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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Results of the anonymous independent Russianlanguage survey of retinologists “SETCHAtochkaRU — 2025”
Retinology is undoubtedly the avant-garde of modern ophthalmology and develops rapidly. The development and implementation of newest scientific and technological advances in clinical practice contribute to the continuous improvement of diagnostics and various treatments for posterior segment pathologies. At the same time, there are certain national and regional medicine development aspects, as well as controversial issues that can be successfully explored through sociological research, particularly expert surveys. In 2024, we organized and conducted the first independent Russian survey of retinologists, “SETCHAtochkaRU”, aimed at collecting and analyzing data on current practices, opinions, equipment, and challenges in the diagnosis and treatment of vitreoretinal pathology in Russia. The project yielded unique insights and was well received by both respondents and the scientific community. For this reason, we decided to repeat the survey a year later and attempt to make it a regular event, which will allow us to discuss the most modern aspects of retinology and evaluate its development trends. The “SETCHAtochkaRU — 2025” survey involved 430 specialists representing all regions of the Russian Federation, as well as Belarus, Germany, Georgia, Kazakhstan, Kyrgyzstan, Croatia, and Uzbekistan. The updated list of questions included such topical and relevant issues as the perspectives for the artificial intelligence use, antiangiogenic therapy trends (new drugs, biosimilars, regimens, and drug switching strategies), various practical aspects of drug use, laser, and surgical treatment for vitreoretinal pathology, the results of the federal project “Fight Against Diabetes”, and many others. Analysis of the survey results revealed a number of positive trends in the development of Russian ophthalmology. In our opinion, the “SETCHAtochkaRU” project has the potential to develop and improve as an annual monitoring study, generating original evidence base tailored to national specifics.
Acute macular neuroretinopathy in combat closed globe injury of posterior eye segment
Purpose: to analyze the prevalence and clinical significance of acute macular neuroretinopathy (AMN) in combat closed globe trauma using multimodal imaging. Material and methods. In total, 154 eyes of 136 patienys with combat closed globe trauma of the posterior segment received standard ophthalmological examination and optical coherence tomography (OCT) and OCT angiography. Patients with AMN were identified and selected for analysis. Structural changes of the retina on cross-sectional scans, as well as the area of AMN lesions were analyzed on structural en-face projections. Results. AMN characterized by thinning of the outer retina was detected in ten eyes of ten patients (10 males, mean age 29 ± 4 years), thus accounting for 6.5 % of cases from all examined eyes with closed eyeball trauma. The analysis of the cumulative distribution showed a trend towards localization of the AMN lesions mainly in the nasal sector of the macula with an average area of 2.4 ± 1.4 mm2. AMN was an isolated manifestation of injury only in two cases, in eight eyes it was combined with other injuries associated with closed eyeball trauma. Conclusion. AMN is one of the typical lesions in closed eye injury, with a prevalence of 6.5 % among these cases. AMN can cause persistent visual deterioration, including paracentral and central scotomas and may explain “unexplained scotomas” and “unexplained decrease of vision” in patients with mild injury. The contribution of AMN to the structure of closed globe injury agrees with the concept of the syndromic nature of this phenomenon. Diagnosis of AMN requires OCT examination even in cases without ophthalmoscopically detectable changes in the macula.
Effect of body mass index on retinal nerve fiber layer thickness in adults
Purpose: to investigate inter-ocular variation in retinal nerve fiber layer (RNFL) thickness, compare RNFL thickness across body mass index (BMI) categories, and examine the relationship between BMI and RNFL thickness. Material and methods. A cross-sectional study was conducted in September 2024 at Al Shifa Trust Eye Hospital with 107 participants (46 females, 61 males) aged 27.17 ± 6.98 yrs. Visual acuity was assessed using Snellen charts, and refraction and slit-lamp bio-microscopic examination was performed. BMI was calculated and classified into underweight, normal, overweight, and obese categories. Optical coherence tomography (OCT) measured RNFL thickness in the superior, inferior, nasal, and temporal quadrants. Results. Statistically significant BMI differences were found between males and females. Males had an average RNFL thickness of 99.23 ± 4.9 μm, with the thinnest RNFL in the temporal quadrant. Females had an average RNFL thickness of 99.20 ± 5.33 μm, with the temporal quadrant also being the thinnest. Obese females had thicker RNFL in the superior quadrant, while obese males had thicker RNFL in the inferior quadrant. A significant positive correlation between BMI and RNFL thickness was found, particularly in the superior quadrant for obese females and the inferior quadrant for obese males. Inter-ocular differences showed thicker horizontal RNFL quadrants in the right eye and thicker vertical quadrants in the left eye. Conclusion. Significant differences in RNFL thickness exist across BMI categories. The inferior quadrant is thicker in obese males, while the superior quadrant is thicker in obese females. Inter-ocular differences show variations in quadrant thickness between the eyes.
