January 09 2021 Content Selection & Advisory Board (CSAB), adopted the decision to include the Russian Ophthalmological Journal into the Scopus database
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Retinal diseases among the adult population in federal statistics of the Russian Federation
The incidence rates, as well as certain aspects of the organization of medical care for patients with retinal diseases, are collected in the main forms of federal statistical observation. These data are important not only from the point of view of assessing the epidemiology of diseases, but primarily as indicators of the quality and accessibility of medical care. The purpose is to analyze the overall incidence of retinal diseases based on data from the federal statistical observation forms for the Russian Federation in 2024 in comparison with data from global epidemiological studies. Material and methods. We studied the indicators of general morbidity presented in the forms of statistical observation of the Russian Federation in 2024, analyzed the indicators by region of the country and compared the average Russian data with the results of international epidemiological studies. Results. The analysis of federal statistics data has shown the relevance of the problem of accounting for retinal diseases. In the Russian Federation in 2024, there were registered in absolute figures 368,358 adult patients with macular degeneration (relative indicator — 317.0 per 100,000 adult population), 34,769 adult patients with degenerative myopia (29.9 per 100,000 adult population), 459,327 adult patients with diabetic retinopathy (399.6 per 100,000 adult population), 39,751 adult patients with rhegmatogenous retinal detachment (34.2 per 100,000 adult population), 9,799 adult patients with chorioretinal inflammation (8.4 per 100,000 adult population). Conclusion. Retinal pathology has a fairly high prevalence and accounts for a significant proportion of hospital morbidity. The deviation of statistical indicators from the data of global epidemiological studies, including in certain regions of the Russian Federation, indicates defects in the coding, diagnosis and accounting of diseases.
Effect of short-term exposure of red light on axial length, anterior chamber depth and visual acuity among young myopes
Purpose: evaluation of the effects of red-light exposure on vision and ocular measurements after a 3-minute exposure. Material and methods. A Quasi experimental study was conducted. The non-random purposive sampling technique was used. The study included 41 patients with myopia. Both genders were included where the female were 90.24% while male were 9.76%. The mean age for females was 23.15 ± 1.58 (range: 19–24 years) and for males was 23 ± 2.16 (range: 20–25 years). Patient’s visual acuity (VA) was assessed with ETDRS chart while axial length (AL), anterior chamber depth (ACD), non-cylcloplegic spherical equivalent refraction (SER), keratometry readings were recorded using IOL Master before and after exposure. To provide exposure an Android mobile application called “SCREEN FLASH” was used in a dark room. The patient was exposed to the Red Screen utilizing 650 nm red light for 3 minutes. SPSS 26 was used for statistical analysis. Results. Significant changes were observed in preand post biometric readings. The mean value of VA increased from 0.68 ± 0.33 to 0.58 ± 0.31 log MAR, (p-value < 0.001), AL decreased from 24.54 ± 1.05 to 24.53 ± 1.05 mm (p-value = 0.001), SER decreases from 4.5 ± 0.85 to 4.47 ± 0.97 D (p-value < 0.001) and ACD decreased from 3.64 ± 0.26 to 3.63 ± 0.25 mm (p-value < 0.001) after exposure. For keratometry values, results were insignificant. Conclusion. A notable improvement in VA was found on exposure to red light in young myopic patients and significant reduction in AL, SER and ACD was observed.
Assessment of the survival rate of patients with malignant neoplasms of the choroid in the Orenburg region
The purpose of the work is to analyze the impact of various factors on the survival of patients with malignant neoplasms of the choroid. Materials and methods. A retrospective analysis of the databases of the V.I. Voynov Orenburg State Clinical Eye Hospital for 2013–2022 was carried out. Among the cases of complaints about malignant neoplasms of the vascular membrane (ICD code C69.3), cases with uveal melanoma were selected. The survival rate of the patients was calculated. Results. Among the completed cases, the most common cause of death was malignant neoplasm of the vascular membrane. The study showed that age and gender do not affect survival rates (p ˃ 0,05). However, among the examined cases, survival was higher among urban residents compared with rural residents (p = 0.019). Also, higher survival rates were demonstrated in the group of patients who underwent laser treatment (p = 0.017). In addition, survival is higher among patients treated at stage 1 of the disease than among patients treated at stage 4 of the disease (p = 0.00140). Conclusions. The life prognosis of patients with malignant neoplasms of the choroid is favorably influenced by living in an urban area, treating the disease at an early stage using organ-preserving techniques.
Autologous retinal transplantation in cases of refractory and primary large macular holes: predictive biomarkers of graft integration, long-term results and personalization of the method
One of the new promising methods of surgical treatment of large macular holes (MH) is autologous retinal transplantation (ART) procedure. Purpose — рersonification of the ART. Material and methods. The first ART in the Russian Federation was carried out by me in March 02, 2021. The study included 35 patients (35 eyes) with diagnosed refractory (previously repeatedly operated without achieving closure of the hole) and large MH with a diameter of more than 800 microns. All patients conducted a standard tripport 25G vitrectomy. Then, a fragment of neurosettes from the peripheral zone was cut. The resulting transplant was transferred to the hole zone, then the PFCL was replaced by silicone or fixed by the gas mixture (C3F8). As a predictive criteria for assessing the integration and viability of the graft after the ART, control points (7 days and 1 month after the surgery) were determined and the following biomarkers were established: reconstruction of the ellipsoid zone, alignment of neurosenerable layers, the speed of vertical and horizontal integration of transplants. Results. 12 months after the operation, 98 % of patients had a complete anatomical closure of the MH. All patients were tracked at least 6 months after surgical treatment. Average value of best corrected visual acuity (BCVA) before surgery was 0.08, 6 months after surgery — 0.23. Two years after the ART, 20 patients were monitored, of which 15 (75 %) patients retained a high BCVA of 0.30 ± 0.08. Conclusion. The obtained high anatomical and functional results can be explained by the personification of ART for MH surgery: the method is overlapped for traumatic and refractory MH, and the edge in the edge for large primary MH.
