Features of pathological changes in the retina and vitreoretinal interface in the macular zone in patients with diabetic macular edema

Background. Diabetic macular edema (DME) is one of the main causes of decreased central vision. Determining the reasons for the refractoriness of DME to treatment is an urgent problem.Aims. Based on the analysis of optical coherence tomography, to study the features of pathological changes in the retina and vitreoretinal interface (VRI) in the macular zone in patients with DME.Materials and methods. We studied 587 patients (587 eyes) with diffuse DME in the setting of nonproliferative diabetic retinopathy. In addition to the standard ophthalmological examination, everyone underwent optical coherence tomography of the macular zone with an assessment of structural changes in the retina, morphometric parameters, and the state of the VRI.Results. In 351 patients (59.80 %) with DME, pathological variants of the VRI were revealed, in which the best corrected visual acuity was significantly lower, and the morphometric parameters (retinal thickness and macular volume) were signifi cantly higher. Analysis of morphostructural changes in the macular zone revealed that in pathological VRI, neuroepithelial detachment and high edema are more common, and cystic edema is larger in area compared to the group with a normal VRI. With detachment of neuroepithelium against the background of a pathological VRI, the worst morphometric data are determined, with solid exudates in the macula, the worst indices of visual loss are determined.Conclusions. The pathological VRI in patients with diabetic macular edema occurs in more than half of the cases and is characterized by a high incidence of neuroepithelial detachment, high edema, higher morphometric parameters with worse visual acuity. At the same time, the presence of neuroepithelial detachment corresponds to the worst morphometric indicators of the macular zone, and the presence of solid exudates corresponds to a lower maximum corrected visual acuity. Further research is needed to assess the effect of the listed morphostructural and morphometric changes in combination with various pathological variants of VRI on the effectiveness of DME treatment.

Determination of the influence of predictors and the probability of retinal detachment in children based on the analysis of the odds ratio

The analysis of the influence of predictors on the probability of retinal detachment in children of the Minsk region was carried out on the basis of a study of the medical records of 660 children's patients treated at the Health care Institutions "4th Children's City Clinical Hospital" and “Minsk Regional Children's Clinical Hospital” for the period 2009–2019. Of these, 313 patients were older than 1 year with an established diagnosis of retinal detachment, 107 children under the age of 1 year, 240 children older than 1 year without retinal detachment at the time of treatment and the presence of predictors of its development (comparison group). To assess the influence of factors, a methodology based on the calculation of the odds ratio was used. The most significant risk factors were assigned a score equivalent from one to four, which allowed quantifying the probability of retinal detachment and identifying risk groups depending on the total score. The use of the proposed method allowed the children of the comparison group to identify changes in the vitreoretinal interface, which required primary laser preventive treatment in 46.7% of cases (113 eyes) during the three-year follow-up period, in 45.4% of children (109 eyes) it was limited only to dynamic observation without treatment. In 95.0% of children in the comparison group, it was possible to prevent the development of retinal detachment.

Retinal Histology and Anatomical Landmarks in Vitreoretinal Surgery

Awareness of important anatomical landmarks during vitreoretinal surgery contributes to favorable outcomes in the postoperative period. While external anatomical landmarks include pars plana, ora serrata, and vortex veins, long posterior ciliary nerves, vortex vein ampulla, and optic disc constitute the internal anatomical landmarks for vitreoretinal surgery. The forces that prevent the development of retinal detachment by keeping the retina in place are the retina pigment epithelium pump, the interphotoreceptor matrix, the presence of vitreous gel, and intraocular pressure. The main aim of the surgeon should be removing vitreous as much as possible and releasing vitreoretinal tractions which cause retinal detachment and vitreoretinal interface problems.

