.6 %). Anatomical retinal attachment was achieved in 80 eyes (92 %).Conclusion. Untimely vitrectomy (42–48 weeks of PCA) in cases of ROP progression after LCR led to a worse result. If progress of ROP after laser treatment happens, early vitrectomy (39–41 weeks of PCA) should be performed. Primary vitrectomy should be performed in case of the optimal timing of laser treatment has been missed (after 36 weeks of PCV).

Application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity

AIM: To conduct a retrospective study of the application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of prematurity in Ural State children`s ophthalmological center at State Autonomic Health Institution of the Sverdlovsk Region Multiprofile Clinical Medical Center BONUM in Yekaterinburg. MATERIAL AND METHODS: The study included 17 patients (33 eyes). The gestation age was from 23 to 30 weeks (mean: 26.51.7 weeks), birth weight was from 600 to 1850 g (mean: 867229 g). 8 patients (47%) had APROP, and 9 patients (53%) had ROP stage III, type 1, plus disease. Laser coagulation of the avascular areas of the retina as the start in ROP therapy was performed in three patients with APROP (4 eyes, 12.1%). Intravitreal injection of the anti-VEGF ranibizumab was performed in 17 patients (33 eyes), including patients with previous laser coagulation. The age of the patients at the time of injection was from 7.7 to 15.6 weeks (10.51.9 weeks), PCA from 32.3 to 39.6 weeks (37.01.8 weeks). Patients with stage IVa ROP (5 patients, 6 eyes) underwent 25G or 27G lens sparing vitrectomy. RESULTS: As a result of the complex treatment of ROP, the following results were obtained: complete regression in 13 patients (28 eyes, 84.8%). Partial regression in two patients (2 eyes, 6.1%). ROP progression to stage V in two patients (3 eyes, 9.1%). CONCLUSION: Complex treatment of severe stages of active ROP with laser treatment, IVI injections, ranibizumab, and vitrectomy made it possible to preserve vision in 90.9% of patients.

Treatment outcomes of central retinopathy of prematurity with localization in the Moscow regional perinatal center

BACKGROUND: Ranibizumab is widely used in retinopathy of prematurity. Therefore, it is necessary to evaluate the effectiveness, the risk of complications, and recurrence of the disease by antiangiogenic therapy. AIM: To demonstrate the experience of using anti-VEGF drugs in the Moscow Regional Perinatal Center and the effectiveness of different approaches to retinopathy of prematurity (ROP) treatment in the central retinal zone. MATERIAL AND METHODS: The case histories of 17 deeply premature infants with threshold ROP stages and localization in the posterior pole were retrospectively analyzed. Children were treated with intravitreal VEGF inhibitor (total 9 children), 5 children underwent laser coagulation of the retina, and 3 children received combined treatment (laser and intravitreal administration of a VEGF inhibitor). RESULTS: The average age of development of threshold stages was 35.2 weeks (range: 30.539 weeks) in our study. The frequency of promising outcomes after using anti-VEGF drugs alone or in conjunction with peripheral laser treatment was 100%. In comparison, the only laser treatment generated a promising result in 70% of the eyes. However, ROP relapses after anti-VEGF therapy developed at 37, 43, 44,5 weeks. In addition, 1 out of 9 children developed a recurrence of ROP and required laser treatment 7 weeks after using anti-VEGF. CONCLUSION: The use of anti-VEGF therapy is an effective method for the treatment of ROP of the posterior pole. However, there is the ambiguity of the available recommendations on the further management of children. Therefore, it is necessary to monitor the children who have received antiangiogenic therapy for as long as possible.

