Vol 13, No 4 (2020)

Aim. To study predictive factors for functional outcome of aflibercept intravitreal antiangiogenic therapy in patients with neovascular age-related macular degeneration (nAMD).

Material and methods. Thirty-six treatment naive nAMD patients (45 eyes, 26 females and 10 males, with a mean age of 74.4 ± 10.9 years) were included in this study. All patients received 3 monthly aflibercept injections followed by 4 bimonthly aflibercept injections. Demographic characteristics, baseline best corrected visual acuity (BCVA), central retinal thickness (CRT), and structural retinal changes on optical coherence tomography (OCT) scans were evaluated for the correlation with BCVA after 10 months follow-up.

Results. At the end of the follow-up period, the mean BCVA increased statistically significantly from 31 ± 15 (~0.32) letters at baseline to 37 ± 14 (~0.4) letters (p = 0.003). CRT at baseline and at the end of follow-up was 357 ± 110 and 269 ± 70 µm (p < 0.001), respectively. Final BCVA correlated statistically significantly with baseline BCVA (r = 0.62, p < 0.0001), baseline CRT (r = –0.48, p = 0.001), and disease duration from the appearance of complaints until the therapy start (r = –0.32, p = 0.03). Structural macular changes on the OCT scans were not related to final BCVA (p > 0.05) apart from the status of the ellipsoid zone (p < 0.001). Final BCVA was statistically significantly lower in males than in females (34.7 ± 14.0 (~0.4) and 45.0 ± 9.2 (~0.63) letters, respectively, p = 0.03).

Conclusion. Baseline visual acuity, gender, CRT, disease duration from the appearance of complaints until the therapy start, and status of the ellipsoid zone are predictive for the functional outcome in wet AMD patients.

The aim of the study was creating a model and evaluating the effect of elevated IOP in the anterior chamber during phacoemulsification on the changes in the stress state of various ocular structures.

Materials and methods. A simplified axial symmetrical anatomical model of the eyeball was created using the finite element method. Using the Deform software package, the deformation problem was worked out by calculating the redistribution of the excess pressure in the anterior chamber during phacoemulsification, on the changes in the stress state of different ocular structures. Results. At processing of modeling results, data were obtained on redistribution of the excess pressure delivered to the anterior chamber towards its decrease in the posterior pole area. The pressure level amounted to 0.85 % of excess pressure applied. The findings are supported by few animal experiments.

Conclusions. Proposed model of the increased IOP level effect on changes in the stressed state of various ocular structures demonstrates that the autoregulation mechanism maintaining ocular blood flow at a constant level includes a compensating mechanism for a steep IOP increase due to elastic properties of the vitreous body. This model allows calculating the redistribution of pressure in different parts of the eyeball, depending on the state of resilient-elastic properties of the vitreous, as well as on avitreal eyes, and in patients with silicone oil tamponade.

Purpose. To optimize the differential diagnosis of chronic central serous chorioretinopathy (CSCR) and of adult-onset vitelliform dystrophies (VD). Research objectives. On the multimodal diagnosis basis, to investigate signs characteristic for VD and chronic CSCR using mathematic modeling, to elaborate algorithms of their differential diagnosis in settings of differently equipped clinics.

Materials and methods. 61 patient (90 eyes) with long-term neuroepithelial detachments (NEDs) were included in the study. In all patients, the disease history was collected, including the family history; all patients underwent a standard ophthalmologic examination: visual acuity testing including best corrected visual acuity (BCVA), biomicroophthalmoscopy, fundus photography, spectral domain optical coherence tomography (SD-OCT) and optical coherence tomography angiography (OCT-A), short-wavelength autofluorescence (SW-AF), fluorescein angiography (FA), indocyanine green angiography (ICGA). Patients were divided into two groups: with vitelliform dystrophies — 30 patients (30 eyes), and with CSCR — 31 patients (31 eyes). To estimate the probability of disease detection, binary logistic regression method was used.

Results. Diagnostic predictors found in both groups were scrutinized; mathematical models for estimating the probability of disease detection were obtained. Differential diagnostics algorithms have been developed taking into account the resulting formulas for calculating the probability of disease detection, including criteria of different examination combinations: SD-OCT (area under ROC curve 0.946); BAF (area under ROC curve 0.955), SD-OCT and SW-AF (area under ROC curve 0.980); SW-AF, FA and ICGA (area under ROC curve 0.989).

Conclusion. The obtained models make it possible to carry out differential diagnosis of vitelliform dystrophies and chronic CSCR in settings of differently equipped clinics.

Presentation of a clinical case of acute keratoconus treatment by the intracameral platelet-rich plasma administration. Clinical and morphological improvement was registered from the first postoperative day, corneal edema and bullous changes completely resolved during 3 weeks. No side effects were observed. The outcome is confirmed by anterior segment optical coherence tomography data Intracameral platelet-rich autologous plasma administration is a safe and effective method of acute keratoconus treatment.

In the review, the analysis of the most common ophthalmic standardized tests for evaluating reading was carried out: Bailey–Lovie Word Reading Charts, MNREAD Acuity Chart, Radner reading chart, Smith–Kettlewell Reading Test (SKread), IReST, Salzburg Reading Desk, Ramulu test, Radner paragraph optotypes, Balsam Alabdulkader–Leat (BAL) chart, Chinese Reading Acuity Charts (C-READ), chart for reading threshold and reading speed evaluation by T.S. Egorova. The following parameters were considered: maximum reading speed, reading threshold, reading acuity, reading accessibility index, threshold reading speed. Recovering the ability to read fluently is one of the criteria for assessing the success of treatment, as well as quality of life for patients of various age groups

Background. Anti-VEGF therapy is currently regarded as the “gold standard” for the treatment of many macular diseases, while the results of its application in real clinical practice are often inferior to those from randomized clinical trials.

Materials and methods. A study group was formed on the basis of a retrospective analysis of the medical data of patients who received anti-VEGF therapy with ranibizumab and/or aflibercept according to registered indications, and who discontinued their follow-up in the clinic (n = 214). A phone survey of patients concerning the reasons for loss to follow-up with a statistical analysis of the obtained data was carried out.

Results. The majority of patients (81.3%) discontinued observation in the clinic within two years from the start of therapy (the median duration of treatment was 7 (3; 18) months). Patients with all considered diseases had an increase in best corrected visual acuity during treatment (p < 0.000001), which confirms the high efficiency of the method. According to the results of the phone survey, the following categories of respondents were identified: complete cessation of treatment – 120 (56.1%) patients, change of clinic – 20 (9.3%), death – 23 (10.7%), status not established – 51 (23.8%). The most frequent reasons for stopping treatment were dissatisfaction with its results (59 cases; 49.2%), financial burden (49; 40.8%), and systemic comorbidities (24; 20.0%).

Conclusion. Searching approaches to increase patients’ treatment adherence is one of the priorities for improving anti-VEGF therapy.

The article is dedicated to the memory of Honored Scientist of the Russian Federation, Professor V.F. Danilichev. The authors reviewed his life path, clinical, scientific and educational activities.