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Purpose. To increase the efficiency of surgical treatment and develop an algorithm for managing patients with the consequences of acute retinal necrosis (ARN).Material and methods. The study included 35 patients (42 eyes) aged 18 to 74 with acute retinal necrosis. All patients underwent a microinvasive (23 Ga) vitrectomy with membrane peel, endolaser coagulation of the retina and endotamponade of the vitreal cavity with silicone oil. The operated eyes were divided into 2 groups. The main group consisted of 17 eyes with a clinical picture of fibrosis of the vitreous without retinal detachment (10 eyes) and retinal detachment without pronounced fibrosis of the vitreous (7 eyes). The comparison group included 25 eyes which had retinal detachment and fibrosis of the vitreous at the time of surgery. The visual acuity varied between incorrect light projection and 0.15 with correction.Results. A stable anatomical and optical result was achieved in all cases. Complete adhesion of the detached retina was achieved in 94.1 %, which is explained by the fact that surgical treatment was in most cases performed in the absence of pronounced stages of proliferative vitreoretinopaty. In all cases of the main group, an increase in visual acuity was noted. In 53 % of cases, visual acuity achieved 0.1 to 0.3 and in the remaining 47 % it was 0.3 % or above. This can be accounted for by the prevalence of peripheral necrotic lesions, as well as a lower incidence of macular edema and optic neuropathy. However, in the comparison group, an increase in visual acuity was only observed in 56 % cases, with visual acuity reaching 0.1 or higher only in 24 % of the eyes. A high frequency (72 %) of necrosis expansion to the posterior eye pole with an irreversible damage to the optic nerve and the macular region was revealed.Conclusion. Active dynamic observation of patients with ARN helps detect changes requiring surgical treatment, which leads to higher functional and anatomical outcomes, as well helps avoid the disability of the patients. Surgical treatment prior to the formation of retinal detachment in severe traction syndrome with or without retinal tears is advisable. An algorithm was proposed for managing surgical patients, depending on the clinical manifestations of ARN effects.

Purpose. To propose the major differential diagnostic criteria of retinal capillary hemangioma (RCH) and vasoproliferative tumor (VPT) aimed at increasing the efficiency of the diagnosis of these diseases.Material and methods. A comprehensive ophthalmologic examination off 19 (26 eyes) patients, aged 19 to 66 (ave. 31.89 ± 11.30 yrs), with vascular neoplasms of peripheral localization included, beside the standard techniques, fundus photoregistration, fluorescent angiography (FAG), optical coherence tomography of the retina and a combined ultrasound testing using B scanning, echographic densitometry, colour Doppler imaging (CDI), and pulse Doppler imaging.Results. Based on the analysis of the clinical picture and the results of the tests performed, the following differential diagnostic criteria were proposed: the age at which RCH and VPT developed, their localization in the eye fundus, and the value of the maximal systolic blood flow velocity in the central vein of the retina.Conclusion. Differential diagnostics of RCH and VPT requires combined approaches and should take into account, in addition to case history and the clinical picture, also the results of instrumental testing techniques: FAG, echography and CDI.