Early results of Preserflo MicroShunt implantation in primary open-angle glaucoma
Purpose: to evaluate the efficacy and safety of Preserflo MicroShunt implantation in patients with primary open-angle glaucoma (POAG) as the first and second glaucoma surgery in the early postoperative period. Material and methods. Single-center prospective non-randomized study of Preserflo MicroShunt implantation in 12 patients (12 eyes) aged 60,4 ± 17,8 with moderate and advanced POAG with an average IOP of 30.3 ± 9.1 mm Hg. IOP was determined at 1, 3, 7 days, 2 weeks, 1 and 3 months after surgery. Results. The IOP level was 10.2 ± 5.0, 9.4 ± 4.4, 11.3 ± 4.5, 10.8 ± 4.2, 12.7 ± 5.6 and 13.0 ± 6.1 mm Hg, respectively. Baseline average visual acuity was 0.5 ± 0.3, unchanged either on day 7 or by 3 month. Hypotony £ 6 mmHg was in 4 cases, with a flat anterior chamber and choroidal effusion without Seidel positive leakage in 2 cases, without anterior chamber reformation. In 5 cases, IOP increase required bleb needling filtration, and in 2 cases — the medication therapy restart. Conclusion. Preserflo MicroShunt implantation in patients with POAG is an effective and safe procedure for up to 3 months after surgery.
Results of a clinical study on the effectiveness of azapentacene in the treatment of early senile cataract
Purpose of the study is to evaluate the effectiveness of azapentacene in preventing the progression of early senile cataract based on a comprehensive assessment of clinical indicators, as well as biomechanical and tomographic parameters of the lens. Material and methods. 30 patients (58 eyes) with initial senile cataract were examined. The azapentacene was used in the form of eye drops (3–5 times a day, instillation into the conjunctival cavity). In these eyes the parameters of the lens layers were studied using optical biometry, sonoelastography, and acoustic density. A comparative analysis of clinical indicators, biomechanical and tomographic parameters of the lens was carried out before the start of therapy and three months after its start. The functional state of the visual system uncorrected (UCVA) and maximally corrected (BCVA) visual acuity, computer perimetry data and the characteristics of the lens, based on a biomicroscopic examination using the LOCS III classification, were evaluated in 57 eyes. Results. A significant improvement in visual acuity was noted in the study group. UCVA increased from 0.39 ± 0.04 to 0.44 ± 0.04 (p < 0.001), and BCVA from 0.91 ± 0.02 to 0.93 ± 0.02 (p < 0.001). Analysis of computer perimetry data showed a significant increase in sensitivity: MS increased from 23.88 ± 0.26 to 24.60 ± 0.23 (p < 0.001). Assessment of lens opacities according to LOCS III classification revealed a decrease in NO from 2.62 ± 0.06 to 2.41 ± 0.06 (p < 0.001) and NC from 2.12 ± 0.06 to 2.02 ± 0.06 (p < 0.001). This indicates a positive trend in the treatment process. Optical biometric data showed a significant decrease in the density of the anterior layers of the lens: from the initial value 9817.5 ± 291.1 to 8781.62 ± 273.95 (p < 0.001). This also confirms an improvement in the condition of the lens. The core density also showed a significant decrease: from 6509.2 ± 151.3 to 5639.97 ± 149.83 (p < 0.001). A similar trend was found for the optical density of the posterior layers of the lens. The results of sonoelastography revealed a significant decrease in the anterior layers and the lens nucleus: from 0.68 ± 0.03 to 0.57 ± 0.02 (p < 0.001) and from 0.38 ± 0.01 to 0.32 ± 0.01 (p < 0.001), respectively. The index of the posterior layers also decreased from 0.51 ± 0.02 to 0.41 ± 0.01 (p < 0.001). The analysis of the acoustic density of the lens showed its significant decrease in the anterior layers, core and posterior layers: from 23.53 ± 0.58 to 21.38 ± 0.54, from 4.93 ± 0.26 to 3.60 ± 0.21 and from 19.97 ± 0.35 to 17.91 ± 0.32 cu, respectively (p < 0.001). Conclusion. The study demonstrated the effectiveness of azapentacene in the initial age-related changes of the lens, which confirms the validity of its use in clinical practice in order to prevent the early development and progression of cataracts. This approach contributes to the long-term preservation of visual function and, accordingly, to the improvement of patients quality of life.
