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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Visual impairment in the elderly as a risk factor for sarcopenic obesity
Visual impairment significantly reduces physical activity in elderly patients, which significantly contributes to the development of sarcopenic obesity. However, visual impairment has not previously been considered as a risk factor for sarcopenic obesity. Purpose: to study the association of visual impairment with sarcopenic obesity. Material and methods. The prevalence of sarcopenic obesity was studied among 315 elderly patients with primary glaucoma and cataracts, diagnosed according to national criteria through a comprehensive ophthalmological examination. Sarcopenic obesity was identified based on recommendations proposed by the European Working Group on sarcopenia in older people (EWGSOP2, 2018). Results. The prevalence of sarcopenic obesity varied depending on the uncorrected visual acuity in the worse eye, with a maximum of 59.37 ± 3.18 % of cases with uncorrected visual acuity of 0.20–0.30. A high prevalence of sarcopenic obesity in patients with primary glaucoma and cataract was also revealed with uncorrected visual acuity of 0.31–0.40, amounting to 22.85 ± 2.06 % of cases, which is 2.59 times lower than with visual acuity of 0.20–0.30. A low and almost equivalent prevalence of sarcopenic obesity was found among those examined with visual acuity without correction of 0,41–0,50 and 0,51–0,60. Factor analysis confirmed a high and reliable association sarcopenic obesity only with visual acuity without correction in the worst eye of 0,20–0,30 and 0,31–0,40. Conclusion. Visual impairment is a significant risk factor for sarcopenic obesity.
Differential diagnostic criteria of lacrimal gland tumors based on comprehensive ultrasound examination
Ultrasound is a highly informative method of noninvasive diagnostics in ophthalmic oncology. However, its potential in the differential diagnostics of lacrimal gland tumors (LGT) has not been sufficiently studied. Purpose of the work was to determine the structural and hemodynamic characteristics of LGT based on complex high-frequency ultrasound scanning. Material and methods. The study included 52 patients (104 orbits), 32 women and 20 men, aged 26 to 81 years, with histologically verified LGT, including 27 cases of lacrimal gland (LG) lymphoma, 12 cases of pleomorphic adenoma, and 13 cases of LG cancer. Various morphological variants of tumors were compared with each other, and healthy LG of these patients were also analyzed, except for bilateral lesions. A comprehensive ultrasound examination of the LGT included B-mode, color Doppler mapping (CDM), and pulsed-wave Dopplerography. The echostructure and vascularization of tumors were assessed, blood flow indices were determined by calculating the indices of peripheral resistance in the tumor’s own vessels, in the lacrimal artery and vein. Results. Diagnostically significant echographic criteria characteristic of OSG of various etiologies have been determined. Conclusion. A comprehensive ultrasound examination can be recommended as one of the visualization methods in the comprehensive differential diagnosis of LGT in order to determine the optimal treatment strategy.
Effectiveness and safety of GlaucoDrain in treating refractory glaucoma
Purpose of the study: to evaluate the anatomic and functional outcomes as well as structure of complications of GlaucoDrain shunt implantation in patients with refractory glaucoma. Materials and methods: 60 patients (average age 70.40 ± 8.97 years) with various forms of refractory glaucoma (operatively treated primary open-angle glaucoma, secondary and juvenile) who had 62 shunts were followed-up. In 83.9% of the implantations, filtration surgeries were performed prior to implantation. Results. After 1 year of observation, “complete success” will be achieved in 86.3% of cases, “partial success” — in 7.0%. Median intraocular pressure (IOP, Pt) decreased from 24.5 [20; 28] to 14.0 [13; 17] mm Hg (p < 0.001). The most frequent complications were choroidal detachment (16.1% of cases, 11.3% of them hemorrhagic), which in most cases was purchased conservatively, and anterior uveitis (8.1%). Conclusion. With the nuances of surgical technique (temporary tube obturation) and postoperative pharmacological support (prolongation of hypotensive therapy for 4–6 weeks after surgery), the GlaucoDrain shunt demonstrates comparable efficiency and safety to the Ahmed valve.
The role of optical coherence tomography in the assessment of axonal damage in autoimmune lesions of the optic nerve
The purpose of the study was to comparatively analyze optical coherence tomography (OCT) data from patients with neuromyelitis optica (NMOSD) and optic neuritis in multiple sclerosis (MS-ON) to identify structural differences and refine diagnostic criteria. Material and methods. A comprehensive ophthalmological and neuroimaging examination, including OCT with assessment of retinal nerve fiber layer thickness (RNFLT), macular area, and choroid, was performed in 26 patients (46 eyes). Results. Patients in both study groups showed a significant decrease in RNFLT compared to the controls (p < 0.01), with the most pronounced changes noted in the NMOSD-ON group, especially in the temporal quadrant. The incidence of macular microcystic edema was 30.7% in patients with NMOSD-ON and 11.5% in patients with MS-ON (p = 0.02). Subfoveal choroidal thickness did not differ significantly between the groups (p > 0.05). Conclusion. OCT results confirm that NMOSD-associated optic neuritis is characterized by more pronounced axonal degeneration and structural changes. Integration of neuroimaging and clinical data improves the accuracy of differential diagnosis and can serve as a basis for developing personalized approaches to treating and monitoring patients with inflammatory optic nerve lesions.
Corneal endothelial cells change in different stages of keratoconus
Purpose. To evaluate the changes in morphology and total endothelial count in patients with different stages of keratoconus (KC). Material and methods. A cross-sectional study included 564 eyes of KC patients (57.8% males and 42.2% females) aged 19.9 ± 6.5 years. Study was conducted at the Cornea and Refractive Surgery department of Alshifa trust eye hospital Rawalpindi. Galilei (G4) Dual Scheimpflug Analyzer and specular microscopy (Tomey EM-4000) were used for all eyes examination. KC eyes were classified according to Amsler classification into stage 1, 2 ,3 and 4. Results. There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.001) between different stages of KC eyes. Regarding cell surface area and cell morphology, there was statistically significant difference between different stages of KC eyes (p < 0.001). Conclusions. Significant changes were seen in endothelial cell count and morphology of eyes by using specular microscopy. For stages 1 and 2 KC, these changes are mild but the endothelium in stage 3 and 4 shows significant changes regarding polymegathism and pleomorphism.