Pathogenesis of retinal capillary hemangioma has not been sufficiently studied at the present time. Therefore, the study of cytokine levels in biological fluids seems to be very relevant in order to increase knowledge about the mechanisms of the disease development and searching for targeted therapies. The content of hematopoietic and vasoactive growth factors in blood serum, lacrimal fluid, and vitreous body was studied in patients with retinal capillary hemangioma. A total of 26 patients with retinal angiomatosis were examined. The samples of blood serum (n = 23) and lacrimal fluid (n = 10) from practically healthy people aged 22 to 46 (27.4±1.4 years) were used as a control. To perform comparative assessment of cytokine concentrations in the vitreous body of patients with retinal capillary hemangioma, were used samples of the vitreous body from 6 patients (average age 33±4.7 years; from 21 to 49 years) with rhegmatogenous retinal detachment. To measure the cytokine concentrations, we applied multiplex analysis technique using the xMAP platform with LuminexxPONENT 3.1 program and ProcartaPlex sets (eBioscience, Austria). A detailed characteristic of vasoactive factors in capillary retinal hemangioma was obtained as a result of this work. Some disorders in chemokine regulation were identified. There was a significant increase in serum concentrations of three vasoactive factors, i.e., PDGF-BB, HGF, and PIGF-1, with a decrease in chemokines (MCP-1, MIP-1α, and MIP-1β). The frequencies of PIGF-1 and MIP-1α detection also significantly differed from the control group. SCF was significantly more often determined in patients with retinal angiomatosis only at the systemic level. Correlations between PDGF-BB and PIGF-1, as well as PIGF-1 and MIP-1β were shown. A significant increase in VEGF-A, HGF, VEGF-D, as well as MCP-1 concentrations was shown in the lacrimal fluid. The inversion of PDGF-BB concentrations in serum and lacrimal fluid was noted. Analysis of intraocular cytokine levels revealed a significant increase in VEGF-A and HGF concentrations, with marked decrease in MIP-1α and MIP-1β. PDGF-BB in 100% of cases was determined only in vitreous body of patients with retinal angiomatosis. With respect to the revealed characteristic shifts of HGF/SF intraocular production in retinal capillary hemangioma, it seems relevant to search ways for its inhibition, thus providing potential basis for a new therapeutic strategy in treatment of retinal angiomatosis.

Purpose: to study the possibilities of complex ultrasound examination in the assessment of hemodynamic and structural features of retinal capillary hemangioma (RCH).Patients and methods. 26 patients (35 eyes) with RCHs at the age of 11 to 53 years (mean 26.6 ± 9.4 years) were examined. Ultrasound examination was performed using B–mode image, echodensitometry, Color Doppler Imaging (CDI) and pulsed Doppler (PD). The peak systolic velocity (Vsyst), the end-diastolic velocity (Vdiast) of the blood flow, and the resistance index (RI) in the orbital vessels were examined using CDI and PD. Qualitative and quantitative assessment of blood flow in a feeding artery and a draining vein of the RCHs were performed. The follow-up efficiency evaluation of the laser coagulation of RCH was performed in 12 eyes.Results. The elevation of RCH was 1.7 ± 0.7 mm (from 0.5 to 3.3 mm) on average, the base diameter — 5.4 ± 2.1 mm (from 1.8 to 11.5 mm). The acoustic density varied from 42 to 176 (mean 109.6 ± 30.9) in relative units. The indices of Vsyst were from 5.5 to 21.4 cm/s (mean value — 10.6 ± 4.2 cm/s) in the feeding arteries, from 3.06 to 14.3 cm/s — in veins (mean value — 4.9 ± 2.4 cm/s). A significant increase in the blood flow velocity in the central retinal vein (CRV), a decrease in RI in the central retinal artery (CRA) and short posterior ciliary arteries (SPCAs) were determined. In 3 (8.6 %) eyes, in the absence of echographic manifestations of small RCHs of optic nerve head (ONH), there was an increase of the blood flow velocity in the CRV (the mean value was 8.95 ± 1.15 cm/s). After treatment, B-scan ultrasonogram showed no visualization of RCHs in 3 eyes. A significant decrease (31 %) of prominence compared to the baseline values was registered in 9 eyes (66.7 %). A decrease of the tumor base the diameter by an average of 37.7 % was also registered in 7 eyes (58.3 %). A significant decrease (26.3 %) in Vsyst in arterial-type feeding vessels was determined.Conclusion. Significant changes in regional ocular blood flow in RCH were registered. The increase of blood flow in the CRV at the localization of RCH on the ONH can be an additional differential diagnostic criterion of the disease. The hemodynamic instability in the retinal vessels feeding the RCH and the positive dynamics of the blood flow after laser coagulation were determined.