CRB1-associated retinopathy: clinical characteristics and molecular genetic features in the Russian population
Purpose: to reveal the phenotype and genotype spectrum in cohort of patients with CRB1-associated retinal degeneration from Russian pathogenic variants. Materials and methods. A prospective cohort study was conducted on 7 patients aged 5 to 38 years from 6 families with CRB1 gene mutations. Clinical examination included best-corrected visual acuity, refraction, Goldmann visual field, slit-lamp biomicroscopy, fundus photography, fundus autofluorescence, and optical coherence tomography. All patients underwent electrophysiological and molecular genetic testing (last-generation sequencing — “Hereditary Retinal Diseases” panel). Results. We revealed 7 different phenotypes of CRB1-associated retinopathies. In all patients compound — heterozygous pathogenic variants in CRB1 genes were found. Among 11 pathogenic variants only three: c.2843G>A, (p.Cys948Tyr), c.2536G>A(p.Gly846Arg21) and c.2308G>A, (p.Gly770Ser) were described on other populations. Pathological sequences in CRB1 gene included 8 previously not described (3 missense: c.1042T>C (p.Cys348Arg), c.2480G>T (p.Gly827Val), c.29T>C (p.Leu10Pro) и 5 nonsense: c.1492delA (p.Ser498Valfs*4), c.2238delT (p.Gln747Asnfs*7), c.624T>G (p.Tyr208*), c.222C>A (p.Cys74*), с.1660del (p.Val554Cysfs*19), which points out the features of Russian population. Missense mutations: c.2308G>A (p.Gly770Ser), c.2480G>T (Gly827Glu) and c.2536G>A (p.Gly846Arg), as well as nonsense mutation c.2238delT (p.Gln747Asnfs*7) are located in “hot” 7 exon of CRB1 gene, in which we also found the biggest number of pathogenic variants. Mutation c.222C>A (p.Cys74*) was found in 3 of 7 patients, 2 of whom were siblings. Conclusions. Cohort of Russian patients with CRB1-associated retinopathy demonstrated wide-spectrum phenotypes of inherited retinal dystrophies, including Leber congenital amaurosis type 8, early onset retinal dystrophy, early onset retinitis pigmentosa (RP) type 12 with or without optic nerve drusen, RP of 12 type with bone spicules and atrophy of the outer layers of parafoveal retina, Coats’ like exudative vasculopathy with cystoid macula oedema, RP with paraarteriolar preservation of retinal pigment epithelium (PPRPE). New molecular genetic characteristics in patients from the Russian population with CRB1-associated inherited retinal dystrophies were revealed.
Assessment of retinal vessels and corneal endothelium alterations in acute and post-COVID-19
The COVID-19 pandemic, caused by SARS-CoV-2, has shown significant systemic effects beyond the respiratory system, including ophthalmologic complications. The purpose of the study is to assess alterations in retinal vessels and corneal endothelium in patients with acute and post-COVID-19 infection. Material and methods. A prospective observational study was conducted at Al-Hussain Teaching Hospital in Iraq at two years 2021–2022, including 50 adult patients (56 % male) aged 61.7 ± 12.5 years with confirmed COVID-19 by PCR testing. Common comorbidities included hypertension (30 %), smoking (26 %), and diabetes mellitus (16 %). Comprehensive ophthalmologic examinations were performed, including retinal imaging and specular microscopy. Clinical and laboratory data were collected and analyzed using SPSS version 26.0. Results. Significant laboratory changes were observed between acute and post-acute phases, indicating an inflammatory response during acute infection. Retinal alterations improved significantly post-acute COVID-19, with reductions in retinal hemorrhage, vessels tortuosity, and veins dilatation. Specular microscopy showed improvements in cell density, average cell area, coefficient of variation, and hexagonality. Conclusion. COVID-19 has significant impacts on retinal and corneal health, with notable improvements post-infection. These findings highlight the need for on-going ophthalmologic monitoring in COVID-19 patients to manage and mitigate long-term ocular complications.
Contrast sensitivity and photostress recovery time in diabetics with and without diabetic retinopathy
Diabetes mellitus (DM) is a major public health concern and a leading cause of diabetic retinopathy (DR), a condition that can lead to vision impairment and blindness. Early detection of retinal changes is essential in preventing vision loss. Purpose. This study investigates the relationship between photo-stress recovery time (PSRT) and contrast sensitivity (CS) in diabetic patients with and without DR compared to healthy controls. Material and methods. A hospital-based comparative cross-sectional study was conducted at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan. A total of 60 participants (age range: 40–75 years) were included, comprising 40 diabetic individuals (20 with DR and 20 without DR) and 20 healthy controls. Visual acuity, CS (using the Pelli — Robson chart), and PSRT (using a direct ophthalmoscope) were assessed. The correlation between DR and PSRT/CS was analyzed using the Spearman’s correlation test, with a significance level set at p < 0.05. Results. The study found significantly lower CS and prolonged PSRT in diabetic individuals compared to controls (p < 0.05). Diabetic individuals with DR showed the most significant delay in PSRT. A weak negative correlation was observed between CS and DR, and a moderate positive correlation was found between PSRT and DR (p < 0.05). Conclusions. PSRT is significantly prolonged in diabetic patients, particularly those with DR, compared to non-diabetic controls. The results suggest that PSRT could serve as a reliable and simple clinical tool for early detection of DR, potentially aiding in the prevention of vision loss. Further studies with larger sample sizes are needed to explore mechanisms and therapeutic interventions to improve PSRT and CS in diabetic retinopathy patients.
