The first experience of application of vessel endothelium growth factor inhibitor ranibizumab in complex therapy of retinopathy of premature in URFO in SAHI of the Sverdlovsk region MСMC «Bonum»

Material and methods. The study included 16 patients (31 eyes). Types and terms of treatment. Stage I in the treatment of ROP, laser coagulation of the avascular areas of the retina was performed in three patients with aggressive posterior ROP (4 eyes, 12.9%). In all patients, the progression of the disease was noted. Intravitreal injection of ranibizumab was performed in the period from 8 to 16 weeks (10.5±2.0 weeks), PCV from 32.3 to 39.6 weeks (37.0±1.8 weeks). Result. After laser treatment and IVI of ranibizumab, 11 patients (31 eyes, 81.6%) showed regression of the disease. In 5 patients (6 eyes, 19.4%) - progression. If the ROP progressed, a 25G or 27G lenssparing vitrectomy was performed. Complete regression of ROP was achieved in one patient (1 eye, 16.7%). Partial regression was observed in two patients (2 eyes, 33.3%). In two patients (3 eyes, 50%), the disease progressed to stage 5 with the development of total retinal detachment. Conclusion. As a result of the complex treatment of severe forms of the active stage of retinopathy of prematurity in the regional children's ophthalmological center MKMC "Bonum" in Yekaterinburg, the following data were obtained: complete regression with retinal adhesion is observed in 12 patients (26 eyes, 83.4%), of which in one patient (1 eye, 3.2%) regression was achieved after vitrectomy. Partial regression with the formation of a peripheral retinal detachment after vitrectomy was achieved in two patients (two eyes - 6.5%). Progression of retinopathy of prematurity to stage V with the development of total retinal detachment in two patients (3 eyes, 9.6%). Complex treatment of severe stages of active ROP using laser treatment, IVI and vitrectomy allows to preserve vision in 90.4% of patients. Key words: retinopathy of prematurity; intravitreal injection; laser coagulation of the retina; vitrectomy.

The experience of using platelet-rich plasma (PRP) in surgery of rhegmatogenous retinal detachment

Purpose. To evaluate the effectiveness of using platelet-rich plasma (PRP) as a blocking of retinal rupture without the use of silicone and gas tamponade (SF6, C2F6, C3F8). Material and methods. In the period from September 2020 to February 2021, in the conditions of the BUZ UR "Republican Ophthalmological Clinical Hospital" of the Ministry of Health of the Udmurt Republic, 12 patients aged 48 to 70 years were treated with a diagnosis of rhegmatogenous retinal detachment with the presence of peripheral tears. In 12 patients, breaks of different localization were revealed - in eight, in the upper half, in four in the lower half of the retina. Myopia was identified as a risk factor in 6 patients. Visual acuity before surgery ranged from 0.001 to 0.3. The operations were performed under retrobulbar anesthesia. In all cases, a subtotal 25Ga vitrectomy was performed with the removal of the posterior hyaloid membrane (PCM) to the extreme periphery and careful excision of the vitreous body in the area of retinal ruptures. The next stage is the introduction of PFOS to the level of the retinal defect, replacing it with air and draining the SRF, minimal endolaser coagulation of the retina around the retinal ruptures. At the final stage of the operation, platelet-enriched plasma was sequentially multi-layered on the rupture area until the rupture was blocked with a PRP layer. In all patients, the operation was completed with air endotamponade. Results. On the first day, visualization of the fundus was reduced in all patients due to air tamponade. By the 4th day, plasma enriched with platelets in the form of a gray film was determined on the surface of the retina in the zone of rupture, the resorption of which occurred within 2 weeks. The duration of the air tamponade averaged 7-10 days. Retinal adhesion in the early postoperative period was achieved in all patients. In 6 patients with the introduction of PRP, a picture of mild uveitis was observed, which was stopped within 1-3 days against the background of anti-inflammatory treatment. No other complications were observed. In the late postoperative period (after 2 weeks), complete retinal adhesion was maintained in 12 patients, visual acuity was 0.05-0.2. According to the data of the performed echography, phosphene and the study of the visual fields, no pathological changes were revealed. In the long-term postoperative period, complete retinal adhesion was noted in 10 patients, visual acuity with correction ranged from 0.3 to 0.5. At different times after the operation, a relapse of retinal detachment occurred in two patients. In one patient with multiple degenerative changes in the periphery of the retina, a relapse of detachment was revealed 2 months after surgery. In all likelihood, the relapse was associated with the emergence of new ruptures in the dystrophy zone and the presence of a proliferative process. In another patient, a relapse of retinal detachment was also observed 4 months after surgery due to the progression of PVR (post-traumatic retinal detachment). All patients with a relapse of retinal detachment within 1–2 days after the detection of a relapse underwent a second operation with revision of the vitreous cavity and subsequent silicone tamponade, which led to complete adhesion of the retina. Conclusion. ROS surgery by subtotal vitrectomy with blocking of retinal tears with platelet-rich plasma and air tamponade is an effective one-stage technique that minimizes the traumatic effect of the operation, reduces postoperative inflammatory complications, and also reduces economic losses. Key words: rhegmatogenous retinal detachment, platelet-rich plasma. Key words: rhegmatogenous retinal detachment, platelet-rich plasma

Retinal Anatomy, Mechanisms of Retinal Adhesion, Retinal Tears, and Pathogenetic Mechanisms of Retinal Detachment

Retinal detachment (RD) is the separation of the retinal pigment epithelium (RPE) and the neurosensorial layer of the retina. To ensure visual function, these two subunits must be in close contact with each other, but there is no mechanical bond between them. In the formation of this connection, mainly the adhesive forces due to RPE metabolism, interfotoreseptic matrix, and some pressure gradients are involved. Against these factors, the retina is also exposed to opposing forces. The most common cause of retinal tear is the posterior vitreous detachment (PVD). Retinal injuries are divided into subgroups as atrophic holes, retinal tears, and retinal dialysis. Lattice degeneration, degenerative retinoschisis, and peripheral cystoid degeneration are predisposing to the development of RD.

Novel role for αvβ5-integrin in retinal adhesion and its diurnal peak

αvβ5-Integrin is the sole integrin receptor at the retinal pigment epithelium (RPE)-photoreceptor interface and promotes RPE phagocytic signaling to the tyrosine kinase Mer tyrosine kinase (MerTK) once a day in response to circadian photoreceptor shedding. Herein we identify a novel role for αvβ5-integrin in permanent RPE-photoreceptor adhesion that is independent of αvβ5's function in retinal phagocytosis. To compare retinal adhesion of wild-type and β 5 -integrin −/− mice, we mechanically separated RPE and neural retina and quantified RPE protein and pigment retention with the neural retina. Lack of αvβ5-integrin with normal expression of other RPE integrins greatly weakened retinal adhesion in young mice and accelerated its age-dependent decline. Unexpectedly, the strength of wild-type retinal adhesion varied with a diurnal rhythm that peaked 3.5 h after light onset, after the completion of phagocytosis, when integrin signaling to MerTK is minimal. Permanent αvβ5 receptor deficiency attenuated the diurnal peak of retinal adhesion in β 5 -integrin −/− mice. These results identify αvβ5-integrin as the first RPE receptor that contributes to retinal adhesion, a vital mechanism for long-term photoreceptor function and viability. Furthermore, they indicate that αvβ5 receptors at the same apical plasma membrane domain of RPE cells fulfill two separate functions that are synchronized by different diurnal rhythms.