Dmitrii Maltsev

Purpose: To analyze the efficacy and safety of optical coherence tomography angiography-based navigated laser treatment in central serous chorioretinopathy (CSCR) complicated by choroidal neovascularization (CNV). Methods: This study included consecutive patients with neovascular nonresolving CSCR who received en face OCT-based navigated laser treatment without fluorescein angiography or were observed untreated for at least 6 months. In all treated cases, the area of the double-layer sign with flow signal displayed with structural en face OCT image was treated with microsecond pulsing laser (up to three sessions), direct continuous wave focal laser photocoagulation, or their consecutive combination. Main outcome measure was complete resolution of subretinal fluid. Results: Sixty-seven eyes of 67 patients (28 male patients, 41.8%) with a mean age of 57.5 ± 7.7 years were included in the treatment group. Thirty eyes of 30 patients (14 male patients (46.7%), mean age 58.1 ± 6.9 years) were included in the control group. Complete resolution of subretinal fluid was achieved in 32 eyes (47.8%) in the treatment group compared with none in the control group ( P < 0.001). The odds ratio for the success of the laser treatment in the presence of fovea-involving CNV was 0.21 (95% confidence interval: 0.073–0.583). After excluding eyes with CNV involving the foveal center, the success rate achieved was 65.0%. No adverse effects in the treatment group were observed except two cases of CNV growth after focal laser photocoagulation. Conclusion: Optical coherence tomography angiography-guided laser treatment is a viable and safe option in the management of CSCR complicated by CNV, mostly effective in cases with extrafoveal CNV.

Background and Objective: Retinal and foveal displacement occur in various congenital and acquired conditions and are currently under active investigation in vitreoretinal interface pathology requiring surgery. Despite substantial evidence, no study has yet synthesized these data. The objective of this review was to summarize the data on the causes and characteristics of foveal and retinal displacement in posterior segment disorders, with a specific focus on the clinical methods used for its assessment. Methods: This was a narrative review of the available literature, conducted using the PubMed and Google Scholar databases, to identify relevant peer-reviewed articles published in English between April 2025 and March 2026. We included peer-reviewed articles describing clinical and basic science research. We analyzed the results of studies that evaluated foveal and retinal displacement in retinopathy of prematurity, familial exudative vitreoretinopathy, epiretinal membrane (ERM), full-thickness macular hole (FTMH), and rhegmatogenous retinal detachment (RRD), including surgically induced displacement. Key Content and Findings: Foveal and retinal displacement is an essential phenomenon in the natural course of ERM and frequently observed following FTMH and RRD surgery. However, the clinical significance of the displacement and associated symptoms are highly variable, depending on the magnitude and direction of the displacement. Various imaging modalities, but most frequently optical coherence tomography (OCT), are used for assessment of the foveal position pre- and postoperatively in relation to the retinal and choroidal vessels. In RRD surgery, fundus autofluorescence is particularly useful since it is able to display the initial position of the retinal vessels as hyperfluorescent footprints. Assessment of foveal position relative to the optic disc is an important tool for analyzing foveal location since it may allow the use of the fellow unaffected eye as a control. Conclusions: Foveal and retinal displacement is a phenomenon highly prevalent among patients with vitreoretinal pathology, which has clinically relevant meaning and may be qualitatively and quantitatively evaluated using multimodal imaging.

Purpose: To describe a clinical case of a patient with multifocal breast cancer and a choroidal metastasis rapidly growing despite targeted cancer therapy and simulating immune-related choroidal adverse reaction. Methods: The patient received multimodal imaging including wide-field color fundus photography, spectral domain optical coherence tomography (OCT), ultra-widefield OCT angiography, fundus autofluorescence, fluorescein angiography, indocyanine green angiography. Additionally, MRI imaging and B-scan ultrasonography was performed. Results: A 35-year-old woman with medical history of metastatic multifocal breast cancer on the fifth course of adjuvant targeted therapy with trastuzumab and docetaxel was presented with flickering in the right eye. Fundus examination revealed central flat choroidal lesion with serous retinal detachment. OCT demonstrated a bacillary layer detachment and mild choroidal thickening. After fluorescein angiography and B-scan ultrasonography a Vogt-Koyanagi-Harada-like reaction was suspected. No response was observed after initiation of systemic glucocorticosteroids. The lesion and associated subretinal exudation rapidly progressed for over a month when the lesion demonstrated signs of choroidal metastasis and extraocular metastasis were identified. Conclusion: Choroidal metastases can develop despite ongoing systemic cancer therapy as a result of acquired resistance. A rapid growth of choroidal metastasis may simulate Vogt-Koyanagi-Harada-like reaction and requires extensive multimodal imaging and close follow-up.