Quality of life of patients after keratorefractive surgery
Purpose: to assess the quality of life (QoL) of patients who underwent keratorefractive surgery and to determine its association with sociodemographic and surgery related factors. Material and methods. A Descriptive Cross-Sectional Study was carried out over a period of six months from March 2024 to August 2024 to assess the QoL of patients who underwent keratorefractive surgery. Data was collected using non-probability consecutive sampling strategy using a validated and interview-based Questionnaire tool: Quality of Life Impact of Refractive Correction (QIRC). Data was analyzed using Statistical Package for Social Science (SPSS) version 26. Results. The results of this study indicated a moderate increase in QoL, while there was no significant association between sociodemographic factors and the QoL of patients following keratorefractive surgery. Specifically, variables such as level of education (p = 0.09), occupation (p = 0.70), age group (p = 0.30), and gender (p = 1.00) did not show a statistically significant relationship. Additionally, no significant association was observed between surgeryrelated factors and quality of life, including the type of refractive surgery (p = 0.107) and post-surgery duration (p = 0.512). Conclusion. The findings indicate a moderate increase in the QoL among individuals who underwent keratorefractive surgical procedures. The majority of the patients reported an improvement in their QoL following keratorefractive surgery.
Possibilities of modern imaging methods in epibulbar lesions diagnostics
Purpose of the study: to determine possibilities of ultrasound examination (US), ultrasound biomicroscopy (UBM), optical coherence tomography (OCT) and OCT-angiography (OCTA) in epibulbar lesions evaluation. Materials and methods. 64 patients (66 eyes) aged 41.5 ± 23.0 years with epibulabar lesions of various genesis were included in the study. In all cases US with scaling function and Colour Doppler (CD), UBM and OCT were performed. For qualitative and quantitative evaluation of tumors’ vascularity OCTA was performed with perfusion density (PD) registration. Results. The use of UBM made possible measurement of tumor thickness in 100.0 % of the cases and measurement of tumor base diameter in 95.6 %. OCT proved to be superior when compared with UBM in evaluation of tumors’ structure and state of conjunctival epithelium. OCT was not informative in assessment of highly pigmented lesions. US with CD allowed evaluation of epibulbar lesions with thickness over 1.4 mm and with base diameter over 3.6 mm. OCTA allowed visualization of tortuous vessels with uneven caliber and distorted course as well as an increase in PD. Signs indicative of malignancy were: maximum PD 50 % or more, 7 or more zones of “lace-like pattern” or at least one zone of “confluent pattern”. Conclusion. UMB is the most informative method in assessment of biometric parameters of epibulbar lesions. OCTA allows evaluation of quantitative and qualitative characteristics of tumors’ vessels.
New possibilities for diagnostics and management of inflammatory reaction in chronic inflammatory processes in the conjunctiva
Chronic conjunctivitis is a common ocular disease characterized by prolonged inflammation of the conjunctiva. Cytological analysis of the conjunctival mucosa is a valuable diagnostic tool for determining the nature of the inflammatory process, its etiology, and stage of development, which is necessary for prescribing adequate therapy and monitoring its effectiveness. Purpose: to improve the efficiency of diagnosis and treatment of patients with chronic inflammatory diseases of the eye by managing the exudative reaction. Material and methods. The study included patients with chronic bacterial conjunctivitis (BC) — group 1 (n = 82), with chronic toxic-allergic conjunctivitis (TC) — group 2 (n = 65), and healthy individuals — the control group (n = 25). Clinical observation of chronic inflammatory processes of the conjunctiva before treatment lasted more than 4 weeks, the total observation period was more than 3 years. Patients were examined more than 3 times to obtain material for diagnostic laboratory testing, then twice at 1 and 2 months after treatment. Results. In the initial cytological picture of conjunctival scrapings in patients with chronic BC, neutrophils were predominant (more than 60 % of the cellular composition). Neutrophils were in various stages of activation and degeneration. The presence of bacteria both within neutrophils (phagocytized) and extracellularly was characteristic. Epithelial cells often demonstrated signs of reactive changes: an increase in the size of the nucleus, nucleoli, and vacuolation of the cytoplasm. In patients with TC (group 2), the cytologically dominant features in patients were eosinophils and mast cells, goblet cell hyperplasia, structureless substance, degenerative altered leukocytes, and naked nuclear elements. Patients in Group 1 were prescribed the aminoglycoside netilmicin (Nettacin eye drops and Nettavisc eye ointment), a broad-spectrum bactericidal antibiotic, applied behind the lower eyelid 3–4 times daily. Patients in Group 2 were prescribed loteprednol etabonate (Lotemaxin), a corticosteroid with potent anti-inflammatory activity, 1 drop in the conjunctival sac of each eye. In the next step, patients in Group 1 with chronic BC were prescribed Lotemaxin, 1 drop in each eye 4 times daily. Analysis of the ocular tissue condition and the cytological picture of inflammation before and after the use of Lotemaxin, as well as 4 weeks after its discontinuation, revealed a significant decrease in the number of eosinophils and neutrophilic leukocytes, while goblet cells and glandular epithelium were preserved. Despite the relatively long staged therapy with Lotemaxin, a rapid reduction in the tissue inflammatory response, no increase in intraocular pressure, and no cataractogenicity were observed clinically. Conclusion. For chronic conjunctival inflammation, therapy with loteprednol etabonate (Lotemaxin) is indicated in the staged treatment of any type of chronic inflammation after etiotropic therapy.