The study of the efficiency of micropulse transscleral cyclophotocoagulation in the combined treatment of patients with secondary neovascular glaucoma

Background: Neovascular glaucoma (NVG) is a highly refractory form, it is characterized by fast development and a high level of the intraocular pressure (IOP). Aims: To evaluate the effectiveness of micropulse transscleral cyclophotocoagulation (mCPC) in the combined treatment of patients with secondary neovascular glaucoma. Methods: The study included 32 patients (32 eyes) with secondary NVG as an outcome of diabetes mellitus and (or) thrombosis of the central retinal vein or its branches. The preoperative IOP averaged 38.88.8 mm Hg with the most intense hypotensive therapy. All the patients underwent mCPC. In the postoperative period, the patients were examined on the first day after the operation, then in 1 week, 1, 3, 6 months, 1 year after the operation. Results: All the operations were performed without complications. Pain syndrome in all cases was stopped on the first day after surgery. Six patients had reactive hypertension on the first day, therefore, the hypotensive therapy was intensified. The IOP 1 week after mCPC was 20.97.9 mm Hg, after 1 month of observation 23.76.0 mm Hg with the hypotensive therapy. 34 weeks post-surgery, six patients with the preserved visual function experienced a repeated IOP increase, and the Ahmed valve was implanted. 6 months after mCPC, the IOP level averaged 22.87.7 mm Hg with the hypotensive therapy. Against the background of the IOP compensation, anti-VEGF drugs were injected in 4 cases, followed by laser coagulation of the retina. Conclusion: Application of mCPC in NVG glaucoma patients showed only a small number of postoperative complications. This method of laser treatment can be used in combination with panretinal laser coagulation before or after the surgery, including administration of anti-VEGF drugs before or after the surgery. In case of the IOP increase, mCPC may be repeated.

Development a Method for Estimating a Safe Distance between Coagulates to Automatically Plan Retinal Laser Coagulation in Diabetic Retinopathy Treatment

Introduction. Diabetes mellitus is a common endocrine disease that can lead to retinal vascular damage caused by the spread of macular edema and the development of diabetic retinopathy. Currently, diabetic retinopathy is treated using retinal laser coagulation. However, since even modern systems do not demonstrate sufficient treatment efficacy, methods for providing laser coagulation support on the basis of patient data analysis are required.Aim. This paper aims to develop and study a method for estimating a safe distance between coagulates via the mathematical modeling of coagulation in order to provide laser coagulation support.Materials and methods. The problem of thermal conductivity is numerically modeled for laser action in a multilayer medium.Results. A method for estimating a safe distance between coagulates has been developed via the mathematical modeling of the thermal conductivity problem. An algorithm was established for reconstructing a three-dimensional fundus structure from OCT images. It was demonstrated that the convergence rate of the integro-interpolation method is higher than that of the finite difference method. The study revealed that the retina heats up to 45 ºС due to heat redistribution from the epithelial layer, as well as laser exposure. According to the study results, the developed method yields a safe distance of 180 µm. By increasing the delay between laser pulses by more than 10 ms, this distance can be reduced to 160 μm.Conclusion. The developed method can calculate distance corresponding to that used in medical practice. Besides safe distance, the use of this method will allow other laser coagulation parameters to be determined non-invasively: laser power and pulse duration recommended to achieve a therapeutic effect. These estimates can be used to automatically produce a preliminary laser coagulation plan to support diabetic retinopathy treatment.

Experience with different techniques of laser coagulation of placental anastomoses to relieve feto-fetal transfusion syndrome in monochorionic diamniotic twins

Introduction. In recent years, the problem of multiple fetuses has become particularly important, which is associated with a steady increase in the frequency of multiple pregnancies worldwide. The feto-fetal transfusion syndrome (FFTS) is a classic example of unbalanced functioning of placental anastomoses, which leads to transfusion between fetuses. The incidence of this syndrome in a group of monochorionic diamniotic twins ranges from 8% to 15% and, in the absence of timely diagnosis and intrauterine correction, leads to death of one or both fetuses in 70-100% of cases. The effect of different methods of intrauterine surgical correction of FFTS in monochorionic diamniotic multiple fetuses on perinatal outcomes is of scientific interest. Purpose of the study — to investigate the effect of different types of laser coagulation of placental anastomosis (LCPA) on perinatal outcomes in intrauterine surgical correction of FFTS. Materials and methods. Depending on the surgical technique used, women were divided into three groups: the total placental anastomosis coagulation method, Group 1 (58 pregnant women); the selective placental anastomosis coagulation method, Group 2 (67 pregnant women); the sequential selective laser coagulation of placental anastomoses, Group 3 (62 pregnant women). Results. We analyzed the results of intrauterine surgical correction of FFTS by different methods of laser coagulation of placental anastomoses in 187 women with monochorionic diamniotic type of placentation of II-IV degrees according to Quintero. We obtained statistically significant differences in many perinatal period indices depending on the LCPA method used. Discussion. Sequential selective LCPA has proven to be the most effective, safe, and promising technique for correction of FFTS. The data obtained indicate possible ways to improve pregnancy prolongation and fetal survival rates after the use of intrauterine surgical correction of placental vascular anastomoses. Conclusion. Sequential selective LCPA has proven to be the best technique to correct FFTS with the least perinatal losses and postoperative complications, as well as the highest efficacy.

