Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics

A.A.&nbsp;Fil'1, E.L. Sorokin1,2, O.V. Kolenko1,3 1Khabarovsk Branch of the S.N.&nbsp;Fedorov NMRC “MNTK “Eye Microsurgery”, &nbsp;Khabarovsk, Russian Federation 2Far Eastern State Medical University, Khabarovsk, Russian Federation 3Institute of Advanced Training of Healthcare Specialists, Khabarovsk, &nbsp;Russian Federation This review article summarizes current data on the pathogenesis of macular edema after retinal vein occlusions (RVOs) and patterns of&nbsp;macular morphometry and chorioretinal hemodynamics. RVOs account for 60% of acute vascular eye diseases. The major cause of vision loss in RVOs is macular edema which results from subclinical inflammation characterized by leukostasis and enhanced expression of adhesion molecules and production of cytokines increasing retinal capillary permeability. The association between the severity of macular edema and vitreous levels of pro-inflammatory mediators (IL-1β, IL-6, TNF-α, MCP-1, and VEGF) is established. Cystic lesions and detachment of the neuroepithelium (75%) are typical for macular edema after RVOs. Impaired chorioretinal hemodynamics (as demonstrated by a significant reduction of vascular density in the superficial and deep vascular plexus, significant decrease in peak diastolic flow velocity, and increase in resistivity index in the ophthalmic artery and short posterior ciliary arteries) is also reported. The paper addresses etiological factors of RVOs and pathogenesis of macular edema, technical tools for vital assessment of the retina, and choroidal/retinal hemodynamics. This provides great opportunities for a complex in-depth study of the development and course of macular edema to identify potential predictors of&nbsp;its development and persistence. Keywords: retinal vein occlusions, macular edema, morphometry, chorioretinal hemodynamics. For citation: Fil' A.A., Sorokin E.L., Kolenko O.V. Macular edema after retinal vein occlusions. Macular morphometry and chorioretinal hemodynamics. Russian Journal of Clinical Ophthalmology. 2021;21(3):164–168 (in Russ.). DOI: 10.32364/2311-7729-2021-21-3-164-168. </p

The initial results of using brolucizumab (Beovu®), an angiogenesis inhibitor, for choroidal neovascularization in patients with age-related macular degeneration

N.S. Zhayvoronok1, O.V. Kolenko1–3, L.P. Danilova1,2, E.L. Sorokin1,3 1Khabarovsk Branch of the S. Fedorov Eye Microsurgery Federal State Institution, Khabarovsk, Russian Federation 2Institute of Advanced Training of Healthcare Specialists, Khabarovsk, Russian Federation 3Far Eastern State Medical University, Khabarovsk, Russian Federation Aim: to assess the clinical efficacy of brolucizumab for choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD). Patients and Methods: clinical assessment of the efficacy of brolucizumab was performed in 25 patients (25 eyes) with neovascular AMD. The dynamic monitoring included optical coherence tomography to assess the localization and area of the neovascular complex, as well as the density and thickness of the new blood vessels (OCT-angiography). Three injections of brolucizumab (in a dose of 6 mg/0.05 mL) were performed once a month. The follow-up period was 4 months. Results: the mean age of patients was 68±5 years. After the first injection of brolucizumab, there was a statistically significant decrease in the mean values of central retinal thickness (CRT) and macular volume (MV) vs the baseline values. By month 4, a statistically significant increase in the best corrected visual acuity (BCVA) vs. that at the baseline was achieved: from 0.3 (0.2; 0.45) to 0.6 (0.4; 0.6) (p&lt;0,001). In all patients after three injections the minimal values of CRT were reported: they decreased from 298 (284; 302) to 268 (263; 270) µm. Also, MV reduced from 10.4 (9.5; 10.7) to 8.8 (8.7; 9.3) mm3 (p&lt;0,001). After one month in 22 of 25 patients and after three intravitreal injections of brolucizumab in 3 patients an adhesion of the neuro- and pigment epithelium was recorded with the complete resorption of the subretinal fluid, and the subretinal fluid was not found. Subjectively, all patients noted an improvement in the quality and contrast sensitivity of central vision after treatment. Conclusions: after each injection of brolucizumab, there was a statistically significant progressive reduction in macular parameters, CRT and MV, coupled with an increase in mean BCVA values. Keywords: vascular endothelial growth factor, anti-VEGF, brolucizumab, age-related macular degeneration, neovascular age-related macular degeneration, wet age-related macular degeneration, treatment efficacy. For citation: Zhayvoronok N.S., Kolenko O.V., Danilova L.P., Sorokin E.L. The initial results of using brolucizumab (Beovu®), an angiogenesis inhibitor, for choroidal neovascularization in patients with age-related macular degeneration. Russian Journal of Clinical Ophthalmology. 2022;22(4):228–233 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-228-233. </p