The effect of the duration of wearing soft contact lenses on the results of laser myopia correction using the ReLEx® SMILE method
Most patients undergoing refractive surgery have a history of soft contact lens (SCL) wear, which may influence the results of ReLEx® SMILE. Purpose of the study was to evaluate the influence of the wearing SCL duration on the refractive results of laser correction of myopia using the ReLEx® SMILE method. Materials and methods. A retrospective analysis of the results ReLEx® SMILE surgery in 80 patients (160 eyes) was performed. Group 1 included 12 patients (24 eyes) with less than 5 years of SCL use, Group 2 —18 patients (36 eyes) with 5–10 years of SCL use, Group 3 —19 patients (38 eyes) with more than 10 years of SCL use. Comparison group consisted on 31 patients (62 eyes) using glasses before the operation. The observation period was 6 months. Results. The SE refraction (D) after 6 months was 0.06 ± 0.30 in the control group, 0.03 ± 0.29 in group 1, 0.21 ± 0.38 in group 2 and 0.02 ± 0.31 in group 3 (p < 0.05). Postoperative refraction of ±0.5 D from the planned refraction after 6 months was found in 87.5 % in the control group, 86.7, 77.0 and 94.7 % of cases in group 1, 2 and 3 respectively (p < 0.05). In all groups, the result of surgery was stable throughout the follow-up period, and a trend towards minimal myopic refraction was noted. The efficacy rate in the control group was 98 %, and 97 % in the group using SCL. Conclusions. Previous use of SCL in patients with myopic refraction had no negative effect on refractive parameters and on the course of ReLEx® SMILE surgery.
Features of the clinical picture and treatment of primary and secondary glaucoma in military personnel — participants in a modern military conflict
Purpose of the study was to investigate the etiopathogenesis and clinical course of primary and secondary glaucoma in military personnel participating in a modern military conflict (MMC). Material and methods. We analyzed the medical records of 18 patients — military personnel who participated in MMCs and underwent examination and treatment at the department of ophthalmology of the Military Medical Academy from 2022 to 2024 with suspected glaucoma or with glaucoma diagnosed before the onset of MMC. In all cases, the diagnosis of glaucoma was confirmed or established for the first time based on international standards — according to the methods of structural and functional assessment of the optic nerve head. Results. Of the 18 patients, 4 servicemen (5 eyes) aged 48 ± 6 years had primary open-angle glaucoma diagnosed long before arrival at the theater of military operations. However, due to violation of the local hypotensive therapy regimen, three of them experienced disease progression. Thirteen patients (13 eyes) aged 27 ± 4 years were diagnosed with secondary post-traumatic glaucoma, which developed because of combined damage to the organ of vision due to mine-blast trauma within a period of 5 to 15 months. Secondary post-traumatic ocular hypertension was diagnosed in only one patient. In most cases (61 %), it was not possible to achieve compensation of ophthalmotonus, despite the maximum regimen of local hypotensive therapy, therefore, various surgical interventions were performed with a positive effect. In the remaining cases (39 %), compensation of intraocular pressure and stabilization of the glaucoma process were achieved through the selection of an individual regimen of local hypotensive therapy. Conclusion. Modern military operations undoubtedly contribute to the increase in the proportion of post-traumatic glaucoma. To prevent injury to the organ of vision and, accordingly, secondary post-traumatic glaucoma, it is necessary to use anti-fragmentation or tactical glasses during active combat operations.
Comparative characteristics of gonioscopy and anterior segment optical coherence tomography in visualizing the iridotrabecular contact
Purpose: to compare iridotrabecular contact (ITC) imaging findings of gonioscopy and anterior segment optical coherence tomography (AS-OCT) in patients with primary angle closure disease (PACD). Material and methods. Retrospective analysis of the data from 20 patients with primary angle closure and 23 with early stage primary angle-closure glaucoma aged 49 to 82 years was performed. All participants along with gonioscopy underwent AS-OCT on CASIA2 (Tomey Corporation, Nayoga, Japan) including assessment of the ITC Index and ITC Area. Results. According to gonioscopy, the average value of the number of sectors of the anterior chamber angle (ACA) of a closed and narrow profile (with a degree of opening from 0 to 2 according to Schaffer) was significantly higher than according to AS-OCT data (3.56 ± 0.65 and 2.04 ± 0.81 respectively, p = 0.02). The degree of opening of the ACA according to Shaffer differed significantly between the superior and inferior (0.06 ± 0.25 and 1.30 ± 1.22, respectively, p = 0.00), superior and nasal (0.06 ± 0.25 and 0.72 ± 1.00, respectively, p = 0.01), temporal and inferior (0.20 ± 0.51 and 1.30 ± 1.22, respectively, p = 0.04) sectors. No significant differences were found between the superior and temporal, nasal and inferior, as well as temporal and nasal sectors (all p > 0.05). According to AS-OCT data, the ITC parameters were: ITC Index = 45.4 ± 21.8% and ITC Area = 5.81 ± 3.90 mm2. Conclusion. In PACD, gonioscopic closure of the ACA (absence of visualization of the trabecular meshwork at least 180°) does not mean the presence of an ITC, as detected by AS-OCT. The superior sector of the ACA is the most vulnerable to angle closure in patients with this pathology.
