glazmagThe EYE ГЛАЗThe EYE GLAZ2222-44082686-8083Академия медицинской оптики и оптометрии10.33791/2222-4408-2022-4-23-28glazmag-390Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESКлинический случай лечения полипоидной хориоидальной васкулопатии, осложненной обширным субретинальным кровоизлияниемTrea tment of polypoid choroidal vasculopathy complicated by extensive subretinal hemorrhage. A case reportПеревозчиковП. А.PerevozchikovP. A.

Перевозчиков Петр Арсентьевич, доктор медицинских наук, врач-офтальмолог

129301, Москва, ул. Бориса Галушкина, д. 3

Petr A. Perevozchikov, Dr. Sci. (Med.), Ophthalmologist

3, Boris Galushkin Str., Moscow, 129301

perev.petr@yandex.ruПерегудовД. В.PeregudovD. V.

Перегудов Дмитрий Васильевич, главный врач

129301, Москва, ул. Бориса Галушкина, д. 3

Dmitry V. Peregudov, Head

3, Boris Galushkin Str., Moscow, 129301

КузнецоваО. Ю.KuznetsovaO. Yu.

Кузнецова Оксана Юрьевна, врач-офтальмолог

129301, Москва, ул. Бориса Галушкина, д. 3

Oksana Yu. Kuznetsova, Ophthalmologist

3, Boris Galushkin Str., Moscow, 129301

ООО «Три-З», московский филиалРоссияTri-Z, Moscow BranchRussian Federation2022211220222442328Copyright © Академия медицинской оптики и оптометрии, 20222022Академия медицинской оптики и оптометрииАкадемия медицинской оптики и оптометрииhttps://www.theeyeglaz.com/jour/about/submissions#copyrightNoticehttps://www.theeyeglaz.com/jour/article/view/390

Полипоидная хориоидальная васкулопатия (ПХВ) – это разновидность влажной формы возрастной макулярной дегенерации (ВМД). Характеризуется образованием аневризматических расширений аномальных сосудов хориоидеи (полипов) под ретинальным пигментным эпителием (РПЭ) в хориоидее. Заболевание приводит к снижению зрения в связи с формированием серозной отслойки сетчатки, отслойки нейроэпителия и РПЭ, субретинальных геморрагий, фиброза, атрофии РПЭ. Общепринятое лечение ПХВ – антиангиогенная терапия.

Цель данной работы – изложение и анализ клинического случая лечения полипоидной хориоидальной васкулопатии, осложненной обширным субретинальным кровоизлиянием.

Описание случая

Описание случая. Представлен клинический случай ПХВ правого глаза, осложненной обширным субретинальным кровоизлиянием на фоне антиангиогенной терапии, у мужчины 72 лет. Помимо стандартных офтальмологических методов исследования мы проводили оптическую когерентную томографию (ОКТ) на аппарате Cirrus HD-OCT 5000 Zeiss (Сarl Zeiss, Германия), ангио-ОКТ на высокоскоростном спектральном оптическом когерентном томографе Optovue Solix (Optovue, США) и фоторегистрацию глазного дна на ретинальной камере Topcon TRC-NW8F (Topcon, Япония). Данному пациенту применен комплексный хирургический подход, включающий заднюю субтотальную витрэктомию на офтальмологическом комбайне Stellaris PC (Baush&Lomb, США) с субретинальным введением проурокиназы, на фоне антиангиогенной терапии препаратом, содержащим афлиберцепт, а также выполнено удаление сопутствующей катаракты с имплантацией интраокулярной линзы (ИОЛ).

Дискуссия

Дискуссия. Раннее обращение пациента и своевременно выполненная процедура микроинвазивной 25-гейджевой витрэктомии с субретинальным введением проурокиназы способствовали рассасыванию кровоизлияния в кратчайшие сроки и улучшению зрительных функций с 0,02 до 0,6.

Выводы

Выводы. Представленный комплексный поход лечения ПХВ и ее осложнений позволил обеспечить социальную реабилитацию пациента и сохранить зрительные функции пораженного глаза на высоких значениях.

Polypoid choroidal vasculopathy (PCV) is a type of wet form of age-related macular degeneration (AMD). It is characterized by formation aneurysmal dilations of abnormal choroidal vessels (polyps) under the retinal pigment epithelium (RPE) in the choroid. The disease leads to a vision loss due to formation of serous retinal detachment, neuroepithelium detachment and RPE, subretinal hemorrhages, fibrosis, atrophy of RPE. The generally accepted treatment of PCV is antiangiogenic therapy.

The purpose of this work is to present and to analyze the clinical case of polypoid choroidal vasculopathy treatment complicated by extensive subretinal hemorrhage.