Effect of cycloplegia on keratometric and biometric parameters in keratoconus and controls
Purpose. This study aimed to evaluate and compare the effect of cycloplegia on keratometric and biometric parameters in keratoconus patients and controls. Materials and methods. A preand post-interventional study was performed on 48 keratoconus (KC) patients diagnosed per Collaborative Longitudinal Evaluation of Keratoconus (CLEK’s) Classification and 41 age-matched controls. Full ophthalmological evaluations included refractive, keratometric, and biometric measurements with an auto kerato-refractometer (Topcon KR-800) and IOL MASTER 700, using 1% cyclopentolate hydrochloride for cycloplegia. Results. The study compared ocular measurements in KC patients and a control group before and after cycloplegia. KC patients exhibited significant changes in flat keratometry K1 (47.52 to 47.34), steep keratometry K2 (52.67 to 52.13), spherical equivalent (SE) (-6.35 to -5.5), lens thickness (LT) (3.49 to 3.44), anterior chamber depth (ACD) (3.75 to 3.84), and central corneal thickness (CCT) (446.78 to 450.72), all significant (p< 0.01), while axial length (AL) remained unchanged (23.5). The control group showed no significant differences in K1, K2, or AL, but SE, LT, ACD, and CCT exhibited significant changes. Conclusion. KC patients have a greater susceptibility to changes in corneal parameters post-cycloplegia compared to controls. These findings highlight the importance of careful evaluation in KC patients due to their distinct ocular responses to cycloplegia.
Fractal phototherapy in visual rehabilitation of patients with Stargardt disease
Currently, there are no effective drug therapies for Stargardt disease (SD), although innovative strategies are being sought in several directions. Even minor improvements in individual visual characteristics are of great importance for improving the quality of life (QL) of visually impaired patients. Therefore, non-drug strategies for visual rehabilitation, with special attention paid to technologies that affect the plasticity of the visual system, can play a decisive role in improving QL. Purpose of the study was to evaluate the effectiveness of visual rehabilitation using fractal phototherapy (FP), a neuroplasticity-activating method, in virtual reality in patients with SD based on electroretinography data. Material and methods. Three patients with SD of STGD1 phenotype were observed. Results. In all patients, a decrease in the central retinal activity compared to the age norm was documented before therapy, according to mfERG data, as well as a generalized decrease in functional retinal activity, according to full-field ERG (cone and flicker ERG). After a 2-week course of fractal photostimulation in virtual reality, a tendency towards an increase in the amplitude of the a-wave of the photopic ganzfeld ERG (p = 0.0728) and a decrease in its peak latency (p = 0.0625), as well as an increase in the amplitude of photopic low-frequency RERG at 10 and 12 Hz, in the generation of which cone photoreceptors make a dominant contribution, was observed. This indicates an activating effect of FP on the function of photoreceptors, which is significant for ABCA4 variants leading to disruption of the visual cycle and functioning of visual cells. The most significant and statistically highly significant changes were documented for the mfERG amplitude in the fovea zone (p = 0.0017), which is especially important for the subjective visual sensations of patients and their daily activities. Conclusion. In future studies, it is advisable to confirm the obtained patterns of the effect of FP on ERG in a larger group of patients with SD and clarify the indications for visual training using FP in various phenotypes of the disease.
Scleral strengthening treatment and its effect on the eyeball coats oxidative stress in progressive myopia
In patients with progressive myopia, there is an imbalance between the processes of lipid peroxidation and antioxidant protection, which is confirmed by changes in the level of hypoxia markers and the activity of the antioxidant enzyme superoxide dismutase (SOD) in the tear fluid (TF). Purpose: to study the SOD activity in the TF of patients with moderate and high progressive myopia after sclera-strengthening treatment. Material and methods. We examined 82 patients (82 eyes) aged 8 to 17 years with progressive myopia (ave 9.1 ± 0.3 D), divided into two main groups: in the 1st group (47 patients), minimally invasive scleroplasty (MIS) was performed using a biologically active graft, in the 2nd group (35 patients) — bandaging scleroplasty (BSP) according to the Snyder-Thompson technique using homoscleral graft. The control group consisted of 12 unoperated patients aged 7–13 years with low hyperopia (0.25 D to 1 D). At various times after MIS and BSP, SOD activity (by inhibition of quercetin autoxidation) and total protein concentration according to Lowry were determined. Results. SOD activity in the TF before surgery in patients of group 1 (32.0 ± 5.3 U/mg protein) and group 2 (24.7 ± 6.4 U/mg protein) was in generally significantly higher than in the control group (20.0 ± 3.2 U/mg protein). At the same time, in some patients with initially low SOD values, enzyme activity significantly increased 1 month after surgery (p < 0.01) and exceeded the control level by 4.3–5.2 times. In case of initially elevated SOD activity, on the contrary, the enzyme concentration significantly decreased (p < 0.01) — 3.5 times with BSP and 1.9 times with MIS. After 6 months, in patients of the MIS group with the initial level of SOD activity below the norm, the enzyme activity remained 2 times higher than normal values (p < 0.01). All other patients showed a decrease in SOD values to the control level, and in some cases below it. Conclusion. Sclero-strengthening treatment has a normalizing effect on SOD activity in the TF, which contributes to the correction of metabolic disorders caused by progressive myopia and confirms the importance of scleroplasty as a method activating bioregulation and normalizing oxidation-reduction processes in the eye tissues.