A study of compliance with antiangiogenic therapy in patients with neovascular age-related macular degeneration
Antiangiogenic therapy of neovascular age-related macular degeneration (nAMD) demonstrates limited patient commitment to this treatment. Purpose of the study is to evaluate the influence of comorbid, clinical, ophthalmological and demographic factors on compliance with antiangiogenic therapy in patients with nAMD. Materials and methods. The data of 105 eyes of 98 patients with nAMD who received antiangiogenic therapy from January 1, 2018, to December 31, 2022, with a follow-up period of at least 24 months were retrospectively analyzed; the withdrawal criterion was the termination of treatment and follow-up (absence of visits) by patients for more than 6 months. The influence of clinical, ophthalmological, therapeutic, methodological, and comorbid factors (cataract surgery) was evaluated during the follow-up period. Results. As part of the study, 29.6 % of patients (29 people) stopped treatment and follow-up. The reasons for withdrawal included: remission of the disease (31.7 % of the discharged patients), development of macular atrophy (26.8%), transfer to another medical facility (12.2 %) and a few others. The average interval before the cease of treatment was 29.45 ± 10.39 months. Dropout from follow-up is more typical for older patients. Patients with bilateral nAMD had a lower loss to follow-up rate (LTFR) (chi-square, p < 0.0001). The type of macular neovascularization did not influence loss to follow-up. Patients who underwent cataract phacoemulsification were significantly more likely to discontinue treatment (chi-square, p = 0.012). Correlation analysis did not establish a relationship with the level of BCVA before and after surgery (p > 0.05). Conclusion. A noticeable influence of demographic, clinical, and comorbid factors on the compliance of patients with AMD has been shown. Withdrawal from observation is more typical for patients who have completed professional activity. The monolateral nature of the disease and surgical treatment of concomitant cataracts negatively affect treatment adherence.
The role of morphometric and biomechanical parameters of the cornea in glaucoma monitoring
Purpose: to study the role of morphometric and biomechanical parameters of the cornea in the diagnosis and monitoring of glaucoma. Materials and methods. A total of 463 eyes of patient aged 17 to 94 years were analyzed: 18 healthy, without glaucoma, without PEX of the older age group — 91, without glaucoma with PEX — 33, young myopic — 30, with POAG — 69, with primary open-angle pseudoexfoliation glaucoma (PXG) — 81, with normal tension glaucoma (NTG) — 60, with pigment dispersion syndrome — 62, with juvenile glaucoma (JG) — 19. In case of glaucoma, it was compensated. IOP was studied taking into account the biomechanical properties of the fibrous membrane of the eye (bIOP), DA Ratio, Integr. Radius (IR), SP-A1, SSI. Results. There is a relationship between the central corneal thickness (CCT) and the development of glaucoma (r = –0.244, p = 0.000), IOP level measured by standard non-contact tonometry (r = 0.301, p = 0.000). It was found a decrease of CCT (r = –0.205, p = 0.000) and bIOP (r = –0.111, p = 0.012) with age. DA Ratio and Integr. Radius are associated with bIOP (r = -0.647 and r = –0.652, respectively, p = 0.000) and with CCT (r = -0.449 and r = –0.456, respectively, p = 0.000). DA Ratio decreases with patient aging (r = 0.108, p = 0.016), but IR does not change (p = 0.208). SP-A1 increases with increasing bIOP level (r = 0.481, p = 0.000), is higher with “thick” corneas (r = 0.421, p = 0.000). The SSI index is related to the axial length of the eye and decreases as it increases (r = –0.441, p = 0.000), is higher in “thick” corneas (r = 0.142, p = 0.001), and this index also increases with age (r = 0.516, p = 0.000). Conclusions. CCT is an independent risk factor for glaucoma development, undergoes changes with age and development of glaucomatous damage. Corneal rigidity indicators are important to evaluate dynamically to determine the achievement of tolerant IOP.
New possibilities for optimizing the effect of scleroplasty in progressive myopia
Purpose: to experimentally develop a method for preparing an allograft with optimized properties for scleroplasty (SP) in progressive myopia. Material and methods. The experiment was performed on 40 eyes of 20 Chinchilla rabbits, which were divided into four groups depending on the method of processing the scleral allograft for SP: Group 1 (control) — 5 rabbits (10 eyes) with an intact graft; Group 2 — 5 rabbits (10 eyes) with a graft after ultraviolet (UVA) crosslinking with riboflavin; Group 3 — 5 rabbits (10 eyes) with a graft after UVA crosslinking with riboflavin and with additional treatment with 0.1 % riboflavin solution; Group 4 — 5 rabbits (10 eyes) with a graft after UVA crosslinking with riboflavin with an additional 1.5 % actovegin solution treatment. Comparative evaluation of biomechanical parameters of the graft before and after UVA crosslinking with riboflavin was carried out in vitro using biomechanical testing (AUTOGRAPH device, Japan). Acoustic density of the sclera (ADS) before and after SP was assessed in vivo using an ultrasound diagnostic device VOLUSON 730 (Kretz), and choroidal thickness (CT) using Mirante SLO / OCT (Nidek). One month after SP, a morphological study of the enucleated experimental eyes was performed. Results. The study of the biomechanical properties of the graft, ADS, CT and the morphological picture of the scleragraft complex showed the advantages of using for SP a graft treated with UVA crosslinking in combination with additional treatment with 0.1 % riboflavin solution (group 3). The elastic modulus as a result of UVA crosslinking increased by 1.2 times. The increase in ADS after SP in the 1st (control) group was on average 14 units, in the 2nd — 17 units, in the 3rd — 23 units, in the 4th — 17 units, i. e. the greatest increase in ADS was noted in group 3. The increase in CT was also the greatest in group 3 — 14.4 ± 0.3 μm, against 6.0 ± 0.3 μm in group 2 and 12.1 ± 0.2 μm in group 4. Morphological study showed better engraftment and ordered structure of the graft in the experimental eyes of group 3. Conclusion. UVA crosslinking, as the first stage of the graft preparation, allowed increasing its biomechanical stability and preservation of structure during engraftment, and additional treatment with riboflavin contributed to the improvement of blood supply to the choroid. Preparation of alloscleral graftt for scleroplasty in progressive myopia, including two stages — UVA crosslinking and subsequent treatment with 0.1 % riboflavin solution, is the most effective way to optimize its properties.