Purpose: to analyze the prevalence and clinical significance of acute macular neuroretinopathy (AMN) in combat closed globe trauma using multimodal imaging. Material and methods. In total, 154 eyes of 136 patienys with combat closed globe trauma of the posterior segment received standard ophthalmological examination and optical coherence tomography (OCT) and OCT angiography. Patients with AMN were identified and selected for analysis. Structural changes of the retina on cross-sectional scans, as well as the area of AMN lesions were analyzed on structural en-face projections. Results. AMN characterized by thinning of the outer retina was detected in ten eyes of ten patients (10 males, mean age 29 ± 4 years), thus accounting for 6.5 % of cases from all examined eyes with closed eyeball trauma. The analysis of the cumulative distribution showed a trend towards localization of the AMN lesions mainly in the nasal sector of the macula with an average area of 2.4 ± 1.4 mm2. AMN was an isolated manifestation of injury only in two cases, in eight eyes it was combined with other injuries associated with closed eyeball trauma. Conclusion. AMN is one of the typical lesions in closed eye injury, with a prevalence of 6.5 % among these cases. AMN can cause persistent visual deterioration, including paracentral and central scotomas and may explain “unexplained scotomas” and “unexplained decrease of vision” in patients with mild injury. The contribution of AMN to the structure of closed globe injury agrees with the concept of the syndromic nature of this phenomenon. Diagnosis of AMN requires OCT examination even in cases without ophthalmoscopically detectable changes in the macula.

Retinology is undoubtedly the avant-garde of modern ophthalmology and develops rapidly. The development and implementation of newest scientific and technological advances in clinical practice contribute to the continuous improvement of diagnostics and various treatments for posterior segment pathologies. At the same time, there are certain national and regional medicine development aspects, as well as controversial issues that can be successfully explored through sociological research, particularly expert surveys. In 2024, we organized and conducted the first independent Russian survey of retinologists, “SETCHAtochkaRU”, aimed at collecting and analyzing data on current practices, opinions, equipment, and challenges in the diagnosis and treatment of vitreoretinal pathology in Russia. The project yielded unique insights and was well received by both respondents and the scientific community. For this reason, we decided to repeat the survey a year later and attempt to make it a regular event, which will allow us to discuss the most modern aspects of retinology and evaluate its development trends. The “SETCHAtochkaRU — 2025” survey involved 430 specialists representing all regions of the Russian Federation, as well as Belarus, Germany, Georgia, Kazakhstan, Kyrgyzstan, Croatia, and Uzbekistan. The updated list of questions included such topical and relevant issues as the perspectives for the artificial intelligence use, antiangiogenic therapy trends (new drugs, biosimilars, regimens, and drug switching strategies), various practical aspects of drug use, laser, and surgical treatment for vitreoretinal pathology, the results of the federal project “Fight Against Diabetes”, and many others. Analysis of the survey results revealed a number of positive trends in the development of Russian ophthalmology. In our opinion, the “SETCHAtochkaRU” project has the potential to develop and improve as an annual monitoring study, generating original evidence base tailored to national specifics.

Purpose: To evaluate the prevalence of retinal fingerprint pattern (RFP) in central serous chorioretinopathy (CSCR) and its association with the anatomical and clinical characteristics of the disease. Methods: In this cross-sectional retrospective study, we included patients with active chronic and acute CSCR. The presence and distribution of RFP was evaluated based on macular 6-mm optical coherence tomography angiography scan pattern. To display RFP structural en face projections of a slab between two segmentation lines of the outer plexiform layer 20 µ m apart, set at the border between outer plexiform and outer nuclear layers were used. Correlation between the presence of RFP and clinical and demographical parameters and anatomical outcomes was evaluated. Results: After evaluation of 120 CSCR eyes, 22 eyes (18.3%) with RFP were identified. The presence of RFP was associated with higher baseline best-corrected visual acuity, central retinal thickness, subretinal fluid (SRF) height, the degree of neurosensory retina bending at the edge of the neurosensory detachment, and the area of the neurosensory detachment ( P < 0.05). Complete SRF resolution, either spontaneously or after laser treatment, was observed in 68.2% eyes with RFP and 36.8% eyes without RFP ( P = 0.03). No cases demonstrated RFP after resolution of SRF. Conclusion: Using en face optical coherence tomography imaging RFP can be observed in a significant proportion of CSCR eyes. The presence of RFP is associated with a higher amount of SRF and more favorable anatomical outcomes. The RFP in CSCR resulted from mechanical deformation of the retina by SRF and has a reversible character.