THERMAL AND NON-THERMAL METHODS OF TREATMENT OF PATIENTS WITH PRIMARY VARICOSЕ DISEASES OF THE LOWER LIMBS OF STAGE C2

Treatment results of primary varicose disorders has been shown. The experience of using of thermal (endovenous laser ablation) and non-thermal methods (endovenous mechanochemical ablation, echo-controlled introduction of bioglue) in treatment of stage C2 chronic venous is shown. The purpose of this work is to evaluate the efficiency of endovenous ablation techniques. The treatment of 58 patients was analyzed. In the group of patients who underwent endovenous laser obliteration, reflux was not detected. In the group of patients with mechanochemical obliteration, reflux was determined in 3 patients (27.2%) at follow-up after 3 months required supplementation with foam sclerobliteration. In the group of patients with the introduction of bio glue, reflux was determined in 1 patient (20%) at the examination after 3 months. The received results lead to conclusion, that endovenous laser coagulation of affected veins is a reliable method of threatment, the gold standard. The advantage of non-thermal methods is the absence of thermal effects on the paravenous structures, respectively, patients have no pain during the procedure, increases comfort, and there is no risk of damage to the paravenous nerves. Another advantage of non-thermal techniques is no need to use of tumescent anesthesia, since only one puncture is required for the operation, which is comfortable for patients. The use of adhesive vein obliteration is justified in patients with signs of a short reflux duration and has an advantage for the patient due to the absence of the need for compression in the postoperative period. Non-thermal methods require further research and widespread implementation in practice.

Сombined (anti-VEGF and laser) treatment for operated secondary refractory neovascular glaucoma

Purpose. To develop an optimal algorithm for the management of patients with operated neovascular uncompensated glaucoma. Material and methods. 2 patients with operated secondary neovascular glaucoma of stage III-c. In the combined sequential therapy, the anti-VEGF medication Ranibizumab (0.5 mg) was used, laser coagulation of residual newly formed vessels, laser reconstruction in the surgical area, contact transcleral cyclolazercoagulation, and laser coagulation of the peripheral parts of the retina were performed. Results. The combined sequential treatment, combined with the appointment of antihypertensive drugs in drops, allowed to stabilize the level of IOP. IOP indicators remained at the level of normal values during 1 year of follow-up. Conclusion. The use of combined laser technologies and anti-VEGF therapy makes it possible to potentiate and prolong the hypotensive effect in the treatment of patients with operated secondary refractory neovascular glaucoma. Key words: operated neovascular glaucoma, anti-VEGF, combined laser treatment.

Experience of using scleroobliteration in venous angiodysplasia (results of 12-month follow-up)

AIM: To evaluate the results of using the minimally-invasive technique of scleroobliteration in patients with venous malformations. MATERIALS AND METHODS: From 2006 to 2020, 41 interventions were performed for venous-cavernous angiomatosis of various localization through scleroobliteration. Nineteen patients (46.3%) underwent complex treatment, which included a combination of this minimally-invasive technique with other surgical interventions (resection of angiomatous tissues, laser coagulation, and radiofrequency obliteration). RESULTS: Clinical improvement was achieved in 38 (92.7%) patients. According to the data of ultrasound control, 25 patients (61%) experienced no blood flow in the obliteration zone, and there was regression of the initial symptoms within 1 year of observation following intervention. The results of treatment were better due to the local spread of the angiomatous process. With diffuse forms, it was not possible to achieve a positive effect in 3 patients (11.1%). CONCLUSION: Scleroobliteration can provide a positive result in the treatment of patients with venous-cavernous angiodysplasia, both as an independent method and in combination with other minimally-invasive techniques.