Dry eye syndrome in academia: from behavioural strategies to AI-oriented prevention
Purpose of the study was to assess the prevalence of dry eye syndrome (DES) among ITMO University students and staff using the OSDI questionnaire, determine the effectiveness of interactive behavioral interventions, and consider the prospects for using artificial intelligence (AI) in DES prevention in the academic environment. Material and methods. A total of 470 people aged 18 years and older completed the initial survey using the OSDI scale. 281 participants (59.8 %) had DES symptoms. Forty-five people with an OSDI score ≥ 13 were randomized to the intervention (n = 21) and control (n = 24) groups. The intervention group received the Eye.Kit and informational support via a Telegram channel. After 14 days, participants repeated the survey. Results. Both groups showed a reduction in DES symptoms. The reduction in the mean OSDI score in the intervention group (from 21.5 to 12.8, p < 0.001) was more significant than in the control group (from 22.8 to 19.4, p = 0.041). The difference between the groups in the final symptoms level was statistically significant (p = 0.023), indicating a higher effectiveness of the behavioral intervention. Conclusion. DES is widespread in the academic environment. Behavioral intervention with elements of digital communication demonstrated a statistically significant reduction in DES symptoms. The implementation of AI can improve the personalization of prevention through lifestyle analysis, monitoring of blink patterns, and adaptation of the learning environment.
Efficacy of prostaglandin analogues as initial therapy in patients with newly diagnosed normal tension glaucoma
Purpose of the study: to evaluate the efficacy of prostaglandin analogues as initial therapy in patients with newly diagnosed normal tension glaucoma (NTG). Material and methods. The study involved changes in functional, morphometric and hemodynamic parameters in 65 patients with newly diagnosed NTG treated with 0.0015 % Tafluprost for 6 months. Results. In patients with the initial stage of NTG (35 patients, 35 eyes), the initial level of intraocular pressure according to Maklakov decreased by the end of the observation period by an average of 25 % from 20.1 ± 1.7 to 15.1 ± 0.75 mm Hg, in patients with stage II NPG (30 patients, 30 eyes) — by an average of 21.0 % from 19.63 ± 1.7 to 15.5 ± 1.0 mm Hg. According to computer perimetry, 77.14 % of patients with stage I newly diagnosed NPG showed a decrease in the severity of local visual field defects; in patients with stage II — an improvement in the average retinal light sensitivity. Using the optical coherence tomography with angiography (OCTA) method in the initial and advanced stages of NTG, an improvement in the retinal vascular density was recorded in the superficial vascular plexus Fovea and Parafovea; in the deep vascular plexus — in the Fovea area in I stage and in Parafovea in II stage NTG. Conclusion. The initial therapy of Tafluprost for 6 months in patients with newly diagnosed NTG demonstrated the absence of progression of glaucomatous optic neuropathy in the initial and advanced stages of the disease. OCTA is a promising direction for assessing the effectiveness of hypotensive therapy in patients with primary open-angle glaucoma, including normal tension glaucoma.
Comparative assessment of the biometric parameters of the lacrimal gland based on computed tomography and echography in healthy individuals of different ages
Analysis of literary sources demonstrates the variability in biometric parameters of the lacrimal gland (LG) obtained by computed tomography (CT) in healthy subjects. The various imaging methods of LG with assessment on biometric parameters of the palpebral and orbital lobes of healthy LG are needed for the development objective criteria and improve the efficiency of diagnostics of LG pathology. The purpose was to conduct a comparative analysis of the biometric characteristics of LG obtained with CT and echography in healthy individuals of different ages. Material and methods. A total of 60 patients (120 eyes) were examined, divided into 3 groups: 18–40 years (the 1st group), 40–60 years (the 2nd group), and 60–90 years (the 3rd group). There are 20 individuals (40 eyes) in each group. Ultrasound was used to assess the structure of the palpebral lobe of the LG, measuring its diameter and thickness in two projections. The diameter of the orbital lobe was also measured. The CT of the orbits was performed in axial, coronal, and sagittal planes. In the axial and coronal projections, the total axial length and thickness of the gland were measured, while the sagittal projection measured the palpebral lobe separately and the diameter of the orbital part. Results. In adult patients, the lowest biometric parameters of the LG were recorded in the 1st group: 8.48 ± 0.5 mm for the palpebral part and 2.2 ± 0.1 mm for the orbital part, as well as 13.47 ± 0.48 mm for the orbital part. There were no significant differences in the parameters of the palpebral part between the 1st and the 2nd groups. In the 3rd group, there was an increase in the diameter and thickness of the palpebral part of the LG by 9.0 and 6.6 %, respectively, compared with the 1st and 2nd groups. The maximum average values of the length of the LG according to CT were observed in the 1st group: 15.1 ± 2.4 mm in the axial plane and 16.2 ± 2.4 mm in the coronary plane. There was no statistically significant difference in size between the 1st and 2nd groups. An age-dependent increase in the size of the LG was recorded in the sagittal plane. The average biometric parameters of the orbital part of the LG in the 3rd group were significantly higher compared to the 1st and 2nd groups. Conclusion. The analysis of ultrasound results demonstrated the comparability of the average values of echographic biometric characteristics with CT data in the sagittal plane. A high reliable correlation has been established between the average length and width of the palpebral and orbital parts of LG using two different research methods.