Comparative analysis of the effectiveness of orthokeratology and bifocal soft contact lenses with high add power
Progressive myopia in children is associated with a risk of ophthalmic pathology in adulthood. Orthokeratology lenses (OKLs) and bifocal/ multifocal soft contact lenses (BSCLs) are widely used for optical control of myopia. Comparative evaluation of their effectiveness is necessary for personalizing the choice of myopia control method in children. Purpose: to compare the change in spherical equivalent refraction (SE) and axial length (AL) in children aged 8–13 years with progressive myopia using OKLs (including those with reduced BOZD/fixed RZD) and BMCLs. Material and methods. The prospective study included 160 children aged 8–13 years (median age 11 years). SE was 1.00–6.00 D, astigmatism £ 0.75 D. To control myopia, children were offered a choice of defocus spectacles, BSCL, and OKL. Participants who chose contact correction were assigned to the BMCL (n = 70) or OKL (n = 90) groups. AL and SE measurements under cycloplegia were performed at baseline and 12 months after discontinuation of OKL wearing. Statistical analysis was performed taking into account clustering by eyes (GEE); the Brunner — Munzel/χ²/Fisher’s exact test was used for comparison. Results. Over 12 months, a statistically significant increase in AL (p < 0.001) and a shift in SE towards increased myopia occurred in both groups (BSCL: p = 0.008; OKL: p = 0.002). When stratifying by the degree of myopia, it was found that with mild myopia, SE increased in both groups (BSCL, p < 0.001; OKL, p = 0.017); with moderate myopia, no significant changes in SE were found (p = 0.125 and p = 0.099). With mild myopia, there were no significant intergroup differences in AL levels initially/after one year (p = 0.526/0.933); however, the absolute increase in AL over one year was greater in the OKL group (p = 0.011). With moderate myopia, the initial AL was slightly higher in the BSCL (p = 0.067); after one year, intergroup differences in AL were statistically insignificant (p = 0.141). The relationship between AL and SE changes: there is no correlation for the cohort as a whole (ρ = 0.07; p = 0.299); In OKL there was no association (ρ = 0.10; p = 0.326), in BSCL there was a tendency towards a positive association (ρ = 0.21; p = 0.07); no intergroup differences in the strength/direction of the association were found (p = 0.115). A 5.7 % dropout was observed in the BSCL group, while in the OKL group it was 0.0 % (p = 0.035). Conclusion. OKL and BSCL demonstrated comparable clinical efficacy in slowing down axial elongation in children aged 8–13 years over the course of a year. No significant differences in AL were found in the presence of mild myopia with OKL and BSCL; intergroup differences were also not proven with moderate myopia. According to the literature, the efficacy of standard OKL (SOKL) is higher in patients with moderate myopia, while the effect is weaker in patients with mild myopia. Since SOKL was not a separate observation group in our study, the comparisons are indirect. Prospective, long-term studies are required to accurately evaluate the comparative effectiveness of three approaches to myopia control over the long term.
Two-steps laser-assisted selective stroma transplantation
Selective stroma transplantation (STS) is a new type of keratoplasty that we have proposed for the surgical treatment of isolated stromal pathology. Due to the closed and intracorneal surgical technique, STS eliminates intraocular complications. This technique is sutureless, allows keeping the corneal surface intact, excludes complications related to corneal epithelialization, and optimizes the use of donor corneal material. At the same time, the indications for the operation are limited due to the low prevalence of isolated stromal pathology. Considering the advantages and prospects of STS, we have developed a two-steps laser-assisted technique of selective stroma transplantation to expand the indications for the operation, the indication for which is a prevalent pathology of stroma with involvement of the anterior corneal surface. Purpose. To present the technique of two-steps laser-assisted selective stroma transplantation and to evaluate short-term results in a series of clinical studies. Materials and methods. The operation was performed in 3 patients aged 44 to 61 (mean age 53 ± 6 years) with corneal stromal dystrophy with involvement of the anterior surface of the cornea. Before and after surgery, refractometry, visometry, biomicroscopy, photoregistration, keratometry, and optical coherence tomography of the cornea were performed. The interval between the first step (STS) and the second step (phototherapeutic keratectomy) ranged from 3 to 4 months and averaged 3,0 ± 0.4 months. After the second step of surgery, eye refraction, visual acuity, corneal thickness, and corneal transparency at the optical center were evaluated. The follow-up period was 10 ± 3 months (6 to 15 months). Results. No intraoperative or postoperative complications were registered. The cornea remained transparent throughout the entire follow-up period. Mean visual acuity increased from a preoperative mean of 0.16 ± 0.02 to 0.60 ± 0.04 at the time of the last follow-up examination after the second step. The mean central corneal thickness was 526 ± 6 μm (517 to 530 μm). Conclusions. The absence of complications in two-steps laser-assisted selective stromal transplantation demonstrates the safety of the technique. The improvement of visual acuity in all patients indicates the effectiveness of the procedure. The two-steps modification retains the same advantages as the one-step modification. At the same time, the two-steps technique has extended indications for surgery and provides higher functional refractive results due to the presence of only one interface and smooth anterior surface as a result of the excimer laser.
