CLINICAL EFFECTIVENESS OF NEUROTRANSMITTERS PATIENTS WITH PRIMARY GLAUCOMA VEGF INHIBITOR IN PATIENTS WITH CHOROIDAL NEOVASCULARIZATION CAUSED BY DEGENERATIVE MYOPIA

Purpose. Morphological and functional evaluation of results of intravitreal injections of ranibizumab in treatment of choroidal neovascularization (CNV) caused by degenerative myopia (DM). patients and methods. The study included 32 patients (32 eyes) aged from 29 to 55 years with the CNV, developed due to the DM. They received 0.5 mg (0.05 ml) ranibizumab according to the standard. Indications for repeat intravitreal injections of ranibizumab were retention of the CNV activity or its recurrence. In addition to the standard ophthalmologic examination all patients were examined with fluorescein angiography (FAG) with photodetection of fundus picture and optical coherence tomography (OCT) of the retina (sizing subretinal neovascular membrane (SNM), evaluation of retinal foveal thickness (FCS). The study was conducted before the introduction of ranibizumab, monthly during the first 6 months after surgery, and then, in the absence of symptoms of CNV activity, every 2-3 months. The total follow-up was 12 months. results. the transition the CNV in inactive form according to FAG was observed in 25 people (78.1%) was observed after 1 month (single injection of ranibizumab). The angiographic signs of CNV activity remained after the first injection in 7 patients (21/9%). They received second intravitreal injection of ranibizumab. After 3 months from the beginning of observation according to FAG and OCT data relapse of activity of myopic CNV occurred in 5 patients (15.6%) after a single injection, and in 2 patients (6.3%) — after a double injection of ranibizumab. After 6 months according to FAG disappearance of pathological leakage of the dye was diagnosed in 87.5% of patients (28 eyes). After 12 months follow-up all 32 patients had remission of the pathological process with no evidence of CNV activity with formation of local subretinal fibrosis with choriocapillaries atrophy. Conclusions. It took from 1 to 3 (average 1.58) injections of ranibizumab to transfer the active phase of the CNV in inactive. Complete inhibition of the growth and activity of myopic CNV was accompanied by positive morphological and functional results, which led to a significant improvement in visual acuity in 2 times at the observation period of 12 months.

1. Soubrane G. Choroidal neovascularization in pathologic myopia: recent developments in diagnosis and treatment. Survey of ophthalmology. 2008;2:121 136.

2. Vitale S., Sperduto R.D., Ferris F.L. Increased prevalence of myopia in the United States between 1971 1972 and 1999 2004. Arch Ophthalmol. 2009;127(12):1632 1639.

3. Libman E.S. [Blindness and disability due to pathology of the vision in Russia]. Slepota i invalidnost› vsledstvie patologii organa zrenija v Rossii. Ophthalmology. National manual. Ed. by S.Je. Avetisov, E.A. Egorov, L.K. Moshetova, V.V. Neroev. M., 2008:38 41 (in Russ.)

4. Libman E.S., Shahova E.V. [Blindness and disability due to pathology of the vision in Russia]. Slepota i invalidnost› vsledstvie patologii organa zrenija v Rossii. [Annals of ophthalmology]. Vestnik oſtal›mologii. 2006;1:35 37. (in Russ.)

5. Jones D., Luensmann D. The prevalence and impact of high myopia. Eye Contact Lens. 2012;38:188 196.

6. Silva R. Myopic maculopathy: a review. Ophthalmologica. 2012;228:197 213.

7. Ohno Matsui K., Yoshida T., Futagami S. et al. Patchy atrophy and lacquer cracks predispose to the development of choroidal neovascularisation in pathological myopia. Br J Ophthalmol. 2003;87:570 573.

8. Degenring R.F., Jonas J.B. Photodynamic therapy in combination with intravitreal triamcinolone for myopic choroidal neovascularization. Acta Ophthalmol Scand. 2005;83:621.

9. Fujikado T., Ohji M., Kusaka S. et al. Visual function aſter foveal translocation with 360 degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. Am J Ophthalmol. 2001;131:101 10.

10. Benediktova O.A., Saksonov S.G., Suk S.A. [Diagnostic value of optical coherence tomography and fluorescein angiography in the evaluation of the dynamics of regression of classical subretinal neovascular membranes at high complicated myopia aſter combined use of ranibizumab and transpupillary thermotherapy]. Diagnosticheskaja cennost› opticheskoj kogerentnoj tomografii i fljuorescentnoj angiografii v ocenke dinamiki regressa klassicheskih subretinal›nyh neovaskuljarnyh membran pri vysokooslozhnennoj blizorukosti posle kombinirovannogo primenenija ranibizumaba i transpupilljarnoj termoterapii. [Ukrainian Scientific Medical Youth Journal]. Ukrainskij nauchno-medicinskij molodezhnyj zhurnal. 2012;2:53 55. (in Russ.)

