Purpose:To analyze the change in the concentration of intraocular cytokines (ICs) in patients with retinal vein occlusion (RVO) before and after intravitreal ranibizumab therapy (IVR), and to find the correlations of IC with clinical activity of RVO and efficiency of treatment.Materials and Methods:Forty-four patients aged 46–79 years old (mean age: 60.7 ± 7.5 years old) with RVO and macular edema (18 patients – with central RVO, 26 – with branch RVO) treated with IVR were included into the study. The concentrations of 27 cytokines were simultaneously measured in aqueous humor by flow fluorometry using Bio-Plex Pro Human Cytokine Panel, 27-Plex (Bio-Rad Laboratories, USA) at baseline and after the first IVR. Control group consisted of 20 age-matched patients.Results:The levels of 11 cytokines (vascular endothelial growth factor [VEGF], receptor antagonist interleukin-1, interleukin-6 [IL-6], IL-8, IL-9, IL-10, IL-12r70, IL-13, IL-15, monocyte chemotactic protein-1 [MCP-1], regulated on activation, normal T expressed and secreted) were significantly (P < 0.05) different compared to control and significantly (P < 0.05) changed after IVR both in central and branch RVO. The patients were divided into two groups: the first -“effective” and the second - “partially effective” therapy. The second group characterized by the higher concentrations of VEGF, IL-8, IL-10, IL-17, and MCP-1 at baseline compared to the first group.Conclusion:The patients with RVO were characterized by the increased levels of VEGF and other pro- and anti-inflammatory cytokines and chemokines. Aqueous concentration of cytokines were different in patients with central and branch RVO and significantly changed after IVR. Insufficient response to IVR was associated with activation of immune-inflammatory processes.
Цель-оценить эффективность лечения и возможность восстановления зрительных функций у больных с окклюзией вен сетчатки (ОВС) в зависимости от степени исходной макулярной ишемии. Материал и методы. Обследовано 84 пациента с перенесенной ОВС. Основными критериями включения в исследование были наличие макулярного отека на фоне ОВС, не превышающей по длительности 3 мес, и отсутствие какого-либо предшествующего лечения. Всем пациентам выполнялись интравитреальные инъекции ингибитора ангиогенеза с последующим лазерным лечением при необходимости. Сравнительный анализ результатов проводился в оппозитных по клиническому эффекту группах до начала терапии, через 1 мес и 12 мес. Всем пациентам и лицам контрольной группы проводились офтальмологическое обследование, включавшее стандартные методы, а также электроретинография, флюоресцентная ангиография, оптическая когерентная томография (ОКТ) и ОКТангиография. Результаты. При сравнительном анализе исходного офтальмологического статуса пациентов с ОВС с оппозитным клиническим эффектом и данных, полученных в течение 12 мес наблюдения, были выделены 3 клинические группы, соответствующие 3 степеням макулярной ишемии-легкой, средней и тяжелой. Заключение. Определение на этапе первичной диагностики степени ишемии макулярной зоны позволяет повысить эффективность лечения, а также ориентировать пациентов в отношении последовательности и длительности анти-VEGF-терапии. Интравитреальные инъекции Ранибизумаба при окклюзии ретинальных вен проводятся до ликвидации макулярного отека и далее в режиме «по потребности», при этом количество введений может варьировать от одной до ежемесячных инъекций в течение года.
AIM: Report cases of choroidal neovascularization (CNV) in children and describe structural and hemodynamic changes in retina associated with this pathology detected by Optical Coherence Tomography (OCT) and OCT-angiography (OCTA).
MATERIALS AND METHODS: 6 children (4 girls, 2 boys) aged from 7 to 17 years with CNV associated with pathological myopia, post-traumatic choroid rupture and optic disc abnormalities were examined. The activity of neovascular complexes was evaluated by ophthalmoscopy, OCT, and OCTA. The maximum follow-up period was 4 years.
RESULTS: 7 cases of CNV were detected. One child had a two-way process. Myopic and posttraumatic membranes were localized sub- and juxtafoveally and were the membranes of type 2. In children with optic disc anomalies of the 1 type membrane and mixed (1st and 2nd) type was located extrafoveally. The decrease in visual acuity was determined by the localization of membranes, the severity of edema, and the severity of dystrophic changes in the retina. On OCT, subretinal fluid and hyperreflective material corresponding to hemorrhages were visualized in the projection of active membranes. OCTA revealed a network of small capillaries with a large number of loops and anastomoses. Intravitreal angiogenesis inhibitors injections were performed in 5 cases. A persistent effect after a single injection was observed in 2 cases. The return of membrane activity in 3 cases allowed us to justify the repeated administration of angiogenesis inhibitors. Along with a decrease in the activity of CNV, progressive dystrophic changes in the pigment epithelium around the membrane were detected.
CONCLUSIONS: High sensitivity of OCT was demonstrated for early detection of structural and hemodynamic retinal disorders, determining the activity of neovascular complexes, predicting outcomes of the disease, and evaluating the effectiveness of therapeutic measures. The progression of dystrophic changes in the retinal pigment epithelium in response to therapy with angiogenesis inhibitors requires long-term monitoring of children and determining the optimal strategy for treating CNV in children.
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