Differentiated approach to the treatment of chronic conjunctivitis in post-COVID syndrome based on data laser doppler flowmetry
Purpose: to develop a differentiated approach to the treatment of chronic conjunctivitis in post-Covid syndrome based on laser Doppler flowmetry (LDF) data. Material and methods. The study included 66 patients (132 eyes) with chronic non-infectious conjunctivitis in the post-Covid period. All patients underwent LGF of the bulbar conjunctiva 3 months after SARS-CoV-2 infection. According to the results of LDF, patients were divided into 2 groups: 1-st with hyperemic and 2-nd with stagnant hemodynamic type of microcirculation. In each group, two subgroups were identified. Patients of subgroup 1-a (18 patients, 36 eyes) were prescribed topical antioxidant agent 3 times a day for 2 months, moisturizing preparations containing sodium hyaluronate 3 times a day, preparation containing heparin during the whole period of observation, systemically a preparation from the group of metabolic agents for 3 months. Patients of subgroup 2-a (15 patients, 30 eyes) were recommended instillations of preparations containing sodium hyaluronate 3 times a day, a preparation containing heparin during the whole period of observation and systemic administration of a preparation from the group of venotonics 3 months. Patients of subgroups 1-b and 2-b were treated with a preparation containing sodium hyaluronate 3 times a day. The effectiveness of therapy was monitored after 1, 3, 6 months. Results. After therapy hemodynamic parameters of microcirculation significantly improved. Correction of microcirculatory disorders contributed to normalization of perfusion in 3 months in patients of subgroup 1-a (M = 24.8 ± 5.5 p. u.), in 6 months in patients of subgroup 2-a (M = 26.3 ± 6.1 p. u.) and mechanisms of its regulation in 6 months in patients of subgroup 2-a (Kv = 15.2 ± 7.4 %). No statistically significant changes in microcirculatory parameters were registered in patients of subgroups 1-b and 2-b. Conclusion. Hyperemic or stagnant type of hemodynamic microcirculatory disorders, established by the evaluation of baseline indices (M, σ, Kv), serves as a basis for the choice of treatment tactics for chronic conjunctivitis in postconcussive syndrome.
Alpha-2-macroglobulin in tear fluid: a step in diagnosis of lacrimal gland tumors
The purpose of the work was to study the activity of the acute phase inflammation protein alpha-2-macroglobulin (α2-MG) in the tear fluid (TF) of patients with different morphological variants of lacrimal gland tumors (LGT). Material and methods. The study included 33 patients with morphologically verified diagnosis of LGT. The control group (healthy individuals) was additionally recruited for comparative evaluation. TF was collected from both eyes before surgery using filter paper. The activity of α2-MG was determined by enzymatic method. Results. It was revealed that in epithelial tumors of the LG — pleomorphic adenoma and lacrimal gland carcinoma, there was an increase of α2-MG activity in the TF on the side of the lesion compared to the control group. At the same time, in 67 % (n = 4) of LG carcinoma cases there was a tendency to increase α2-MG activity also on the healthy side. In LG lymphomas, no significant differences from the norm in α2-MG activity in the TF both on the tumor side and on the healthy side could be detected. The α2-MG activity did not depend on the tumor volume and clinical features. In patients with LG carcinoma with a history of more than 10 months, high values of α2-MG activity in the TF on the contralateral healthy side were detected. Conclusion. For the first time we evaluated the activity of α2-MG protein in the TF and showed characteristic features in different morphologic variants of LGT. The search for biochemical markers in TF opens new opportunities for studying the pathogenesis of this category tumors, which may contribute to the development of personalized therapy. The obtained data allow to improve diagnostics of LGT and can be applied in clinical practice in the system of complex diagnostics at the stage of preoperative preparation.
Features of the aqueous humor proteome in patients with primary open-angle glaucoma and its changes during treatment with neuropeptides
Purpose of the work was to study aqueous humor (AH) proteome in patients with primary open-angle glaucoma (POAG) and evaluate its changes during treatment with neuropeptides. Material and methods. AH samples were collected during surgery from 80 patients, divided into the main (n = 52, aged 75 (71,5; 78) yrs) and control groups (n = 28, aged 76 (74; 78) yrs). Subgroup 1 of the main group consisted of patients (n = 31) with developed and advanced stages of simple and pseudoexfoliative POAG. Subgroup 2 of the main group included patients (n = 21) with simple and pseudoexfoliative forms of POAG, who received a 10-day course of intramuscular injections of a complex of neuropeptides before surgery. The control group consisted of patients with age-related and complicated forms of cataract. In addition to routine and specialized ophthalmological examination, an analysis of the proteomic profile of the AH was performed using the Cytokine/ Chemokine/ Growth Factor Convenience 45-Plex Human Panel 1 multiplex panel (ThermoFisher scientific, USA). Results. The study of 45 biomarkers revealed changes in 13 of them (28.9 %) in patients with POAG compared with the control group. In addition, statistically significant differences were obtained in 2 of these 13 cytokines (15.4 %) after a course of neuroprotective treatment. Conclusion. The shifts in the cytokine system revealed as a result of proteomic mapping of the AH indicate their role in the implementation of systemic mechanisms of glaucoma development and progression as modulators of the chronic inflammatory component. The detected changes in the Eotaxin protein apparently reflect involutional shifts characteristic of patients with age-related changes in the retina. It is necessary to continue research to determine the risk factors for the development of POAG at the stage of preclinical changes, the development and implementation of an accessible method for early non-invasive diagnosis, as well as personalized therapy.