To assess peripapillary intervortex venous anastomoses in patients with central serous chorioretinopathy (CSCR) and in healthy individuals and its association with the clinical characteristics of CSCR. All participants received multimodal imaging, including a 12-mm optical coherence tomography angiography (OCTA) scan pattern centered on the optic disc for assessment of intervortex venous anastomoses in en face mode. Index of Vortex Anastomoses Number (IVAN) was defined as the number of quadrants of the peripapillary area with apparent vascular connectivity between neighboring quadrants of the eye fundus. IVAN was assessed in accordance with conventional and multimodal-based classifications of CSCR, as well as with laterality of the disease, its course, best-corrected visual acuity, subfoveal choroidal thickness, and central retinal thickness. One hundred twenty eyes of 60 CSCR patients (46 males (76.7%), 41.7 ± 7.9 years) and 47 eyes of 47 healthy individuals (36 males (76.6%), 42.2 ± 11.8 years) were included. IVAN was higher in chronic CSCR (median 4.0) compared to acute CSCR (median 2.0), and in chronic and acute CSCR compared to healthy eyes (median 1.0) (p < 0.001). IVAN was higher in the eyes of patients with bilateral CSCR (median 4.0), than in the active eye of unilateral CSCR patients (median 2.0) (p = 0.0002). The area of retinal pigment epithelium alteration and subfoveal choroidal thickness showed a statistically significant correlation with IVAN (r = 0.45, p < 0.001 and r = 0.35, p = 0.006). Semiquantitative analysis of intervortex venous anastomoses in peripapillary area based on en face OCTA showed their variable prevalence in eyes with CSCR, which correlates with clinical classifications of CSCR.

Purpose: To investigate the prevalence, clinical course, and prognostic significance of hyporeflective micro-elevations and irregularity of the ellipsoid zone (MEEZ) in blunt ocular trauma. Methods: Patients with blunt ocular trauma underwent standard ophthalmological examination and optical coherence tomography angiography. MEEZ was defined as small hyporeflective foci at the level of the ellipsoid and interdigitation zone, with disappearance of the thin hyporeflective band between these layers. The prevalence and spatial distribution of MEEZ, choriocapillaris perfusion, and associated findings were evaluated. Results: MEEZ was identified in 62 (40.3%) out of 154 eyes with blunt trauma, including nine eyes with MEEZ as the only form of posterior segment injury, and 53 eyes where MEEZ was found with other posterior segment injuries. Mean best-corrected visual acuity in eyes with MEEZ only was 0.0 logMAR (20/20 of Snellen equivalent). In eyes where MEEZ was associated with other posterior segment injuries, mean best-corrected visual acuity was 0.9 ± 0.64 logMAR (approximately 20/160 of Snellen equivalent). Choriocapillaris perfusion area in eyes with MEEZ only and healthy fellow eyes was 21.1 ± 1.3 and 20.4 ± 1.2 mm ² ( P > 0.05), respectively. During the follow-up, MEEZ showed complete resolution in all cases with available follow-up data ( n = 15) after a median period of 34.0 days. Conclusions: MEEZ is an important part of the spectrum of traumatic retinal changes frequently observed in blunt ocular trauma. As the only manifestation of blunt ocular trauma, MEEZ is associated with a favorable prognosis.

Purpose: To describe the role of topical fluorometholone in the treatment of eyes with central serous chorioretinopathy complicated by posterior cystoid degeneration. Methods: Patients with posterior cystoid degeneration associated with central serous chorioretinopathy were prospectively recruited, examined with multimodal imaging, and prescribed for topical fluorometholone four times daily. Eyes with macular neovascularization were excluded based on optical coherence tomography angiography. Spectral-domain optical coherence tomography was used to monitor central retinal thickness, subfoveal choroidal thickness, and the thickness of the anterior sclera. Results: Five eyes of four patients were included. Intraretinal and subretinal fluid in all eyes had been unresponsive to all standard treatments, but improved remarkably or completely resolved with limited improvement of visual acuity after a mean of 6.0 ± 2.0 weeks of topical fluorometholone administration. In all cases, significant reduction of scleral thickness was observed with no or mild intraocular pressure rise. Conclusion: Severe cases of central serous chorioretinopathy complicated by posterior cystoid degeneration associated with vision loss may be managed with topical fluorometholone. The positive effects of steroids in central serous chorioretinopathy may be mediated by their effects on reduction of the scleral thickness.