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AIM: to study long-term (≥2-year) RESULTS of ranibizumab treatment in patients with macular neovascular disorders. MATERIAL AND METHODS: The study group included 27 patients (mean age±SD of 66.7±13.8 years) treated with ranibizumab for approved indications. Follow-up period ranged from 24 to 58 months (34.5±9.1 months on average). RESULTS: Optical coherence tomography showed statistically significant improvements of functional and anatomical parameters, namely, an increase in visual acuity (from 0.34±0.20 to 0.57±0.24, p≤0.01) and a decrease in both central retinal thickness (from 372.26±96.21 µm to 272.48±69.70 µm, p≤0.01) and macular volume (from 8.01±1.46 mm3 to 7.10±1.08 mm3, p≤0.01). There was also a decreasing tendency of the average annual number of intravitreal ranibizumab injections per patient: 4.56 injections were done during the 1st year, 1.93 - during the 2nd year, and only 1.6 - during the 3rd year of follow-up. A total of 29.6% of patients showed no need in resuming the treatment at year 2 and 40.0% - at year 3. Exudation from the neovascular membrane relapsed in 24 patients (88.9%) at some time during the follow-up; at that, in 74.1% of patients the injection-free intervals lasted from 6 to 36 months. None of the 231 injections was associated with any complications concerning ocular functions and morphology and requiring additional treatment. No correlation was found between the anti-angiogenic therapy and the progression of cardiovascular disease. CONCLUSION: Intravitreal ranibizumab has been proved effective and safe for the treatment of neovascular macular disorders. Moreover, flexible dosing schemes for ranibizumab contribute to rapid (during the 1st year already) and stable clinical benefits.

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AIM: The study of glycosaminoglycanes (GAG) in leukocytes and platelets of patients with hereditary coagulopathy. MATERIALS AND METHODS: GAG concentration, composition and fraction identification were made in 25 patients with hemophilia A and 10 patients with Willebrand disease. RESULTS: In hemophiliacs, leukocytes contained low concentrations of GAG. In those with bleeding and synovitis GAG levels were lower than the average, in those with extensive hematomas in the absence of locomotor disorders the above levels were close to normal. Chondroitinsulphate dominated in GAG composition though it was less polydisperse. Heparin sulphate levels were elevated. Platelet GAG characteristics were close to normal. In Willebrand disease leukocyte GAG content and composition was similar to those in hemophilia A except some differences in electrophoretic properties of small GAG components. CONCLUSION: Metabolism and/or release of GAG from blood cells may be involved in pathogenesis of hemophilia A and Willebrand disease.

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The work presents findings of an ultrasonic examination of joints in 30 patients with hemophilia and in 15 healthy persons. Of 30 hemophilic patients 15 had hemarthroses and 15 had chronic hemorrhagic-destructive arthropathies. On the basis of the examinations carried out a conclusion was made about high informative value of sonography as a non-invasive diagnostic method and as estimation of the efficiency of treatment of hemophilic arthropathies.

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Urinary system was examined in 35 hemophiliacs. 25 of them had in the past 2 to 6 episodes of hematuria. The examinees had also depressed cellular immunity. Their humoral immunity, on the contrary, was activated. In the absence of clinical and x-ray evidence of urinary abnormalities, renal affections were registered in 88.6% of the examinees. According to the data obtained all hemophiliacs suffer from unbalance of cellular and humoral immunity, abnormal clearance of immune complexes, probable renal damage. Therefore, it is desirable to make ultrasonic investigation of the kidneys in all hemophiliacs to check latent renal affection and take therapeutic measures.

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Ultrasonic investigation of the urinary system and the kidneys has been performed in 40 hemophilia A patients. The size of the kidneys was reduced in the majority of patients, the area of the calices in relation to relevant parenchyma was relatively enlarged. Parenchyma to caliceal-pelvic system ratio made up 1.5:1. The caliculi and pelves were dilated. The resultant ultrasonic picture was characteristic of chronic pyelonephritis. Concrements of the right and left kidney were detected in 45% and 62.5% of the patients, respectively. The bladder looked asymmetric with thick walls and echogenic particles in the cavity. Control laboratory findings failed to reveal any renal pathology. It is clear that diagnostic ultrasound is important in hemophiliacs who may develop latent renal disorders. The risks of replacement therapy with blood preparations and sequela of renal hemorrhages are considered.

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This study was aimed at investigation of immune status in patients with hemophilic arthropathies and design of optimal therapeutic programs for them. 103 hemophiliacs were examined. Of them 56 patients had chronic productive synovitis and 47 osteoarthrosis. All the patients displayed higher levels of CIC and immunoglobulins than normal subjects, the highest values being registered in synovitis. Synovial fluid in them contained CIC and IgG, IgA, IgM. The findings suggest that immune disorders are actively involved in pathogenesis of hemophilic arthropathies. Programs of immunocorrecting therapy of synovitides and osteoarthroses including plasmapheresis and intraarticular administration of hormonal and cytostatic drugs produced a clinical response in 80% of the cases. The remission lasted up to 1 year.

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