Cases of congenital bilateral anophthalmos in children
Two clinical cases of congenital bilateral anophthalmia associated with systemic and syndromic diseases in children undergoing continuous observation at a palliative care facility in the Perm Territory for three years are presented. Currently, only conjunctival hygiene is indicated for these children. Given the bilateral nature of the congenital pathology, the lack of previous prosthetics, and the resulting deformation of the bony and soft walls of the orbit, as well as the presence of severe neurological pathology, step-by-step prosthetics and surgical treatment are currently impossible. Conclusion. These clinical cases of congenital bilateral anophthalmia confirm the importance of early prevention of anomalies. Since the eyeball is formed during the 9th week of intrauterine development, the prevention of these malformations should be undertaken during pregnancy planning. This is especially necessary in families where both spouses have congenital visual pathology.
Sub-tenon’s injection of recombinant prourokinase (Hemase) combined with intravitreal injection of a neoangiogenesis inhibitor (Eylea) in the treatment of massive subretinal hemorrhage in neovascular age-related macular degeneration. A clinical case
This paper describes a clinical case of neovascular age-related macular degeneration complicated by subretinal hemorrhage and analyzes the effectiveness of minimally invasive combination treatment, which included a sub-Tenon injection of recombinant prourokinase (Hemase) simultaneously with an intravitreal injection of a neoangiogenesis inhibitor (Eylea). This treatment resulted in significant positive results within a short period of time (1 month), including complete hemorrhage resorption and improved visual acuity, which made it possible to postpone or completely avoid open surgery.
A clinical case of choroidal melanoma recurrence in the orbit 14 years after enucleation
Uveal melanoma is a multifactorial malignant intraocular tumor of neuroectodermal genesis, developing from melanocytes of the uveal tract, characterized by a high risk of metastasis and a poor vital prognosis. The paper describes the clinical observation of a 67-year-old patient with a late recurrence of choroidal melanoma in orbit in 2024 after enucleation in 2010. Clinically, echographically, and according to computer tomography, the presence of a neoplasm in the orbit has been confirmed. The patient underwent a transconjunctival orbitotomy, and a dark brown pseudocapsule about 2 cm in size was removed. According to the pathohistological conclusion, the morphological picture of the neoplasm of the left orbit corresponded to a recurrence of melanoma with the presence of perineural invasion. The patient is directed to irradiate the left orbit with a narrow medical proton beam. Despite the rarity, such a case demonstrates the need for lifelong monitoring of patients with choroidal melanoma, regardless of the time after surgical treatment, in order to timely identify and treat local and long-term complications.
About Williams syndrome. Literature review and case report
The authors present a literature review and their own observation of a 6-year-old child with Williams syndrome, which, however, was not immediately diagnosed. Initially, the child was diagnosed with partial optic nerve atrophy (ONA). The presence of photophobia, normal optic nerve coloration in combination with low visual acuity gave reason to suspect congenital retinal pathology. Based on the obtained data of a comprehensive examination (including the use of visual evoked potentials for a flash and a reversible pattern, testing color vision, etc.), the diagnosis of ONA was exluded and the following diagnosis was made: OU — cone retinal dystrophy, congenital nystagmus. In addition, the boy’s extreme sociability and talkativeness (he constantly demanded attention) attracted attention, although some phrases in the child’s speech were meaningless and unrelated. After retrosclerofilling with Alloplant biomaterial, the patient was discharged with a recommendation to undergo a genetic examination. After examination at the Bochkov N.P. Medical Genetic Center (Moscow), the child was diagnosed with a rare genetic pathology — Williams syndrome.
Effects of ultraviolet corneal cross-linking upon the limbus. Literature review
Today, corneal ultraviolet (UV) collagen cross-linking (CXL) appears to be the most effective and preferable technology for treating keratectasia. CXL is a simple, minimally invasive procedure, therefore, it has become the most reliable treatment for corneal degeneration, compared to other surgical modalities. In the vast majority of cases, CXL provides good clinical and functional outcomes and remains the safest technique for the treatment of corneal degenerations. The data from experimental studies and clinical observations indicate the potential of developing CXL-induced damage to the limbal niche structures. This process contributes to the development of cytotoxicity, stimulates apoptosis, reduces cell proliferation and can result in delayed cellular mutations. It is necessary to protect corneal limbus from undesired UV exposure during CXL. This can be achieved by forming the required diameter of the UV spot (8–9 mm), and by using filters or protective rings that prevent UV rays from reaching the corneal periphery. There is still a need for long-term experimental and clinical studies on the effect of UVA radiation on sensitive limbal structures in order to adjust CXL protocols and minimize the risk of possible complications.