Features of biomechanics of the cornea, IOP and parameters of the eye anterior segment in primary glaucoma in the indigenous inhabitants of the Republic of Sakha (Yakutia)
The study of the biomechanical properties of the cornea in patients of different ethnic groups with primary glaucoma is very relevant and determines a personalized approach to the management and treatment of these patients. The purpose of the work is to study the biomechanical properties of the cornea and the parameters of the anterior segment of the eyes in patients with primary glaucoma of the indigenous inhabitants of the Republic of Sakha (Yakutia). Materials and methods. A total of 220 eyes of 112 native residents of the Republic of Sakha (Yakutia) aged 65.79 ± 4.98 years were examined, including 72 eyes with primary angle-closure glaucoma (PACG), 70 eyes with primary open-angle glaucoma (POAG) stages II–III, and 78 eyes with incomplete age-related cataracts without glaucoma. Corneal topographic parameters were measured using a Pentacam corneotopographer (Oculus). Intraocular pressure (IOP), corrected IOP (bIOP), biomechanical parameters including stress-strain index (SSI), and applanation stiffness parameter (SP-A1) were determined using a Corvis ST analyzer (Oculus, Germany). Results. A “thin” central corneal thickness (CCT) was found in individuals without glaucoma and in patients with POAG, but biomechanical parameters indicated increased corneal stiffness: patients with POAG had higher SP-A1 and bIOP values. Patients with PACG had a “normal” CCT, and biomechanical parameters indicated a more elastic cornea compared to individuals without glaucoma and POAG, which is probably a protective mechanism in people with a shallow anterior chamber from a potential increase in IOP. High SSI values were found in all three groups, which is related to the patients’ age. However, the SSI in the POAG group was lower than in the other groups, likely due to therapy with prostaglandin analogues, which reduce the stiffness of the eye fibrous layer. Conclusion. The identified differences in the parameters of the eye anterior segment and corneal biomechanics in patients with various forms of glaucoma will improve the effectiveness of dynamic monitoring and treatment.
Long-term anatomo-functional results of surgical treatment of retinal detachment by temporary extrascleral ballooning method
Purpose of the study was to conduct a clinical and functional analysis of the results of surgical treatment of retinal detachment using temporary extrascleral ballooning. Material and methods. Extrascleral ballooning was performed in 30 patients (30 eyes) with rhegmatogenous retinal detachment. Preoperative visual acuity ranged from 0.05 to 1.0 (0.63 ± 0.35). During the surgery, a tunnel was formed in the sub-Tenon space with the introduction of a balloon into the projection area of the retinal break, then the balloon was filled with saline until the indentation required by the height of ridge of the buckle was created. On the first postoperative day, delimiting laser coagulation of the retina along the break margin was performed using a 3-mirror Goldmann lens. On the 7th day, after the formation of chorioretinal adhesions, the balloon was smoothly emptied and removed. The follow-up examination was performed on the first day, 1 week, 1 month and 12 months after the surgery. The follow-up period ranged from 1 year to 8 years (5.12 ± 2.4 years). Results. The surgery was without complications in all cases. In the early postoperative period, complete retinal reattachment was achieved in all patients. In the period from 1 week to 3.5 years, recurrent retinal detachment was noted in 6 cases (20%). Visual acuity in the late postoperative period improved in 17 cases (56.7%), remained unchanged in 10 (33.3%), and decreased in 3 (10%). Conclusion. Temporary extrascleral ballooning is still an effective and relevant technique that provides good anatomical and functional results in the treatment of uncomplicated retinal detachment. Temporary ballooning can be recommended for patients with uncomplicated forms of retinal detachment, in which proliferative vitreoretinopathy does not exceed stage A, there is no traction from the vitreous body at the edge of the rupture, the ruptures themselves are within the access of the forming depression shaft (for up to 1 hour), and the retinal pigment epithelium has sufficient pigmentation for reliable chorioretinal adhesions.
The long-duration flash electroretinogram in children with retinopathy of prematurity
Purpose of the study was to determine the functional activity of the retina in children depending on both the degree of cicatricial retinopathy of prematurity (ROP) and the gestational age (GA) at birth based on the results of the long-duration flash electroretinogram (ERG) recording. Material and methods. A total of 31 patients (57 eyes) with ROP grades I–III aged 13.4 ± 2.7 years were examined, of which 13 children were born at ≤ 27 weeks GA. All children underwent recordings to a long-duration flash ERG. The amplitude and latency (peak time) of the a- and b-waves of the On-response and the d-wave of the Off-response were assessed. Results. When comparing ERG indices to a long-duration stimuli at different grades of ROP, a decrease in the amplitude of the a-, b- and d-waves of the On and Off ERG responses was noted compared to both the age norm and with an increase of ROP stage. When comparing the ERG parameters to a long-duration stimuli in children born at different gestational ages, a statistically significant difference was determined in the amplitude of the a-wave of the On-response and the d-wave of the Off-response between the control group and in children with GA ≤ 27 weeks and with GA > 27 weeks. Comparison of the temporal parameters of the analyzed ERG waves in the norm and in the eyes of children with GA ≤ 27 and GA > 27 weeks revealed statistically significant differences in the latency of the a-wave of the On-response (p < 0.01), while the latency of the b-wave of the On-response significantly differed only in the norm and GA > 27 weeks. Conclusion. A significant decrease in the amplitude of the a-wave of the On-response and the d-wave of the Off-response relative to the age norm in all eyes with ROP confirms the similarity of their generation from cone photoreceptors with the contribution of Off-bipolar cells and indicates their primary vulnerability early at stage I of ROP. Registration of ERG to a long-duration stimuli in children with ROP seems to be a sensitive and informative method for objective assessment of functional activity of the retina and may be used in combination with other types of ERG to allow more accurate determination of the degree and level of damage to the visual system in ROP.
