Abstract Topic: 35. Quality of life and palliative care
Background: Due to therapeutic achievements, the survival rate of patients with onco-hematological pathology has significantly increased. The diverse clinical picture of the lesion and often asymptomatic recurrence on the part of the organ of vision threatens serious complications. Ocular manifestations in hemoblastosis, mainly damaged retina, as a result of direct tissue infiltration and secondary vascular disorders is an unfavorable prognostic sign. Newest оcular involvement diagnosis with the use of modern non-invasive ultrasound and laser technologies is relevant in for improving the quality of life of onco-hematological patients.
Aims: Assessment of ocular morphofunctional and hemodynamic changes in patients with onco-hematological diseases.
Methods: 14 patients (28 eyes) with hematological cancers, including 8 women and 5 men aged 28-52 years (age average 42 ± 6.3 years) were examined. The study group consisted of 4 patients (8 eyes) with chronic myeloid leukemia (CML), 3 (6 eyes) with chronic lymphocytic leukemia (CLL), 3 (6 eyes) with multiple myeloma, 3 (6 eyes) with diffuse B-large cell lymphoma, 1 patient (2 eyes) with essential thrombocytemia. At the time of the ophthalmological examination 3 patients had not yet been treated for the underlying disease, 11 patients had received targeted therapy within a period of 2 weeks to 1 month. The control group consisted of 10 healthy volunteers (20 eyes). In addition to the standard examination, all patients underwent color Doppler mapping (CDM) of the eye and orbit vessels using the ultrasound diagnostic device (Voluson E8 Expert); flowmetry using an ocular blood flow analyzer (Paradigm, USA); optical coherence tomography (OCT) of the macular region and optic nerve in standard mode (Stratus OCT-3000, Germany) and OCT- angiography (OСT-A) (Optovue RTVue-100, USA); combined electroretinography (general and multifocal) (o-ERG and mf-ERG) (EP-1000 Multifocal Tomey, Germany).
Results: At the time of examination, there were no complaints about the organ of vision in all patients, visual acuity with correction was 0.8 - 1.0. In the study group retinal angiopathy in the form of vasodilation and tortuosity was detected in 43% of cases and single intraretinal hemorrhages -in 14%. OCT data revealed an increase in the average chorioretinal thickness in the parafoveal region and the average thickness of the peripapillary layer of nerve fibers (p < 0.05). Along with a decrease in the volumetric eye blood flow (68%) OCT-A demonstrated a lower vascular density in the superficial retinal capillary plexus and choriovascular pattern (“shortening” of arterioles) in macula and peripapillary. The analysis of ocular blood flow according to CDM data showed a decrease in all velocity characteristics mainly in the central retinal artery (CRA) and posterior short ciliary arteries (PSCA) (p < 0.01). According to the electrophysiological study, subnormal o-ERG was recorded in 71.4% of cases. A significant correlation was found between the maximum systolic blood flow rate in the CRA and the amplitude of the b-wave o-ERG (p < 0.01). In 45% of cases of a subthreshold b-wave of mf-ERG, a violation of the biopotential topography of the central retinal zone was recorded, that indicated local retinal ischemia.
Summary/Conclusion: Modern technologies allow to obtain a comprehensive qualitative and quantitative assessment of morphofunctional and hemodynamic disorders of the visual organ on preclinical stage. It is an important prognostic value for monitoring local microcirculatory disorders in patients with onco-hematological diseases.
Keywords: Quality of life, Thrombotic microangiopathy, Intravital microscopy, Pathology