Rationale for Clinical Approaches to the Use of Modern Pharmacological Neuroprotection in Patients after Endovitreal Surgery of Rheumatogenic Retinal Detachment

Background. Annual disability index among patients with rheumatogenic retinal detachment (RRD) is 2–9 %. One of the factors, causing the development of morphofunctional disorders of macula, is the change in intraocular hemodynamics. Aim: substantiation of rational timing of neuroprotection with cytoflavin depending on the prediction of visual functions after endovitreal surgery of RRD.

Materials and methods. There were 21 patients (21 eyes) with RRD. A three-port vitrectomy with silicone tamponade and its subsequent removal was performed. Two groups of patients: the 1st group – 10 patients with tolerable prediction of restoration of visual functions (increasing of visual acuity to 0.4–0.2 relative units), the 2nd group – 11 people with low level of visual prognosis (increasing of visual acuity to 0.15 and lower). All patients received cytoflavin at both stages of surgery. We used laser doppler flowmetry (microcirculation index (MI) and microcirculation efficiency index (MEI)). The criteria of “sufficiency” of cytoflavin receiving was periods of recovery of MI and MEI to indexes that were not significantly different from the norm.

Results. Dynamics of response of chorioretinal microcirculation at both stages of endovitreal surgery of RRD was unidirectional. At the same time, the indexes of MI and MEI under influence of cytoflavin in patients with tolerable level of visual prognosis reached maximum index at the 15th day of observation as at the stage of silicone oil tamponade and after its removal; and in patients with low level of visual prognosis only at the 25th day of observation.

Conclusions. Therapy with cytoflavin neuroprotection in patients after endovitreal surgery of RRD leads to significant increase of indexes of chorioretinal blood flow. The period of cytoflavin treatment justified until achievement of the required positive dynamics of chorioretinal microcirculation depending on the level of visual prognosis: tolerable – 15 days, low – 25 days.

1. Libman ES, Shakhova EV. Blindness and disability due to pathology of the organ of vision in Russia. The Russian Annals of Ophthalmology. 2006; 122(1): 35-37 (In Russ.)

2. Slepova OS, Razik S, Zakharova GYu. Prediction of recurrence of retinal detachment after rhegmatogenous retinal detachment. Ophthalmology in Russia.2006; (1): 16-19 (In Russ.)

3. Suslina ZA, Tanashyan MM, Smirnova IN, Kashina EM, Fedorova TN, Fedin PA. Antioxidant and neurotrophic effects of Cytoflavin in chronic cerebrovascular diseases. Vestnik SZGMU im. I.I. Mechnikova. 2002; (3): 110-114 (In Russ.)

4. Coppe AM, Lapucci G. Posterior vitreous detachment and retinal detachment following cataract extraction. Curr Opin Ophthalmol. 2008; 19(3): 239-242. doi: 10.1097/ICU.0b013e3282fc9c4a

5. Mitry D, Charteris DG, Yorston D, Fleck BW, Wright A, Campbell H, et al. Rhegmatogenous retinal detachment in Scotland: research in design and methodology. BMC Ophtalmol. 2009; (9:2). doi: 10.1186/1471-2415-9-2

6. Bayborodov YaV, Dzhusoev TM. Prediction of functional outcomes of surgical treatment of retinal detachment. Oftal’mokhirurgiya i terapiya. 2002; (2): 54-60 (In Russ.)

7. Mashchenko NV, Khudyakov AYu, LebedevYaB, Zhigulin AV, Rudenko VA. The comparative analysis of surgical treatment of primary rheumatogenic retinal detachment by methods of episkleral and vitreal surgery. Sovremennye tekhnologii v oftal’mologii. 2014; (1): 77-78 (In Russ.)

8. Aznabaev MT, Akhtyamov KN, Babushkin AE. Causes of low visual functions and rehabilitative methods in patients after successful surgery for retinal detachment. The Russian Annals of Ophthalmology. 2005; 121 (5): 50-52 (In Russ.)

9. Egorov VV, Egorov AV, Smoliakova GP. Possibilities of clinical prediction of level of restoration of visual functions in patients with anatomical adherence of retina after endovitreal surgery of rheumatogenous retinal detachment with proliferative vitreoretinopathy. Sovremennye tekhnologii v oftal’mologii. 2016; (2): 116-119 (In Russ.)

10. Egorov VV, Egorov AV, Smoliakova GP. Clinical analysis of visual recovery in patients after successfully endovitreal surgical treatment of complicated rhegmatogenous retinal detachment. Sovremennye tekhnologii v oftal’mologii. 2016; (1): 71-75 (In Russ.)

11. Pasechnikova NV, Rodin SS, Levitskaya GV, Rosanova ZA, Kovaleva EV. Residual detachment of the neurosensor epithelium of the maculararea after transscleral interventions for rhegmatogenic retinal detachment. Journal of Ophthalmology (Ukraine). 2008; (4): 36-40 (In Russ.)

12. Takhchidi KhP, Kazaikin VN, Rapoport AA, Kazantsev VS, Chashchin GV. Prediction of the results of treatment of retinal detachment using silicone tamponade based on pattern recognition methods. Annals of the Russian Academyof Medical Sciences. 2007; (8): 31-36 (In Russ.)

13. Colucciello M. Rhegmatogenous retinal detachment. Phys Sportsmed. 2009; 37(2): 59-65. doi: 10.3810/psm.2009.06.1710

14. Zavgorodnyaya NG. The hemodynamic background in patients with rhegmatogenous retinal detachment. Zaporozhskiy meditsinskiy zhurnal. 2014; (5): 66-69 (In Russ.)

15. Yakimov AP, Zaika VA. Complex assessment of structural and functional status of posterior segment after surgery for reghmatogenous retinal detachment. Actabiomedica scientifica. 2011; (6): 141-143 (In Russ.)

16. Neroev VV, Sarygina OI, Zueva MV, Tsapenko IV, Egorova EN. Impact of ozone therapy on the electrophysiological parameters of the retina in patients operated on for its rhegmatogenous detachment. The Russian Annals of Ophthalmology. 2007; 123(5): 33–36 (In Russ.)

17. Karazhaeva MI, Saksonova EO, Klebanov GI, Lubitskii OB, Gurieva NV. Flavonoid antioxidants in the complex treatment of patients with dystrophic retinal detachment. Russian Journal of Clinical Ophtalmology. 2004; 5(1): 41–43 (In Russ.)

18. Bulion VV, Khnychenko LK, Sapronov NS, Kovalenko AL, Alekseeva LE. Correction of consequences of postischemic reperfusion brain damages with cytoflavin. Bulletin of Experimental Biology and Medicine. 2000; 129(2): 149–151 (In Russ.)

19. Gusev AN, Krasnogorskaya VN. Antioxidants in complex treatment of far-advanced open-angle glaucoma. The Russian Annals of Ophthalmology. 2016; 132(1): 63-67 (In Russ.) doi: 10.17116/oftalma2016132163-67

20. Krasnogorskaya VN, Gusev AN, Sorokina EV. The use of Cytoflavin in complex treatment of primary open-angle glaucoma. Pacific Medical Journal. 2012; (3): 19-20 (In Russ.)