Comparative analysis of the structure of surgically formed drainage pathways in patients with primary open angle glaucoma and pseudophakia after trabeculectomy using various types of drains
Purpose of the study: To carry out a comparative analysis of the structure of surgically formed outflow pathways in patients with primary open angle glaucoma (POAG) and pseudophakia after sinustrabeculectomy (STE) using various drains. Materials and methods. A randomized prospective study included 136 patients (140 eyes) with aphakia and advanced and far-advanced POAG who underwent STE with basal iridectomy (STE + BI) with or without implantation of different types of drains, differing in material and properties. Group 1 consisted of 35 eyes of STE + BI with implanted resorbable drainage from a composition of polylactic acid (polylactide) and polyethylene glycol Glautex (HighBi Tech LLC) (Glautex), Group 2 consisted of 35 eyes of STE + BI with implantation of hydrophilic slowly resorbable collagen drainage MP (Mak-Medi LLC Rectangular micro drainage) (MP), group 3 — 35 eyes of STE+BI with implantation of collagen non-absorbable drainage Xenoplast (Transcontact LLC). The control group included 35 eyes that underwent STE + BI without drainage implantation. The surgical drainage pathways using ultrasound biomicroscopy (UBM) and optical coherence tomography (OCT) of the eye anterior segment, as well as the number of complications were evaluated. Results. After 2 years, according to UBM and OCT data, the filtration bleb (FB) flattened to 0.40 ± 0.14 mm (group 1), to 0.42 ± 0.12 mm (group 2) and to 0.38 ± 0.21 mm (group 3), while in the control group, the height of the FB increased to 0.58 ± 0.19 mm due to the appearance of cystic changes. The thickness of the scleral flap (SF) increased to 0.44 ± 0.19 mm and 0.46 ± 0.17 mm when using Glautex and MP, whereas in the control group and using Xenoplast it decreased with loss of drainage function due to sclero-scleral adhesions (0.34 ± 0.05 mm and 0.29 ± 0.045 mm, respectively). The height of the intrascleral space (ISS) decreased with the use of Glautex, Xenoplast and in the control group (up to 0.26 ± 0.04 mm, 0.25 ± 0.15 mm, 0.35 ± 0.08 mm). The maximum height of the ISS was noted in the group using MP drainage (0.68 ± 0.28 mm). After 24 months, the IOP in group 1 approached the target value and amounted to 18.29 ± 3.67 mm Hg; group 2 — 18.6 ± 2.15 mm Hg; group 3 — 20.60 ± 3.95 mm Hg; control — 24.7 ± 5.0 mm Hg. It was revealed that the height of FB and ISS does not always correlate with IOP, and by the end of the follow-up, the prognostic significance of qualitative UBM parameters exceeds quantitative ones in several cases. Conclusions. According to UBM and OCT data, resorbable and partially resorbable drains — Glautex and MP — provide more stable maintenance of the volume of ISS and FB in the remote period, contributing to the long-term preservation of the functional patency of the filtration pathway, compared to non-resorbable Xenoplast and traditional STE + BI without the use of a drain. The use of these drains provides a longer and more stable maintenance of IOP in patients with pseudophakia.
Prospective possibilities for assessing the impact of scleroplasty in high myopia on ocular hemodynamics
Purpose of the study was to evaluate changes in choroidal thickness (CT) and hemodynamics parameters in patients with high progressive myopia before and after banding scleroplasty (BSP) using optical coherence tomography (OCT) and laser speckle flowgraphy (LSFG). Material and methods. The study included 42 patients (42 eyes) aged 13.0 ± 1.8 years with high progressive myopia, which according to the spherical equivalent (SE) averaged 10.4 ± 3.3 D, and the axial length (AL) equal to an average of 27.6 ± 1.6 mm. BSP was performed using a modified Snyder – Thompson technique in our own modification. CT was measured on a multimodal SLO/OCT Mirante multimodal platform (Nidek, Japan). Blood flow in the macular area was assessed using the LSFG-RetFlow instrument (Nidek, Japan) with the determination of the mean blur rate (MBR). Results. One month after surgery, a statistically significant increase in TC was detected in the center of the macular zone compared to the baseline level by 34.6 μm (p ≤ 0.05), after 6 months by 18.8 μm, and after 12 months by 11.8 μm. According to LSFG data, a trend towards an increasing in choroidal blood flow was noted after BSP, which by the end of the observation period amounted to 20.4% . A correlation between the dynamics of choroidal blood filling intensity and blood flow velocity was determined only 1 month after BSP, which was confirmed by a parallel increase in TC by 17.6% and an increase in MBR by 10.9%. However, subsequently (after 6 and 12 months), the former indicator decreased, while the latter maintained an upward trend. Conclusion. The use of OCT and LSFG methods allowed us to establish a relationship between changes in choroidal blood filling (TC) and blood flow velocity (MBR). The obtained results clarify the mechanisms of the stimulating effect of BSP on choroidal microcirculation in patients with high myopia.
Application of a neural network model for OCT image classification in the diagnosis of choroidal melanoma
Early and accurate diagnosis of choroidal melanoma (CM) is required to initiate treatment in a timely manner and improve the prognosis. The purpose of the study was to develop an automated system for supporting medical decision-making in the diagnosis of choroidal tumors based on optical coherence tomography (OCT) images using artificial intelligence (AI) technologies and to evaluate its performance. Material and methods. The article describes the creation process and evaluates the effectiveness of the YOLO11n-cls convolutional neural network in the automatic classification of OCT fundus images into three classes: CM, choroidal nevus, and healthy fundus. Results. To train and evaluate the model, a dataset of 1,700 OCT images obtained at the Helmholtz National Medical Research Center of Eye Diseases over the period 2014–2024 was created. Training was performed using augmentation methods and weights pre-trained on ImageNet. According to the testing results, the accuracy of the model was 95 %. The primary limitations identified include insufficient variability in unique cases and the necessity for further external validation of the model. Conclusion. The potential of using AI-based technologies in the creation of programs to support medical decision-making in ophthalmological practice has been demonstrated.
