Chichur D. Efficacy of a modified immunosuppressive therapy method in patients suffering from rhegmatogenous retinal detachment

The thesis is devoted to improving efficacy of treatment of rhegmatogenous retinal detachment (RRD) patients, aimed to prevent the disease relapse and its development in a conjugate eye by using a modified immunosuppressive therapy method, by studying autoimmune process activity in patients with different disease course. 170 patients suffering from RRD were included to the study. Two types of bilateral RRD clinical course were distinguished from clinical assessment: type I - favorable, observed in 13.7% of the cases, manifested through its tendency for simultaneous affection of both eyes, absence of vitreoretinal traction, law relapse rate, and high effectiveness of extrascleral sealing reaching 100%; type II - unfavorable, observed in 86.3% of the cases, manifested through successive lesion of eyes, pronounced vitreoretinal traction, frequent use of endovitreal surgery, and decrease of surgical treatment efficacy to 57.0%. Excessive activation of autoimmune processes and their maintenance has been found to be one of pathogenetic mechanisms of recurrent RRD and bilateral rhegmatogenous retinal detachment development in 80% of the cases. It is manifested through essential (50%-75% on average) intensification of autoantibodies synthesis to eye tissue (the highest autoantibodies levels were detected in a group of patients with bilateral RRD : 19.2 U to vitreous, 13.6 U to neuroepithelium, 22.6 U to pigment epithelium-choroid complex), and their prolonged persistence, which results in increase of their levels, elevation of Ig and circulating immune complexes levels both in blood serum and ocular fluids. Application of steroidal hormones (both systemic and topical) in complex treatment of patients with high levels of circulating autoantibodies to ocular tissues (20.0 U and higher) prevents realization of autoimmune cytotoxic reactions, thus decreasing the risk of relapse and RRD development on a conjugate eye. Efficacy of the suggested treatment scheme was 82.0%: relapse rate in unilateral RRD patients was decreased from 35.7% to 4.2%, and the same parameter in BRRD patients was decreased from 76.9% to 18.8%.