11. Virgili G., Menchini F. Laser photocoagulation for choroidal neovascularisation in pathologic myopia. Cochrane Database Syst. Rev. 2005;19(4):CD004765.

12. Izmajlov A.S., Balashevich L.I. [Choroidal neovascularization (diagnostics and treatment] . Horioidal›naja neovaskuljarizacija (diagnostika i lechenie). SPb.: SPbMAPO, 2001. (in Russ.)

13. Medvedev I.B., Belikova E.I., Sjamichev M.P. [Photodynamic therapy with Vizudin in treatment of choroidal neovascularization at complicated myopia] Fotodinamicheskaja terapija s Vizudinom v lechenii horioidal›noj neovaskuljarizacii pri oslozhnennoj blizorukosti. [Annals of ophthalmology]. Vestnik oſtal›mologii. 2007;6:23 25. (in Russ.)

14. Lam D.S. Photodynamic therapy with verteporfin for subfoveal choroidal neovascularization of pathologic myopia in Chinese eyes a prospective series of 1 and 2 year follow up. Br. J. Ophthalmol. 2004;88:1315 1319.

15. Ruiz Moreno J.M., Montero J.A. Visual acuity results aſter argon green laser photocoagulation of juxtafoveal choroidal neovascularization in high myopic eyes: long term results. Eur J Ophthalmol. 2002;12:117–122.

16. Pece A., Milani P., Isola V., Pierro L. A Long term study of photodynamic therapy with verteporfin for choroidal neovascularization at the edge of chorioretinal atrophy in pathologic myopia. Ophthalmologica. 2011;225:161 168.

17. Mateo C. Two year results of macular translocation with scleral infolding in myopic choroidal neovascularization. Sem. Ophthalmol. 2004;19:29 42.

18. Kobayashi H., Kobayashi K. Radiotherapy for subfoveal neovascularisation associated with pathological myopia: a pilot study. Br. J. Ophthalmol. 2000;84:761 766.

19. Bojko E.V., Sosnovskij C.V., Berezin R.D. et al. [Antiangiogenic therapy in ophthalmology] Antiangiogennnaja terapija v oſtal›mologii. SPb., 2013:182 196. (in Russ.)

20. Neelam K., Cheung C.M., Ohno Matsui K. et al. Choroidal neovascularization in pathological myopia. Prog Retin Eye Res. 2012;31:495 525.

21. Wolf S., Balciuniene V.J., Laganovska G., Menchini U., Ohno Matsui K., Sharma T., Wong T.Y., Silva R., Pilz S., Gekkieva M. RADIANCE: a randomized controlled study of ranibizumab in patients with choroidal neovascularization secondary to pathologic myopia. Ophthalmology. 2014;121(3):682 692.

22. Tufail A., Narendran N., Patel P.J. et al. Ranibizumab in myopic choroidal neovascularisation: the 12 month results from the REPAIR study. Ophthalmology. 2013;120(9):1944 1945.

23. Baba T. et al. Optical coherence tomography of choroidal neovascularization in high myopia. Acta Ophthalmol. Scand. 2002;80(1):82 87.

24. Bojko Je.V., Sosnovskij S.V., Berezin R.D., Kacherovich P.A., Tavtilova D.A. [Intraviteral injections: theory and practice] Intraviteral›nye in#ekcii: teorija i praktika. [Ophthalmic journal]. Oſtal›mologicheskie vedomosti. 2010;2:28 35. (in Russ.)

25. Shchuko A.G., Zajceva N.V., Zlobin I.V., Malyshev V.V. [Angiogenesis inhibitors in treating of various types of vascular and neovascular eye pathology] Ingibitory angiogeneza v lechenii razlichnyh vidov sosudistoj i neovaskuljarnoj patologii glaza. [Ophthalmosurgery]. Oſtal›mohirurgija. 2012;2:30 35. (in Russ.)

26. Danilova L.P., Egorov V.V., Smoljakova G.P., Emanova L.P., Povaljaeva D.A. [The first experience of ranibizumab in patients with pathological myopia complicated by choroidal neovascularization]. Pervyj opyt primenenija Ranibizumaba u pacientov s patologicheskoj miopiej oslozhnennoj horioidal›noj neovaskuljarizaciej. [Modern technologies in ophthalmology]. Sovremennye tehnologii v oſtal›mologii. 2015;2:129 132. (in Russ.)