Glaucoma filtering surgery: rational algorithm of patients’ follow-up
Purpose of the study: to present a rational algorithm of post-operative visits of patients who have undergone trabeculectomy (TE). Material and methods. In a prospective interventional single-center open cohort study participated 1,100 sequentially enrolled patients operated by three surgeons (the authors of the study) in 2022–2024 in the City Multidisciplinary Hospital No. 2 regarding the non-compensated primary open-angle glaucoma and then observed in the clinic for 3–6 months. The frequency and optimal timing of post-operative examination, providing timely diagnosis and adequate treatment of TE complications, the main ones being shallow anterior chamber (AC) due to hyperfiltration in the first 2 weeks as well as excessive scarring later after surgery is analyzed. Results. The date of the next visit was determined during the first examination of the operated patient 2 to 3 hours after the TE. The unchanged depth of the AC, combined with the diffuse filtration bleb (FB), allowed for outpatient treatment with follow-up in the hospital 3 weeks after TE, at the beginning of the FB remodulation phase, and then 2–4 times during the 2nd month after the surgery. Slightly reduced due to overfiltration depth of the AC allowed outpatient treatment, but required checkups at the clinic 3, 7 and 14 days after TE (until normalization of anatomical relationships in the anterior segment) and then 2–4 times during the second month after the surgery. Flat AC, recorded a few hours after TE, was the reason for the prolongation of the stationary treatment, at least 2–3 days for its therapeutic and surgical recovery. The follow-up examinations were carried out on the 7th and 14th day after TE and then 2–4 times during the second month after the surgery. Lack of aqueous flow from under the scleral flap in the first hours after surgery did not prevent patient discharge but involved a set of recovery and maintenance filtration measures during checkups after 3, 7 and 14 days after TE and then weekly for the second month following the surgery. Conclusion. Unlike uncomplicated phacoemulsification of senile cataracts, where the adequacy of a one-time visit to the local clinic is not in doubt, the success of conjunctival glaucoma surgery is not possible without a close 2-month follow-up by the glaucoma surgeon, which involves 5 to 7 check-ups. In the uncomplicated early postoperative period, special attention should be given to the patient on the 4th–8th week after TE while in hyperfiltration or lack of FB the main therapeutic activities occur in the first 2 weeks after the surgery.
Clinical analysis of trabeculectomy filtering bleb vascularization parameters based on tomographic images using machine vision methods
The shape of the filtration bleb (FB) largely determines the hypotensive effect of glaucoma surgery. Purpose: to conduct a clinical analysis of the vascularization parameters of FB after trabeculectomy based on tomographic images using machine vision techniques. Material and methods. 83 patients (100 eyes) aged 57 to 81 years with moderate and advanced primary open-angle glaucoma underwent trabeculectomy using the standard technique. Biomicroscopic photography and optical coherence tomography with angiography of the filtration zone were performed preoperatively and at 1, 2, and 6 weeks postoperatively. IOP levels were monitored using a contactless pneumotonometer. Vascular network density, vascular tortuosity, and the degree of hyperemia were assessed using the tomographic image of the surgical area. Results. All assessed FB parameters increased to varying degrees by 1 week postoperatively, with a tendency to normalize by 6 weeks. Vascular density and the degree of superficial hyperemia experienced the greatest changes. A high correlation was observed between vascular density and hyperemia at all follow-up periods, as well as a significant correlation between postoperative IOP and vascular density beginning in the 2nd week of follow-up, with a tendency toward increased strength by 6 weeks. Conclusion. The development of a combined software method for determining the degree of vascularization and tortuosity of the FB vascular network, as well as hyperemia, using tomographic images and machine vision techniques can serve as a basis for assessing the effectiveness of glaucoma surgical treatment.
Predicting of penetrating keratoplasty outcome in children
Purpose of the study: to analyze risk factors affecting the outcome of penetrating keratoplasty (PK) in children. Material and methods. We retrospectively and prospectively analyzed the medical records and outpatient charts of children undergoing surgery at the Pediatric Eye Pathology Department of the Helmholtz National Medical Research Center of Eye Diseases between 2000 and 2024. Cases were selected that met the following criteria: a) PK was performed; b) non-preserved donor material was used; c) the patient was 14 years or younger at the time of transplantation; d) the graft was followed for at least 3 months postoperatively. The sample size consisted of 236 cases of PK performed in 222 children (236 eyes). Risk factors affecting graft survival and functionality were assessed. Results. A significant impact of patient age on the outcome of corneal transplantation was revealed: in younger children, the outcome is often more favorable, which is associated with high tissue plasticity and less severe immunological reactions. The presence of comorbidities significantly worsens the prognosis and increases the risk of graft rejection. The quality of the donor material and adherence to postoperative care rules, which help reduce the risk of corneal opacity, are also important factors. Conclusion. Predicting the outcome of corneal transplantation is usually hypothetical and subjective, based primarily on the surgeon’s personal experience and intuition. Identifying risk factors in corneal transplantation allows us to identify those factors that critically affect the outcome of the surgery within the diversity of clinical presentations; their quantitative assessment allows us to present a prognosis in terms of statistically verified probability.
Comprehensive diagnostics of intraocular lymphomas: the role of optical coherence tomography and fine-needle aspiration biopsy
Purpose of the study: to evaluate the capabilities of optical coherence tomography (OCT) and fine-needle aspiration biopsy (FNAB) in the diagnosis of intraocular lymphoma. Material and methods. 9 patients aged 39 до 67 (ave 51.0 ± 8.7) yrs with suspected intraocular neoplasm were examined. OCT, FNAB, cytologic and immunocytochemical (ICC) examination with the use of monoclonal antibodies CD19, CD20 were performed. Results. An amorphous light-gray protruding diffuse formation with pigmented hyperreflective small foci was diagnosed ophthalmoscopically. According to OCT data, were determined the following biomarkers: wave-like changes in the choroidal profile, point hyperreflective clusters at the level of the inner choroid. In addition, pronounced disorganization of the retinal pigment epithelium and wave-like changes in the inner and outer layers of the retina, extensive diffuse detachment of the neuroepithelium, multiple hyperreflective foci at the level of the photoreceptor layer, small hyperreflective foci in the posterior layers of the vitreous body, hyperreflective infiltrates in the outer layers of the retina were diagnosed. The results of organ-preserving diagnostics (FIAB and imprint) showed an abundance of diffusely located lymphoid elements of small and medium sizes, among which small lymphocytes, prolymphocytes, cells with a round nucleus and characteristic “spotting” of chromatin, a narrow rim of cytoplasm prevailed. According to the ICC data, positive expression of specific markers CD19 and CD20 was revealed, manifested by a brown color of the cell cytoplasm, which confirmed the B-cell nature of the tumor. Conclusion. Among all clinical and instrumental examination methods, OCT and FNAB are of decisive importance in intraocular lymphoma. In addition to ultrasound, the examination complex should include OCT to identify morphometric biomarkers of lymphoma. In opaque optical media, organ-preserving diagnostics (FNAB and imprint) makes it possible to obtain a diagnosis of lymphoma and determine its belonging to the most malignant B-cell type. The above measures allow for early patient referral to a hematologist to determine further treatment tactics.