Description of the case

Description of the case. This clinical case of PCV in the right eye that is complicated by extensive subretinal hemorrhage on the background of antiangiogenic therapy in a 72-year-old man is presented. In addition to standard ophthalmological research methods, we performed optical coherence tomography (OCT) with Cirrus HD-OCT 5000 Zeiss (Carl Zeiss, Germany), angio-OCT with Optovue Solix High-Speed Spectral Optical Coherence Tomograph (Optovue, USA) and fundus photo registration with Topcon TRC-NW8F Retinal Camera (Topcon, Japan). The comprehensive surgical approach was applied to this patient, including posterior subtotal vitrectomy with our Stellaris PC microsurgical system (Baush&Lomb, USA) and the prourokinase subretinal injection against the background of aflibercept antiangiogenic therapy and removal of a concomitant cataract with implantation of an intraocular lens (IOL).

Discussion

Discussion. The early treatment of this patient and at the right time procedure of microinvasive 25-G vitrectomy combined with prourokinase subretinal injection contributed to the resorption of hemorrhage in the shortest possible time and improved visual functions from 0.02 to 0.6.

Conclusions

Conclusions. The presented comprehensive approach of PCV treatment and its complications made possible to provide social rehabilitation of the patient and to preserve high values of visual functions in the affected eye.