Infrared imaging of the morphological stages of rhegmatogenous retinal detachment
Purpose of this study is to investigate the features of infrared (IR) imaging in rhegmatogenous retinal detachment (RRD) depending on the morphological stages of changes in the outer layers of the retina. Material and methods. The study included 60 patients (60 eyes) with primary dysregulated, progressive RRD (32 women and 28 men; mean age 46.7 ± 13.3 years). Before surgery all patients underwent a standard ophthalmological examination. As an additional diagnostic method, a study was performed on a Mirante device (Nidek, Japan) with parallel registration of IR images and structural optical coherence tomography (OCT) scans that record the stage-by-stage changes in the neuroepithelium during RRD. OCT scans were performed from the area of the tear to the boundaries of the retinal detachment, with each stage being determined. The obtained OCT data were then compared with the IR images. Results. IR-imaging was used to describe sequential morphological changes in the outer retinal layers in dysregulated RRD. In IR light, the stages of RRD are characterized by: stages 1–2 — they had no distinguishing features among themselves and were visualized as a hyporeflective area, less expressed than in stages 3 and 4; stage 3 — a hyporeflective background with different heights and amplitudes, randomly arranged, clearly outlined hyperreflective folds; stage 4 — expressed hyperreflectivity without visible folds; stage 5a — a spotted pattern (“moth-eaten retina”) on a hyperreflective background, alternating hypo — (thickened photoreceptors) and hyperreflective (loss of photoreceptors) zones. Stage 5b is an expressed hyperrefletive zone with distinct boundaries. Conclusions. IR-imaging revealed characteristic diagnostic signs of stage morphological changes of neuroepithelium after RRD, correlated with the OCT. The obtained results confirm the clinical significance of IR ophthalmoscopy in assessing structural changes of the retina, expanding the diagnostic capabilities of IR-imaging in the diagnosis and monitoring of patients with RRD.
Assessment of retinal nonperfusion zones dynamics in pregnant women with diabetes mellitus according to optical coherence tomography — angiography
Purpose of the study was to investigate the possibility of assessing the dynamics of retinal non-perfusion zones in pregnant women with diabetes mellitus (DM) using a standard and the proposed objective method. Material and methods. Fifty-seven pregnant women (114 eyes) were examined: 28 with DM, including 17 with diabetic retinopathy (DR), and 29 without concomitant somatic pathology. Using optical coherence tomography angiography (OCTA), the total area of non-perfusion zones was assessed using the device software. In addition, an objective assessment of changes in the proportion of retinal non-perfusion zones was performed using the proposed method with a graphic editor. Results. Throughout pregnancy and 3 months after delivery, patients with DR progression showed a significant increase in the total area of non-perfusion zones. In the third trimester, the proportion of non-perfusion zones in both plexuses was higher in the DM group than in the control. An increase in the proportion of nonperfused zones in both plexuses and a dynamic increase in the total area of retinal nonperfused zones from the first trimester to the third trimester and at 3 months postpartum were found in the subgroup with progressive DR. Conclusion. OCTA allows for the assessment of changes in nonperfused retina in pregnant women with DM. This method of objectively assessing the dynamics of retinal nonperfusion zones enables quantitative assessment of changes in nonperfused retina areas separately for the superficial and deep retinal plexuses.
Rationale for the treatment of chronic blepharoconjunctivitis and meibomian gland dysfunction
Chronic blepharoconjunctivitis, often combined with meibomian gland dysfunction (MGD), disrupts the homeostasis of the ocular surface. Traditional diagnostics of microbiocenosis is insufficient, therefore gas chromatography-mass spectrometry (GC-MS according to Osipov) was used in the study. The purpose of the study: to substantiate the tactics of treatment of blepharoconjunctivitis and MGD based on the results of the analysis of the conjunctival cavity microbiocenosis. Material and methods. The prospective comparative study included 48 patients (96 eyes), divided into 3 groups of 16 people (32 eyes), matched for age and gender: Group 1 — patients with combined pathology — chronic blepharoconjunctivitis and MGD; Group 2 — patients with isolated chronic blepharoconjunctivitis without severe MGD. Group 3 included patients with isolated MGD without clinical signs of active blepharoconjunctivitis. In addition to a standard ophthalmological examination, the conjunctival microbiota was analyzed using GC-MS, and combination therapy was prescribed based on this analysis. Follow-up was performed after 14 days and 1 month. Results. Significant differences in the microbiota structure were found between the groups. Patients in Group 1 had a high total bacterial load (TBL) with a predominance of anaerobes (Clostridium spp.) and pyogenic cocci (Staphylococcus aureus). In patients in Group 2, TBL was lower. The microbial profile was characterized by mixed flora with the presence of both opportunistic (Streptococcus mutans) and certain representatives of normal flora (Lactobacillus spp., Propionibacterium freudenreichii). In patients of Group 3, dysbiosis with a deficiency of saprophytes (Bifidobacterium spp., Lactobacillus spp., Eubacterium spp.) and the growth of resistant microorganisms (Bacillus cereus) was detected. Combination therapy with moxifloxacin (Moxioftan®) and a moisturizing preparation (Optinol® Soft Recovery) led to a decrease in TBL in patients of all groups by 1 month of follow-up, with the greatest dynamics in patients of Groups 1 and 3. Clinical improvement correlated with the normalization of microbiological parameters. Conclusion. Identification of specific microbial markers and TBL levels allows for the prescription of targeted antimicrobial therapy and the application of methods aimed at restoring the microbial and functional homeostasis of the ocular surface using modern tear substitutes.
