Surgical treatment of extensive submacular hemorrhage in patient with exudative age-related macular degeneration (clinical case)

Purpose. To evaluate the result of surgical treatment of submacular hemorrhage in patient with exudative age-related macular degeneration (AMD) by subretinal injection Gemase® and pneumatic retinopexy of blood clot. Material and methods. The article presents a clinical case of surgical treatment of submacular hemorrhage in patient with exudative AMD. The patient underwent three-port 25G vitrectomy, subretinal injection Gemase® 2000 ME by 38G needle, after which pneumatic retinopexy was performed. Results. Next day after the operation, there was displacement of subretinal blood clot from macula beyond out the lower vascular arcade. When observed after 6 months, the subretinal hemorrhage completely resolved, there was a regression of activity of subretinal neovascular membrane and macular edema, the retina was adherent in all cases. Visual acuity has improved. There was no recurrence of hemorrhage. Conclusion. This method of treatment allows you to increase and maintain the central visual acuity, as well as significantly reduce size of absolute central scotoma. Key words: submacular hemorrhage, recombinant prourokinase, Gemase®, exudative age-related macular degeneration, choroidal neovascularization, subretinal neovascular membrane.

The use of autologous conditioned plasma (acp) in surgery of severe posterior eye segment pathology. Three years of experience on using the technology

Purpose. To evaluate the effectiveness and long-term results of the use of autologous conditioned plasma in the surgery of open eye injury, including perforating eye injuries, surgery of the cicatricial stage of the subretinal neovascular membrane, rhematogenous retinal detachment, including retinal detachment with macular hole in people with high myopia with expressed scleral staphyloma, without the use of an additional laser coagulation of the retina and the almost complete exclusion of silicone tamponade. Material and methods. Since 2018, more than 250 patients with various vitreous pathologies of the posterior eye segment have been operated on perforating eye injuries, cicatricial stage of the subretinal neovascular membrane, idiopathic macular rupture, rhegmatogenous retinal detachment, including those with macular holes, including cases with high myopia and expressed scleral staphyloma. The developed technology of surgical closure of defects of the retina, choroid, sclera of various lengths using autologous conditioned plasma, made it possible to completely eliminate the need for laser coagulation of the retina, which in most cases would be difficult and unsafe, and to practically exclude silicone tamponade. A method of seamless sealing of sclero and conjunctivotomies with the variant of air tamponade using autologous conditioned plasma has been developed and successfully applied. Results. In the early postoperative period the patients in all clinical groups had no complications. Complete adhesion of the retina and sealing of defects in the structures of the eye after using autologous conditioned plasma without additional laser coagulation of the retina on the background of the applied air and silicone tamponade was observed in all patients. In the long-term follow-up period up to 28 months, there were isolated recurrences of retinal detachment after surgery of complex open eye injury, rhematogenous retinal detachment on the background of progression of proliferative vitreoretinopathy. More than 89% of patients had no complications in the long-term period. Complete closure of the sclero and conjunctivotomies without the use of additional suture fixation had been achieved. In all cases, the vascular pattern of the conjunctiva was preserved, in no case was a reactive process detected at the site of application of autologous conditioned plasma. Conclusion. The use of autologous conditioned plasma is an effective and safe method of sealing defects of the retina, choroid, sclera of various lengths in complex open eye injury, of surgery of rhematogenous retinal detachment, including high myopia and the presence of a macular hole, of surgery of the cicatricial stage of the subretinal neovascular membrane, allowing to completely eliminate the need for laser coagulation of the retina, minimize the need for silicone tamponade.

Optical Coherence Tomography Angiography of Macular Telangiectasia Type 2 with Associated Subretinal Neovascular Membrane

Optical coherence tomography angiography (OCTA) is a recently established noninvasive technology for evaluation of the retinal and choroidal vasculature. The literature regarding the findings in macular telangiectasia type 2 (MacTel2) is scarce. We report the OCTA findings associated with a subject with MacTel2 and secondary subretinal neovascularization (SNV). The commercially available Cirrus 5000 with AngioPlex (Zeiss, Jena, Germany) was used, without any subsequent image modification or processing. Subretinal neovascularization was detectable with OCTA at the level of the outer retina and choriocapillaris. Microvascular abnormalities associated with MacTel2 were present mostly in the deep capillary plexus of the retina temporally.

ANTI-ANGIOGENIC THERAPY IN PATIENTS WITH PATHOLOGIC MYOPIA AND CHOROIDAL NEOVASCULARIZATION

Purpose of the study: to study the efficacy and safety of Ranibizumab in patients with pathologic myopia and choroidal neovascularization (CNV).22patients (22eyes) with myopic CNV were included in the study. Mean age was 54.0±14.4years, axial length – 28.25±1.9mm, follow-up – from 12 to 59months (mean follow-up – 26.9±13.8months). Ranibizumab was administered intravitreally according to the label in patients with active CNV confirmed by fluorescein angiography. The treatment was shown to have favorable early and long-term outcomes. For example, visual acuity increased (from 0.25 to 0.54; p<0.01), central retinal thickness decreased (from 335.8 to 273.25μm; p<0,05), subretinal neovascular membrane area decreased (from 1272 to 969μm; p<0.05). Clinically significant treatment complications were not observed.Conclusions: The study confirmed high efficacy and safety of anti-angiogenic therapy.