Preservatives in eye drops. Myths and realities
Preservatives in eye drops are an important ingredient that helps prevent microbial contamination of the drug and allow it to be used in an open bottle for a long time. Quaternary ammonium compounds are most often used for the purposes in question — benzalkonium chloride, cetrimonium chloride, etc. Chlorobutanol, chlorhexidine, thimerosal, methylparaben, sodium perborate, etc. have also found application. Numerous studies indicate the effectiveness and relative safety of eye drops containing a preservative in an acceptable dosage. In addition, there is information about the ability of preservatives to increase the penetration of drugs into the eye. At the same time, a certain toxicity of the listed preservatives serves as a limitation to their widespread use, especially in patients with destructive corneal pathology, when wearing contact lenses, etc. In this regard, preservatives have been developed that have sufficient antimicrobial activity “in a bottle”, in the absence of toxicity for the tissues of the ocular surface, including due to their decay to biologically inert compounds in the conjunctival cavity (under the influence of physical factors, enzymes of the lacrimal fluid, etc.): polyquad, oxide, purit, ocupur, SofZia, GenAqua, etc. A number of eye drops are now manufactured without preservatives at all (due to the special design of bottles or the use of single use dropper tubes). As clinical practice shows, preservative-free drugs are certainly preferable in the following situations: 1) the presence of dry eye syndrome in the patient or its development against the background of the use of drops with preservatives; 2) dystrophic or other diseases of the cornea or conjunctiva; 3) increased sensitivity of the ocular surface; 4) the need to wear soft contact lenses.
Corneal crosslinking in children with keratoconus. Literature review
The article presents a review of the literature data on the results of corneal crosslinking (CXL) for the treatment of keratoconus (KC) in pediatric patients. There are many reports on the results of corneal CXL in children with KC, but most studies were conducted in small cohort groups, have a short follow-up period, and there are conflicting opinions on the effectiveness of different protocols for this procedure. The use of this procedure in the treatment of pediatric KC stops or slows down its progression according to the results of all studies. Due to the rapid progression of KC in childhood, some authors suggest the use of corneal CXL even in the absence of documentary evidence of disease progression. The development of the most optimal corneal CXL protocol with high efficiency and safety for children of different age groups remains an important problem, which requires further research.
Geroprotective technologies in the prevention and modifying treatment of age-associated retinal diseases
Aging of the visual system is accompanied by a decline in visual functions and a number of features determined by genetic and epigenetic changes. Studies show that strategies affecting epigenetic mechanisms can lead to a weakening of the features associated with aging and an increase in life expectancy. On the other hand, slowing down aging is an important factor that can stop or decelerate the occurrence of age-associated retinal diseases. Numerous studies have shown various molecular mechanisms underlying aging and proposed a number of therapeutic approaches based on them associated with epigenetic regulations. Geroprotective drugs have been developed to slow down aging and senolytics aimed at removing aging cells. It is recognized that the best prospects are for a therapeutic strategy of multiple approaches, which includes the simultaneous use of several compounds and approaches aimed at different aspects of aging. It is assumed that the combined use of various technologies will also determine the success of gene or cell therapy. Multi-aspect therapy appears to be the most effective method for both decelerating aging and preventing or reducing the signs of age-related retinal diseases. Since most of the methods being developed today are still at the stage of preclinical or clinical trials, the most accessible (and efficient) means for slowing down aging today are healthy longevity technologies, such as physical activity, calorie restriction, and restoration of healthy biorhythms of the body, which are capable of exerting a profound effect on all physiological systems, including the visual system. The results of experimental studies on animals and the first clinical studies of fractal optical stimulation effects in patients with AMD show its promise as a method of geroprotective therapy and visual rehabilitation of patients with age-associated retinal diseases to improve the quality of life and slow down vision loss.
Anatomical and topographic features and structural characteristics of the vitreous body
The article presents an analysis of literature data about the anatomical structure and topographical characteristics of the vitreous body, as well as information on the distinctive features of its internal structure in various segments. Particular attention is given to the biochemical composition and age-related structural changes of the vitreous body, which are crucial for understanding the pathogenesis of its disorders.
Coats' disease: current treatment trends. A literature review
In 1908, G. Coats first described a group of patients with eye damage, manifested by telangiectasia with massive intraand subretinal exudation, leading to local elevation of the retina and/or its complete detachment. Until now, a generally accepted pathogenesis model has not been developed and the causes of Coats disease (CD) have not been identified. It was assumed that the cause of the disease could be an infectious process, an inflammatory reaction, but there is currently no consensus on this issue. A study of the cytokine profile showed an increased concentration of VEGF in the intraocular, subretinal fluid and vitreous humor, an increase in the concentration of IL-6, IL-1b and MCP-1 levels was also noted. Complications of CD include vasoproliferative tumors, neovascular glaucoma, intraretinal and intraocular hemorrhages, vitreous fibrosis, traction retinal detachment. CD treatment includes laser coagulation, cryotherapy, intravitreal administration of glucocorticosteroids and angiogenesis inhibitors. In severe forms and advanced stages of CD, vitreoretinal surgery is resorted to. Enucleation may be necessary is some cases.
Feasibility of a prostaglandin-timolol fixed combination first-line treatment of primary glaucoma
Glaucoma is the most common cause of irreversible blindness worldwide. The reasons for the high and growing level of blindness due to glaucoma are low diagnostic population coverage, the incorrect hypotensive therapy and low glaucoma patient’s adherence. In practice, the recommended initial monotherapy does not allow achieving target IOP at moderate and advanced glaucoma with a high IOP level, which, according to clinical guidelines, is an indication for the initial combination therapy. Starting with a latanoprost-timolol fixed combination allows achieving a significant IOP decrease and increasing patient compliance by optimizing the number of instillations, reducing the total treatment cost, the total preservative volume, the absence of a washout effect and waiting between instillation of two drugs.
On the 100th anniversary of the birth of professor Yuri Z. Rosenblum
The article is dedicated to the 100th anniversary of the famous Russian ophthalmologist Yuri Z. Rosenblum, his life path and main scientific achievements.