Central corneal epithelial thickness in diabetic patients: a cross-sectional study
Purpose of the study: a cross-sectional study was conducted to compare the central corneal epithelial thickness (CCET) between patients with diabetes mellitus (DM) and age and gender matched controls. We also explored correlation between CCET and duration of DM, DM control and severity of diabetic retinopathy (DR). Material and methods. The study included 111 diabetics aged 57.62 ± 11.02 years and 111 controls of comparable age — 53.74 ± 15.98 years who underwent a comprehensive ophthalmology evaluation. Optical coherence tomography of anterior segment was performed on all participants to measure the central corneal thickness (CCT) and CCET. Demographic data and data on duration of DM and blood sugar control were recorded. Results. The mean CCT was significantly higher in diabetics (Mean = 514.8 ± 31.15 μm) compared to controls (Mean = 500.87 ± 32.34 μm; p-value = 0.001 with 95% CI 5.527 to 22.33). The mean CCET was lower in cases (Mean = 50.15 ± 4.49 μm) compared to controls (Mean = 50.6 ± 5.67 μm; p-value = 0.513) however, it was not statistically significant. A significant difference in CCT was observed between controls and patients with severe nonproliferative DR and proliferative DR (p = 0.034), but no significant difference in CCET was found between any subgroups of degree of DR (p > 0.05). There was no correlation between CCET and HbA1с levels and duration of DM. Conclusion. CCET showed no significant difference between diabetics and controls. There is no correlation between CCET and blood sugar control and duration of DM. Hence, corneal epithelial thickness may not be a contributory factor for diabetic keratopathy.
Safety and efficacy of combined Nd:YAG laser goniopuncture after non-penetrating deep sclerectomy: results of a cohort study
Non-penetrating deep sclerectomy (NPDS) is one of the safest and most effective surgical treatments for glaucoma. Nd:YAG laser goniopuncture (LGP) as a mandatory adjuvant procedure is associated with a significant risk of delayed complications. Purpose of the study: to evaluate the clinical efficacy and safety of a combined technique of LGP after non-penetrating deep sclerectomy compared to a control group. Materials and methods. A retrospective cohort study was conducted in 2 groups of patients with primary open-angle glaucoma who underwent NPDS followed by LGP between 2016 and 2021. In the main group, a microfistula was formed in the superolateral part of the trabeculodescemet membrane (TDM). In the control group, LGP was performed in the central part of the TDM. The primary endpoint to evaluate the efficacy of the technique was the maintenance of complete surgical success of NPDS at 6, 12, 18, 24 months after LGP compared to the control group. The safety endpoint was the number and outcome of postoperative complications. Results. 71 patients were included in the main group and 63 patients in the control group. At the end of 2 years of follow-up, 55 (77 %) patients in the main group maintained complete surgical success of NPDS, while in the control group — 39 (62 %) patients (χ2 = 3.870, p = 0.049). In the main group, the Kaplan — Meier survival analysis showed statistically significant greater odds of maintaining surgical success of NPDS after LGP (p = 0.032). In the main group, 3 out of 71 patients (4.2 %) developed microfistula blockage by the iris root, in all cases the complications were resolved by laser reconstruction of the surgical field. In the control group, microfistula blockage was described in 11 out of 63 (17.5 %) cases (p = 0.012), in 1 case it was resolved during laser reconstruction of the intervention area, 6 patients were treated with hypotensive eye drops, 4 patients underwent surgical intervention. Conclusions. The combined technique of LGP and risk-oriented approach to patient monitoring significantly reduces the incidence of complications, ensures their early detection and allows to manage their consequences through non-invasive treatment methods. As a result, the probability of maintaining complete surgical success of NPDS during 2-year follow-up is increased, which improves the long-term prognosis for vision preservation in glaucoma patients.