Navigated single-capture 3D and cross-sectional wide-field OCT of the mid and peripheral retina and vitreoretinal interface

Purpose: Assess the mid and peripheral neuroretina and vitreoretinal interface using a novel Navigated Single-Capture 3D and Cross-Sectional Wide-Field Swept-Source Optical Coherence Tomography (WF SS-OCT) technology with correlation to Multi-Wavelength Ultra-Widefield Imaging (MW UWFI) and Histopathology reference. Methods: Retrospective observational study. A total of 74 patients (148 eyes) were imaged using WF SS-OCT and Navigated Single-Capture twelve 23 mm cross-sectional radial scan pattern at 15° intervals. Image diagnosis included: congenital hypertrophy of the retinal pigment epithelium, choroidal nevus, ora serrata pearls, retinal tuft, lattice, snail track, cobblestone degeneration, retinal hole, retinal tear, degenerative retinoschisis, peripheral laser retinopexy, white without pressure, vitreous floaters, subclinical peripheral rhegmatogenous retinal detachment (RD), and tractional RD in proliferative diabetic retinopathy. WF SS-OCT images were correlated with MW UWFI and histopathological references where available. Results: WF SS-OCT successfully imaged structural features in all diagnoses with significant improvement in diagnostic capability and increased the diagnosis of specific features such as vitreoretinal attachment, full thickness hole or tear and subretinal fluid. Histopathological correlation was available for five (5) different peripheral retinal pathologies imaged by both WF SS-OCT and MW UWFI and good anatomical correlation was observed in all diagnosis. Conclusions: Navigated Single-Capture 3D and Cross-Sectional WF SS-OCT provides detailed anatomic information of the mid and peripheral neuroretina and vitreoretinal interface, allowing early recognition of vision-threatening features that may influence clinical management, particularly in an era of telemedicine or when there is limited or no access to Indirect Ophthalmoscopy with 360° Scleral Indentation.

EXPERIENCE OF COMBINED LASER TREATMENT IN COMPLICATED PERIPHERAL VITROCHORIORETINAL DYSTROPHIES

Currently, one of the topical subjects of ophthalmology is the study of morphological features of the vitreoretinal interface. Peripheral changes encompass a range of entities, from incidental findings to retinal detachment. Therefore, diagnosis and treatment in the zone of the peripheral interface seem relevant.Keywords: peripheral vitreochorioretinal dystrophy, regmatogenic retinal detachment, inner retinal border membrane, vitreoretinal interface, optical coherence tomography, restrictive retinal laser coagulation, laser tractotomy.

Comparative analysis of the effectiveness of antiangiogenic therapy and vitrectomy in the treatment of diabetic macular edema occurring against the background of the vitreoretinal interface pathology

Background. Diabetic macular edema is a specific complication of diabetes. Antiangiogenic therapy is an effective treatment for diabetic macular edema. Another manifestation of diabetic retinal damage is a change in the vitreoretinal interface. There is evidence of the effectiveness of vitrectomy in the treatment of other ophthalmic diseases with pathology of vitreoretinal interface. Purpose. Comparative analysis of the effectiveness of antiangiogenic therapy and vitrectomy in the treatment of diabetic macular edema occurring against the background of the vitreoretinal interface pathology. Materials and methods. The study involved 60 patients (60 eyes) with diabetic macular edema accompanied by vitreoretinal interface pathology. The patients were divided into 2 groups: group 1 30 eyes, which received antiangiogenic therapy with intravitreal injections of ranibizumab; group 2 30 eyes, on which vitrectomy was performed with removal of the internal limiting membrane. The observation period was 12 months. Results. In group 1, a significant increase in visual acuity was obtained 1 month after the intravitreal injections. During the observation and performing, if necessary, intravitreal injections, visual acuity decreased and by 12 months did not statistically differ from the initial one. In group 2, there was a gradual reliable increase in the visual acuity. A decrease in retinal thickness in the second group was significantly greater by the end of the study. The average number of intravitreal injections required during the observation in the first group was significantly greater than in the second group. Conclusions. In the patients with diabetic macular edema against the background of pathology of the vitreoretinal interface, vitrectomy led to a significant increase in visual acuity by 12 months of observation, in contrast to the patients receiving antiangiogenic therapy only. In the patients with diabetic macular edema and pathology of the vitreoretinal interface, complex treatment (antiangiogenic therapy + vitrectomy) led to a significant decrease in the thickness of the retina and the number of injections of angiogenesis inhibitors.