New diagnostic opportunities for uveitis
Purpose — to substantiate the diagnostic value of general blood test indicators in the diagnosis of the etiology of uveitis. Material and methods. A total of 88 inpatients diagnosed with uveitis were prospectively examined. Patients were divided into three age- and gender-matched groups based on etiology. Group 1 (n = 28) included patients with unclear etiology. Group 2 (n = 28) included patients with viral etiology. Group 3 (n = 32) included patients with an established diagnosis of ankylosing spondylitis. Results. According to our study, lymphocytes play the most important role in providing information. A significant difference in the parameters between groups 1 and 2 was found for neutrophils (p = 0.0000) and platelets (p = 0.0242). When comparing groups 1 and 3, the parameters of leukocytes (p = 0.0020), neutrophils (p = 0.0000), and the size of erythrocytes, fl (p = 0.0446) were noted. The following integral indices showed significant diagnostic value in the etiology of uveitis: leukocyte shift, neutrophil-to-lymphocyte ratio, adapted systemic inflammatory response, and a marker of viral infections. When studying the integral indices, the expected and statistically significant differences between the groups were recorded. Conclusion. When prescribing etiopathogenetic treatment for a uveal patient, an ophthalmologist should focus not only on the results of a clinical blood test, but also on the integral indices of peripheral blood.
Dynamics of anatomical and optical parameters of the eye after discontinuation of long-term use of orthokeratological lenses
The purpose of the study was to evaluate the dynamics of the anatomical and optical parameters of the eye after the cessation of long-term orthokeratological exposure. Material and methods. The study included 18 patients aged 11–22 years (mean 15.6 ± 4.2 years) with initial low to moderate myopia (mean 4.75 ± 1.7 D) who had been wearing orthokeratological lenses (OKL) for 3 to 11 years (mean 6.7 ± 3.8 years). In 10 cases, OKL were removed due to the end of the growth period and preparation for excimer laser correction, in 8 cases — due to an increase in the axial length (AL) of the eye by 0.3 mm or more over a year and preparation for scleroplasty. In 36 eyes (31 with OKL discontinuation and 5 fellow eyes with ongoing OKL exposure), visometry, refractometry, keratometry, pachymetry were performed, the AL, transverse diameter of the eye, and choroidal thickness (CT) were determined immediately before OKL discontinuation and 2, 4, and 6 weeks after discontinuation. Results. Before OKL discontinuation, the refraction was –2.2 ± 0.6 D. Two weeks after discontinuation, it was –5.2 ± 0.35 D, four weeks later, it was –5.3 ± 0.26 D, and six weeks later, it was –5.4 ± 0.22 D. The AL increased by 0.08 mm 2 weeks after OKL discontinuation, by 0.1 mm 4 weeks later, and by 0.11 mm 6 weeks later (p < 0.05). The TC decreased by an average of 16 μm in the first 2 weeks, by 19 μm after 4 weeks, and by 20 μm after 6 weeks (p < 0.05). Conclusion. Discontinuation of the OKL wearing is accompanied by increased refraction, an increase in the central corneal thickness and AL, and a decrease in the CT. More than 90 % of changes occur in the first 2 weeks; by 6 weeks, the parameters have practically stabilized.
Assessment of refractive error by retinoscopy using fogging lens and cycloplegia in school aged children
Purpose. To compare the refractive error measurements obtained through cycloplegic retinoscopy and fogging retinoscopy in school-aged children with myopia and hyperopia. Material and methods. A comparative cross-sectional study was conducted using a non-probability consecutive sampling technique among school-age children. The study analyzed 240 readings in children aged 6 to 15 years, with a mean age of 10.64 ± 2.82 years, including 45% males and 55% females. Visual acuity was measured using a LogMAR chart. Two retinoscopic procedures were performed to assess refractive error: fogging retinoscopy with a high-power plus lens and cycloplegic retinoscopy with 1% cyclopentolate and 0.5% tropicamide. The readings were entered into SPSS version 26.0 and compared after converting them into spherical equivalents (SE) using the Wilcoxon Signed-Rank Test, as preliminary analysis indicated that the data did not follow a normal distribution. Results. Descriptive statistics revealed minimal differences in SE measurements between fogging retinoscopy (mean = -0.41, SD = 5.63) in hyperopes and (mean = -4.8, SD = 3.65) in myopes and cycloplegic retinoscopy (mean = -0.47, SD = 5.64) in hyperopes and (mean = -4.9, SD = 3.69) in myopes. Inferential analysis showed no significant difference between the two methods in low to moderate hyperopes and myopes (p > 0.05) and a significant difference between the two methods in high hyperopes and myopes (p < 0.05). Conclusion. The present results confirm that fogging retinoscopy when performed with proper protocols by an experienced clinician, gives accurate results and can be a good alternative to cycloplegic retinoscopy.