Cutaneous amyloidosis in the orbital region (case report)

A.N. Bochkareva1, V.V. Egorov1,2, O.V. Kolenko1,2, G.P. Smolyakova1,2, P.A. Banshchikov1 1Khabarovsk Branch of the S.N. Fyodorov Eye Microsurgery Federal State Institution, Khabarovsk, Russian Federation 2Institute of Advanced Training of Healthcare Specialists, Khabarovsk, Russian Federation Amyloidosis is an extracellular mesenchymal dysproteinosis characterized by deposition of amyloid in tissues, parenchymal atrophy and functional organ failure leading to fatal outcomes. A significant problem of this disease for a doctor of any specialty remains a long period of establishing a clinical diagnosis. Insufficient awareness of the disease, due, among other things, to the extremely low incidence of patients with amyloidosis — today about 50 thousand people suffer from amyloidosis in the world. The article presents a clinical case of the early stage of primary systemic AL-amyloidosis affecting the eyelid skin bilaterally with further disease progression involving the skin of palms, soles and the oral mucosa. Among the types of amyloidosis described so far, the ocular adnexal involvement is an extremely rare finding which has such manifestations as periorbital cutaneous purpura and ecchymoses — “racoon eyes.” Timely diagnosis, the selection of individualized treatment strategies and the administration of chemotherapy would ensure clinical and hematological remission of amyloidosis, halt the disease progression, and thus reduce the probability of adverse outcome. The described clinical case has demonstrated that diagnosis of amyloidosis can be challenging, and that the disease has diverse and non-specific clinical manifestations. Keywords: amyloidosis, periorbital purpura, cutaneous ecchymoses, racoon, eyes, orbital amyloidosis, ocular adnexal amyloidosis, chemotherapy. For citation: Bochkareva A.N., Egorov V.V., Kolenko O.V. et al. Cutaneous amyloidosis in the orbital region (case report). Russian Journal of Clinical Ophthalmology. 2023;23(2):94–98 (in Russ.). DOI: 10.32364/2311-7729-2023-23-2-94-98. </p

Predictors of the development of retinal vascular diseases in women after preeclampsia

O.V. Kolenko1,2, E.L. Sorokin1,3, N.S. Khodzhaev4, N.V. Pomytkina1, G.V. Chizhova2, A.A. Fil1, Ya.E. Pashentsev1 1Khabarovsk branch of S.N.&nbsp;Fedorov NMRC “MNTK “Eye Microsurgery”, Khabarovsk, Russian Federation 2Postgraduate Institute for Public Health Professionals, Khabarovsk, Russian Federation 3Far Eastern State Medical University, Khabarovsk, Russian Federation 4S.N. Fedorov NMRC “MNTK “Eye Microsurgery”, Moscow, Russian Federation Background: in recent years, retinal vascular diseases occur more frequently, in particular, in younger individuals. Aim: to assess choroidal blood flow in pregnant women with preeclampsia and after birth. Materials and Methods: 42 pregnant women with preeclampsia aged 21–40 years were included in the study group. 30 women with normal pregnancy aged 19–38 years were included in comparison group 1. 27 women without pregnancy aged 35–57 years with vascular diseases of posterior eye segment were included in comparison group 2. Controls were 25 healthy age-matched (19–43 years) women without pregnancy. Linear blood flow velocity in short posterior ciliary arteries and prothrombin index were measured in all women. Results: reduced linear blood flow velocity in short posterior ciliary arteries in the third trimester of pregnancy was revealed in pregnant women with preeclampsia. However, in 6 to 8 months after birth these parameters have returned to normal values. In 12 women, these parameters were still low while prothrombin index was high. Retinal vein occlusions occurred in all these women after 6.5 to 8.5 years. Conclusion: our findings demonstrate that measurin g linear blood flow velocity in short posterior ciliary arteries and prothrombin index in pregnancy complicated with preeclampsia as well as within a year after birth may help to identify risk groups for vascular retinal diseases. Keywords: choroidal blood flow, short posterior ciliary arteries, pregnancy, preeclampsia, prothrombin index, vascular retinal diseases, retinal vein occlusion. For citation: Kolenko O.V., Sorokin E.L., Khodzhaev N.S. et al. Predictors of the development of retinal vascular diseases in women after preeclampsia. Russian Journal of Clinical Ophthalmology. 2019;19(4):189–194. </p