Interleukin profile of patients with cataracts and sarcopenic obesity
The combination of cataracts and sarcopenic obesity is a common age-associated pathology with the involvement of interleukins as one of the leading pathogenetic mechanisms. However, the interleukin profile in patients with cataracts aggravated by sarcopenic obesity has not been analyzed to date. Purpose: to analyze the level of interleukins in blood plasma in patients with cataracts and sarcopenic obesity, depending on the stage of cataract. Material and methods. The systemic interleukin profile of elderly patients aged 60–74 years with sarcopenic obesity and initial cataract (n = 21), immature cataract (n = 23), mature cataract (n = 22), overripe cataract (n = 23) and 32 patients of the same age without age-related cataracts and sarcopenic obesity was studied by flow cytometry. The stages of cataract were determined in accordance with the Clinical Recommendations “Senile cataract”, and the detection of sarcopenic obesity according to the criteria of the European working Group on sarcopenia in older people (2018). Results. A statistically significant increase in individual systemic interleukins was found in patients with initial cataract combined with sarcopenic obesity: IL-1β to 38,2 ± 1,3 versus 33,5 ± 1,2 pg/ml in the control, IL-6 to 8,3 ± 0,5 versus 4,9 ± 0,6 pg/ml, IL-8 to 15,9 ± 1,2 pg/ml versus 10,3 ± 2,1 pg/ml and IL-17 up to 12,1 ± 0,7 versus 8,2 ± 1,0 pg/ml. As the initial cataract combined with sarcopenic obesity progressed, the content of most pro-inflammatory interleukins in blood plasma increased significantly in the immature, mature and overripe stages of cataract, with the exception of IL-5. Particularly pronounced interleukin production was observed at the overripe stage of cataract, aggravated by sarcopenic obesity. On the contrary, the content of anti-inflammatory interleukins decreased in the blood plasma at this stage — IL-4 to 1,7 ± 0,6 versus 3,2 ± 0,4 pg/ml in the control, and IL-10 to 7,2 ± 0,5 versus 15,1 ± 1,2 pg/ml, respectively. Conclusion. A marked increase in the production of pro-inflammatory systemic interleukins and inhibition of the production of anti-inflammatory interleukins contributes to the progression of age-related cataracts combined with sarcopenic obesity from the initial stage to the overripe stage.
The use of a combination of mesh coating based on allogeneic collagen and platelet-rich plasma lysate in the surgical treatment of symblepharon. Experimental study
Purpose of the study was to evaluate the efficacy of a combination of allogeneic collagen-based mesh covering and platelet-rich plasma (PRP) lysate for the surgical treatment of symblepharon in an animal experiment. Material and methods. The study was approved by the local ethics committee of the Helmholtz National Medical Research Center of Eye Diseases (protocol No. 63/1 dated February 16, 2023). Thirty-two mature chinchilla rabbits (64 eyes) were divided into four equal groups based on the time of withdrawal from the experiment. Collagen isolated from rabbit tendons was used to manufacture the mesh covering. Allogeneic plasma-free lysate was obtained from the venous blood of rabbits not included in the study. A 10 × 10 mm defect down to the sclera was created in the bulbar conjunctiva of the superior-inner quadrants of both eyes and covered with a membrane made of a reticular wound dressing based on allogeneic collagen. At the end of the surgery, 0,2 ml of PRP lysate was additionally injected into the conjunctiva of the left eye of all rabbits. Results. On day 45 of observation, pale pink conjunctiva was visualized in the defect area, indistinguishable from the adjacent tissues in color and density. Morphological evaluation revealed complete restoration of the histoarchitecture of the mucous membrane. The use of PRP lysate contributed to a more favorable course of the postoperative period in the first 14 days after surgery. Conclusion. The unique fibrillar structure of reticular membranes was shown to stimulate the growth of conjunctival epithelial cells and its phenotypic development.
Evaluation of the efficacy of platelet-rich plasma lysate in patients after urgent keratoplasty based on an analysis of changes in the protease-inhibitor balance of tears (pilot study)
Purpose: to estimate the effectiveness of platelet-rich plasma (PRP) lysate to reduce the activity of matrix metalloproteinases in tear fluid and prevent graft lysis in patients after urgent keratoplasty. Material and methods. The study was carried out on 10 patients after urgent penetrating keratoplasty. Control group included 12 healthy adults (24 eyes). After surgery, patients received PRP lysate in subconjunctival injections and instillations. Tear fluid was collected using filter paper before the operation and on the 7th day after it. Concentrations of MMP-9 and TIMP-1 in tears were determined by ELISA. Clinical criterion for the corneal status in the early postoperative period was the area of transplant epithelization on the 7-th day after surgery. Results. Concentrations of MMP-9 in tears in all patients before surgery were significantly higher than in healthy controls. Patients with repeat keratoplasty had higher MMP-9 concentration than ones before the first keratoplasty — 15.50 ± 1.54 ng/ml and 17.28 ± 0.47 ng/ml. Treatment with PRP lysate caused a statistically significant decrease of MMP-9 concentration in tears of patients after first keratoplasty. Patients with repeat keratoplasty demonstrated a tendency for decrease of MMP-9 concentration after treatment. Conclusion. Timely decrease of MMP-9 activity in cornea after its function in the tissue remodeling is completed is a necessary condition for the successful corneal engraftment. PRP lysate contains a large amount of TIMP-1 and can be used for the prevention of keratolysis in urgent corneal surgery.