Shifts in subsets of blood lymphocyte subpopulations in patients with keratolysis as predictors of the outcome of emergency corneal transplantation
Purpose of the study: a detailed description of shifts in subsets of blood lymphocyte subpopulations associated with lysis of the native cornea/graft prior to emergency keratoplasty. Material and methods. We conducted immunological studies of 30 patients aged 18–76 with lysis of own cornea and keratotransplant. All patients underwent urgent keratoplasty. After the operation, patients received standard therapy. Depending on the outcome of the surgical intervention, the patients were divided into two groups. The 1st group consisted of 10 people with favorable engraftment of the keratoplasty; the 2nd included 20 patients with keratolysis. The study material was blood samples taken from the cubital vein on an empty stomach in the morning. Phenotyping was performed by flow laser cytofluorimetry on a BD FACS Canto II cytometer using the Multitest 6-Color TBNK Reagent monoclonal antibody system in BD TruCount tubes. For erythrocyte lysis and leukocyte fixation, BD FACS TM Lysing Solution is used. The relative and absolute content of lymphocyte populations and subpopulations is determined in the Canto program. Results. We have identified some common changes characteristic of patients before urgent keratoplasty, i.e., a increase in the numbers CD45+, a significant increase absolute contents of the T-cell population CD3+, CD3+CD4+ subpopulation as compared with the control group. A statistically significant increase relative and absolute contents of the natural killer cells, significant reduction relative and absolute contents of the T-cell population, CD3+CD4+ subpopulation proved to be a distinctive feature of the group with keratograft lysis. Conclusion. Parameters of cellular immune status have been determined that can be used to predict unfavorable engraftment of кeratotransplant. The obtained data are important for understanding pathogenesis of keratograft lysis, and should be taken into account when predicting and developing a differentiated approach to the treatment of this pathological process.
Pigment Epithelium-Derived Factor as a possible predictor of corneal transplant rejection reaction
Keratoplasty remains one of the most effective methods of restoring vision in diseases and injuries of the eye that lead to the cornea opacity. Despite the success of modern surgery, corneal transplant rejection is the most common cause of unsuccessful operations. Pigmented epithelial derivative factor (PEDF) is known for its antiangiogenic and anti-inflammatory properties, which play an important role in maintaining the immune privilege of the eye and make it one of the important regulators of the intraocular environment. Purpose of the work was to study the concentration of PEDF in the tear fluid (TF) after penetrating keratoplasty and to evaluate its role in the development of the corneal transplant rejection reaction. Material and methods. 48 patients aged 35 to 60 years (average age of 48.1 ± 5.4) including 30 men and 18 women participated in the study. Subgroup 1 (n = 35) consisted of patients who had no episodes of corneal transplant rejection during the observed period, subgroup 2 (n = 13) consisted of patients who demonstrated an episode of rejection reaction during one year after surgery. The control group included 15 healthy individuals without ophthalmological pathology. The level of PEDF (ng/ml) in the TF was determined during postoperative period using multiplex analysis on a Luminex Magpix 100 immunoanalyzer (USA) by the Bio-Rad multiplex analysis test system (USA). The graft condition was assessed using biomicroscopy and optical coherence tomography with angiography of the anterior segment. Results. In postoperative period a significant increase in the volume of vascularization with a maximum increase on day 360 in subgroup 2 was revealed. The concentration of PEDF in subgroup 1 increased to reference values on day 120, while maintaining this level at the end of the study. On the contrary, in subgroup 2, the PEDF level remained reduced until the end of the follow-up period and significantly differed from the indicator of the control group, which, along with an increase in the volume of vascularization and a progressive decrease in maximally corrected visual acuity, may indicate a violation of control over the processes of neovascularization and contribute to graft rejection. Conclusion. Given the crucial role of PEDF in curbing corneal neoangiogenesis, its decrease can be considered as a predictor of the development of a graft rejection reaction, as evidenced by the data we have obtained.
Apocrine hydrocystoma of the bulbar conjunctiva: a case report
The purpose of the study was to demonstrate a clinical case of apocrine hydrocystoma (AH) of the bulbar conjunctiva and the features of clinical and morphological diagnostics of this disease. Clinical observation. A 55-year-old woman complained of a painless lesion in the nasal sector of the bulbar conjunctiva of the left eye that had existed for about 30 years and that had not increased in size and retained a stable shape and color, but in the last year, discomfort appeared when blinking. Slit-lamp biomicroscopy revealed a yellowish-gray cystic lesion up to 3.5 mm in diameter, raised above the surface of the eye at 9 o’clock at a distance of 1.5 mm from the limbus. It was painless on palpation, tightly connected to the conjunctiva, and easily displaced within the underlying tissues. Optical coherence tomography (OCT) of the anterior segment of the eye showed that the lesion consisted of several vesicles filled with medium-reflectivity fluid surrounding a central zone with a fine-mesh structure and areflexive zones. An atypical epithelial inclusion cyst of the bulbar conjunctiva was suspected. Under local anesthesia, the lesion was excised within the intact surrounding tissues. Microscopic examination revealed structural changes characteristic of bulbar conjunctival AH, including PAS-positive staining of the cavity contents. Immunohistochemical (IHC) analysis of the material demonstrated expression of SMA, CK7, CDGFP-15 and p63 by the cells lining the cystic formations. Analysis of the results of the clinical and morphological examination and IHC study of the tissue material made it possible to diagnose multilocular subepithelial AH. During the control examination after 2 weeks, restitution of the epithelium in the projection of the surgical wound with no signs of inflammation was recorded. Conclusion. The modern standard for diagnosing AH of the bulbar conjunctiva is a morphological examination of the removed tumor, indicating the origin of the neoplasm from the epithelial cells of the sweat glands. If a cystic formation is detected in the bulbar conjunctiva, it is advisable to include AH in the differential diagnostic spectrum with subsequent structural analysis of the tissue material.