полипоидная хориоидальная васкулопатиявозрастная макулярная дегенерациясубретинальное кровоизлияниеpolypoidal choroidal vasculopathyage-related macular degenerationsubretinal hemorrhageReferencesCiardella A.P., Donsoff I.M., Huang S.J. et al. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004;49(1):25–37. https://doi.org/10.1016/j.survophthal.2003.10.007Ciardella A.P., Donsoff I.M., Huang S.J. et al. Polypoidal choroidal vasculopathy. Surv Ophthalmol. 2004;49(1):25–37. https://doi.org/10.1016/j.survophthal.2003.10.007Hayashi H., Yamashiro K., Gotoh N. et al. CFH and ARMS2 variations in age-related macular degeneration, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation. Invest Ophthalmol Vis Sci. 2010;51:5914–5919. https://doi.org/10.1167/iovs.10-5554Hayashi H., Yamashiro K., Gotoh N. et al. CFH and ARMS2 variations in age-related macular degeneration, polypoidal choroidal vasculopathy, and retinal angiomatous proliferation. Invest Ophthalmol Vis Sci. 2010;51:5914–5919. https://doi.org/10.1167/iovs.10-5554Liu Y., Wen F., Huang S. et al. Subtype lesions of neovascular age-related macular degeneration in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2007;245:1441–1445. https://doi.org/10.1007/s00417-007-0575-8Liu Y., Wen F., Huang S. et al. Subtype lesions of neovascular age-related macular degeneration in Chinese patients. Graefes Arch Clin Exp Ophthalmol. 2007;245:1441–1445. https://doi.org/10.1007/s00417-007-0575-8Yannuzzi L.A., Sorenson J., Spaide R.F. et al. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8. https://doi.org/10.1097/00006982-199001010-00001Yannuzzi L.A., Sorenson J., Spaide R.F. et al. Idiopathic polypoidal choroidal vasculopathy (IPCV). Retina. 1990;10:1–8. https://doi.org/10.1097/00006982-199001010-00001Sho K., Takahashi K., Yamada H. et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121(10):1392–1396. https://doi.org/10.1001/archopht.121.10.1392Sho K., Takahashi K., Yamada H. et al. Polypoidal choroidal vasculopathy: incidence, demographic features, and clinical characteristics. Arch Ophthalmol. 2003;121(10):1392–1396. https://doi.org/10.1001/archopht.121.10.1392Cheung C.M., Yang E., Lee W.K. et al. The natural history of polypoidal choroidal vasculopathy: A multi-center series of untreated Asian patients. Graefes Arch Clin Exp Ophthalmol. 2015;253(12):2075–2085. https://doi.org/10.1007/s00417-015-2933-2Cheung C.M., Yang E., Lee W.K. et al. The natural history of polypoidal choroidal vasculopathy: A multi-center series of untreated Asian patients. Graefes Arch Clin Exp Ophthalmol. 2015;253(12):2075–2085. https://doi.org/10.1007/s00417-015-2933-2Lee M.W., Yeo I., Wong D., Ang C.L. Argon laser photocoagulation for the treatment of polypoidal choroidal vasculopathy. Eye (Lond). 2009;23:145–148. https://doi.org/10.1038/sj.eye.6702955Lee M.W., Yeo I., Wong D., Ang C.L. Argon laser photocoagulation for the treatment of polypoidal choroidal vasculopathy. Eye (Lond). 2009;23:145–148. https://doi.org/10.1038/sj.eye.6702955Akaza E., Yuzawa M., Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:39–44. https://doi.org/10.1007/s10384-010-0886-xAkaza E., Yuzawa M., Mori R. Three-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Jpn J Ophthalmol. 2011;55:39–44. https://doi.org/10.1007/s10384-010-0886-xKang H.M., Kim Y.M., Koh H.J. Five-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;155:438–447. https://doi.org/10.1016/j.ajo.2012.09.020Kang H.M., Kim Y.M., Koh H.J. Five-year follow-up results of photodynamic therapy for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;155:438–447. https://doi.org/10.1016/j.ajo.2012.09.020Kang H.M., Koh H.J. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:652– 660. https://doi.org/10.1016/j.ajo.2013.05.038Kang H.M., Koh H.J. Long-term visual outcome and prognostic factors after intravitreal ranibizumab injections for polypoidal choroidal vasculopathy. Am J Ophthalmol. 2013;156:652– 660. https://doi.org/10.1016/j.ajo.2013.05.038Oishi A., Kojima H., Mandai M. et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013;156:644–651. https://doi.org/10.1016/j.ajo.2013.05.024Oishi A., Kojima H., Mandai M. et al. Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results. Am J Ophthalmol. 2013;156:644–651. https://doi.org/10.1016/j.ajo.2013.05.024Taipale C., Lindholm J.M., Kaarniranta K., Tuuminen R. Comparison of two different treat-and-extend protocols with Aflibercept in wet age-related macular degeneration: two-year results. Adv Ther. 2020;37(5):2256–2266. https://doi.org/10.1007/s12325-020-01312-2Taipale C., Lindholm J.M., Kaarniranta K., Tuuminen R. Comparison of two different treat-and-extend protocols with Aflibercept in wet age-related macular degeneration: two-year results. Adv Ther. 2020;37(5):2256–2266. https://doi.org/10.1007/s12325-020-01312-2Chaikitmongkol V., Sagong M., Lai T.Y.Y., Tan G.S.W. et al. Treat-and-extend regimens for the management of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy: consensus and recommendations from the Asia-Pacific Vitreo-retina Society. Asia Pac J Ophthalmol (Phila). 2021;10(6):507–518. https://doi.org/10.1097/APO.0000000000000445Chaikitmongkol V., Sagong M., Lai T.Y.Y., Tan G.S.W. et al. Treat-and-extend regimens for the management of neovascular age-related macular degeneration and polypoidal choroidal vasculopathy: consensus and recommendations from the Asia-Pacific Vitreo-retina Society. Asia Pac J Ophthalmol (Phila). 2021;10(6):507–518. https://doi.org/10.1097/APO.0000000000000445Chen L., Qu L., Gui Q., Wang S. et al. Effects of anti-vascular endothelial growth factor drugs before and after pars plana vitrectomy in patients with polypoidal choroidal vasculopathy and vitreous hemorrhage. J Ocul Pharmacol Ther. 2021;37(10):591–596. https://doi.org/10.1089/jop.2021.0039Chen L., Qu L., Gui Q., Wang S. et al. Effects of anti-vascular endothelial growth factor drugs before and after pars plana vitrectomy in patients with polypoidal choroidal vasculopathy and vitreous hemorrhage. J Ocul Pharmacol Ther. 2021;37(10):591–596. https://doi.org/10.1089/jop.2021.0039Mun Y., Park K.H., Park S.J., Woo S.J. Efficacy of anti-vascular endothelial growth factor agents for treating neovascular age-related macular degeneration in vitrectomized eyes. PLoS One. 2021;16(6):e0252006. https://doi.org/10.1371/journal.pone.0252006Mun Y., Park K.H., Park S.J., Woo S.J. Efficacy of anti-vascular endothelial growth factor agents for treating neovascular age-related macular degeneration in vitrectomized eyes. PLoS One. 2021;16(6):e0252006. https://doi.org/10.1371/journal.pone.0252006Laugesen C.S., Ostri C., Brynskov T., Lund-Andersen H. et al. Intravitreal ranibizumab for diabetic macular oedema in previously vitrectomized eyes. Acta Ophthalmol. 2017;95(1):28–32. https://doi.org/10.1111/aos.13160Laugesen C.S., Ostri C., Brynskov T., Lund-Andersen H. et al. Intravitreal ranibizumab for diabetic macular oedema in previously vitrectomized eyes. Acta Ophthalmol. 2017;95(1):28–32. https://doi.org/10.1111/aos.13160Totuk O.M., Kanra A.Y., Bromand M.N., Tezanlayan G.K. et al. Effectiveness of intravitreal renibizumab in nonvitrectomized and vitrectomized eyes with diabetic macular edema: a two-year retrospective analysis. J Opthalmol. 2020:2561251. https://doi.org/10.1155/2020/2561251Totuk O.M., Kanra A.Y., Bromand M.N., Tezanlayan G.K. et al. Effectiveness of intravitreal renibizumab in nonvitrectomized and vitrectomized eyes with diabetic macular edema: a two-year retrospective analysis. J Opthalmol. 2020:2561251. https://doi.org/10.1155/2020/2561251Bressler S.B., Melia M., Glassman A.R. et al. Ranibizumab plus prompt or deferred laser for diabetic macular edema in eyes with vitrectomy before anti-vascular endothelial growth factor therapy. Retina. 2015;35:2516–2528. https://doi.org/10.1097/IAE.0000000000000617Bressler S.B., Melia M., Glassman A.R. et al. Ranibizumab plus prompt or deferred laser for diabetic macular edema in eyes with vitrectomy before anti-vascular endothelial growth factor therapy. Retina. 2015;35:2516–2528. https://doi.org/10.1097/IAE.0000000000000617

The authors declare that there are no conflicts of interest present.