Low vision assessment and management in Stargardt disease: diagnostic approach and therapeutic strategies. Case report
A 19-year-old female presented to the outpatient department with reduced visual acuity and recurrent headaches. Initially recorded as 15 due to an oversight, her age was clarified, and her best-corrected visual acuity was measured at 6/60P logMAR bilaterally, with a prescription of -0.5 D. Cyclorefraction revealed -1.5 D bilaterally. Fundus examination demonstrated vascular tortuosity, bull’s-eye maculopathy, and peripheral pigmentary retinopathy, leading to a diagnosis of Stargardt disease, confirmed through advanced imaging. She was referred to the low vision department for a specialized assessment to address her progressive vision loss and was also evaluated by neurology for recurrent headaches. A comprehensive low vision evaluation helped determine her specific visual needs, with recommendations aimed at enhancing her daily activities and managing her visual prognosis. This case underscores the essential role of low vision assessments in juvenile macular dystrophies like Stargardt disease, where early intervention and personalized visual aids can significantly improve functional vision and quality of life.
Comorbidity in patients with primary open-angle glaucoma and ocular hypertension: potential use of a fixed-dose combination of Dorzolamide and Timolol
The pathogenesis of glaucomatous optic neuropathy involves both mechanical and vascular components. Comorbidity associated with concomitant systemic and/or ophthalmic diseases and conditions may aggravate the course of primary open-angle glaucoma (POAG) and ocular hypertension. Many patients with arterial hypertension (AH) and systemic atherosclerosis experience microcirculatory problems in the optic nerve and retina. Another additional factor contributing to microcirculatory alterations in the posterior segment of the eye may be vitreous cavity tamponade with silicone oil. In patients with POAG or ocular hypertension accompanied by microcirculatory disturbances the use of fixed combinations containing carbonic anhydrase inhibitors appears reasonable. These agents not only reduce intraocular pressure by decreasing aqueous humor production but also improve blood flow in the optic nerve and retina, increase diastolic ocular perfusion pressure, and exhibit antioxidant properties, thereby providing both indirect and direct retinoprotective effects. The article presents a series of clinical cases demonstrating the use of a generic 2 % dorzolamide and 0.5 % timolol fixed combination (DT-FC) — Dortis — in POAG or ocular hypertension patients with concomitant pathology. The first clinical case demonstrates the effectiveness of initial therapy with DT-FC in a patient with stage II B (moderate) POAG of the right eye and hypertensive retinal angiopathy (HRA) grade 1 in both eyes, associated with stage II AH (grade 3, risk 3) and coronary artery disease (stable angina pectoris, functional class II, atherosclerotic coronary artery disease). The second clinical case illustrates the effectiveness of switching to DT-FC due to insufficient hypotensive efficacy of timolol in a patient with stage II B (moderate) POAG in both eyes, a history of retinal detachment surgery of the left eye with silicone oil tamponade, and HRA grade 1 in both eyes associated with stage II AH (grade 2, risk 2). The third clinical case demonstrates the effectiveness of Dortis eye drops in a patient with ocular hypertension that developed after microinvasive vitrectomy for retinal detachment with silicone oil tamponade in the left eye, as well as HRA grade 1 in both eyes associated with stage II AH (grade 2, risk 2).
Topical steroids in ophthalmology. Part 1. Pharmacokinetics
Topical glucocorticoids remain the cornerstone of therapy for inflammatory disorders of the anterior segment of the eye; nevertheless, their clinical efficacy exhibits considerable variability. This heterogeneity is rooted in the distinct pharmacological profiles of individual steroids, which directly govern their capacity for ocular penetration and tissue accumulation. The review offers a comprehensive analysis of the pharmacokinetics of key ophthalmic steroids — prednisolone, dexamethasone, fluorometholone, hydrocortisone, loteprednol, and difluprednate. The principal determinants of corneal penetration are examined in detail, including the physicochemical properties of the molecule (lipophilicity, solubility, molecular size), formulation characteristics, the condition of the ocular surface, and the route of administration. Emphasis is placed on a comparative assessment of aqueous humor concentrations, which serve as a key integrative indicator of intraocular bioavailability. The analysis demonstrates considerable heterogeneity in pharmacokinetic profiles — a finding of direct clinical relevance. Furthermore, the relationship between the physicochemical properties of these steroids, their relative anti-inflammatory potency, and anticipated clinical outcomes are discussed. The data presented herein provide a scientific foundation for the rational selection of a therapeutic agent, ensuring that the desired clinical result is achieved in consideration of the specific pharmacokinetic properties of each drug, as well as the nature and localization of the inflammatory process.
Biomarkers of aging. Part 1. General state of the problem and approaches to assessing biological age
Given the heterogeneity of the aging process for various tissues, organs and systems of a person and significant differences in the rate of aging between people, an objective idea of the biological age — individual rates of aging is of great clinical importance. Identification of reliable biomarkers capable of predicting the aging profile and the risk of developing age-related pathology can play a key role in the prevention of accelerated aging, geroprotective therapy and timely diagnosis and treatment of age-associated diseases. By now, a wide range of biomarkers of aging has been developed at the cellular, organ and molecular levels. Based on these biomarkers, models of “biological clocks” (phenotypic, epigenetic, immune, metabolic and many others) have been proposed, which, with varying degrees of accuracy, make it possible to determine a person’s biological age and the risks of diseases of specific organs and systems. Combinations of different types of biomarkers can be used to assess the potential for health and healthy longevity in humans and serve as objective criteria for the effectiveness of geroprotective strategies when testing new methods and technologies. However, today very high demands are placed on biomarkers of aging, which, unfortunately, the proposed markers and models do not yet fully meet. It is noted that since most modern biomarkers reflect changes that are a consequence of aging, but not its cause, which in turn limits the accuracy of the biological clock and its clinical significance. This determines the relevance of the development of new, accessible, non-invasive, sensitive to age-related changes and “reliable” biomarkers of aging, which will be useful for the early prevention of age-related diseases. This part of the review provides a brief excursion into the state of the problem of predicting biological age and a description of approaches to biological clock models. The second part of the review will be devoted to markers of normal and pathological aging of the retina and the problem of predicting age-associated pathology of the visual system. The fundamental knowledge about biological age can be applied to promising research in ophthalmology, in particular with the aim of developing new biomarkers of retinal aging.