Purpose. Retrospective analysis of clinical, instrumental and pathomorphologic features of primary orbital melanoma based on our own observations between 2007 and 2024. Materials and methods. 6 cases of primary melanoma of the orbit were examined and treated at the Department of Ophthalmic Oncology and Radiology of the Helmholtz Medical Center of the Russian Ministry of Health. The age of the patients at the time of diagnosis ranged from 18 to 65 years (mean — 48.0 ± 17.6 years). 2 patients had oculodermal melanosis. The clinical course of the disease at the stages of dynamic follow-up of the patients and the peculiarities of vital prognosis taking into account the management tactics and pathomorphological features of the tumor were evaluated. Results. The duration of the history varied from 3 months to 3 years. The main clinical signs included exophthalmos (n = 6), restricted eye movement (n = 4) and partial ptosis (n = 3). The development of metastatic disease occurred in 3 of 6 patients: to the lungs, liver, and brain in 12, 18, and 48 months after the start of treatment, respectively. Epithelioid and mixed cell type tumors with high number of mitotic cells, congenital melanosis were the indicators of unfavorable prognosis. Life expectancy was higher in patients who underwent remote irradiation after tumor removal. Conclusions. Primary orbital melanoma is a rare, aggressive orbital tumor that does not have specific clinical and instrumental symptoms, which complicates the diagnosis and simulates a benign orbital tumor. It is necessary to be alert to the development of this pathology in patients with primary oculodermal melanosis, which requires lifelong dynamic monitoring. The vital prognosis of patients is influenced by both the histological type of the tumor and early radiation therapy after surgical treatment. For a better understanding of the pathogenesis of the disease, it is necessary to consolidate and conduct multicenter studies with the study of the genetic profile of the disease to subsequently search for and develop optimal therapy.
Tolosa — Hunt syndrome: a clinical case in the practice of an ophthalmologist
Purpose of the study: to present a clinical case of a patient with Tolosa — Hunt syndrome in the practice of an ophthalmologist. A patient with pain in the left side of the head, ptosis and ophthalmoplegia of the upper eyelid came to our clinic. These complaints are characteristic of the superior orbital fissure syndrome, however, the absence of secondary causes of damage to the structures of the superior orbital fissure and the walls of the cavernous sinus can lead to incorrect diagnosis and treatment. Tolosa — Hunt syndrome (painful ophthalmoplegia), if diagnosed in a timely manner, responds well to treatment with glucocorticosteroids, therefore, it is mandatory for ophthalmologists to be vigilant and conduct a thorough ophthalmological and neurological examination of such patients. Conclusion. Ophthalmologists need to carry out differential diagnosis in patients with superior orbital fissure syndrome with Tolosa — Hunt syndrome.
Features of retina remodeling during its physiological aging and age-related macular degeneration
Aging is the main risk factor for the development of all age-associated diseases of the central nervous system and retina, such as agerelated macular degeneration (AMD) and glaucoma. The lack of effective treatments for these diseases is partly due to a lack of understanding of the impact of normal physiological aging on neural network remodeling, which reflects adaptive neuroplasticity and is aimed at preserving and maintaining the normal function of neurons in the aging retina, as well as differences in the signs of retinal remodeling during normal and pathological aging. A characteristic feature of aging is subtle plastic changes, restructuring of connections between neurons in the outer retina and weakening of the functional activity of the retina, depending on the structure of neural networks. In the inner retina, the localization of contacts of bipolar cells with amacrine and ganglion cells does not change, but with age, simplification and narrowing of dendritic branches in most retinal ganglion cells occurs. Remodeling of neuronal contacts in eyes with AMD differs from that of normally aging retina by the degree of neuroplastic changes, rapid growth and remodeling of dendritic branching of bipolar cells, and the formation of multiple tangential contacts that provide connections between bipolar dendrites and distant photoreceptors. In advanced AMD and other age-related diseases, structural remodeling of the retina is significantly affected by cellular losses (of photoreceptors and other retinal neurons), rupture and simplification of dendritic branching, modification of Müller glial cell processes, and weakening of their functional symbiosis with retinal neurons.
Modern artificial intelligence capabilities in the diagnosis and treatment of ocular complications of diabetes mellitus
Artificial intelligence (AI) is currently considered one of the most rapidly developing and improving fields in science and practice, including medicine. Deep machine learning algorithms enable systems to recognize images, process natural language, and predict trends based on large databases. This review analyses the role of AI using the example of ocular complications in patients with diabetes mellitus (DM). Literature data on the use of AI technologies in screening patients with DM, diagnosing diabetic retinopathy and diabetic macular edema, disease monitoring, treatment selection, retinal laser photocoagulation, and targeted delivery of angiogenesis inhibitors in patients with retinal damage due to DM are analyzed. The advantages of AI technologies, including the high speed and accuracy of analyzing large volumes of medical data and the possibility of remote interaction, are demonstrated, which can assist ophthalmologists in making medical decisions.
Brinzolamide/brimonidine fixed combination for open-angle glaucoma and ocular hypertension treatment: hypotensive efficacy and tolerability
The literature review analyzes the data of 12-year clinical use of a fixed combination of 1% brinzolamide and 0.2 % brimonidine (BBFC) in the treatment of glaucoma and ocular hypertension. This drug is an alternative for patients with systemic contraindications in the form of broncho-obstructive syndrome and cardiovascular pathology. The monotherapy BBFC hypotensive effect is 30 % of the IOP initial level and corresponds to that of brinzolamide/brimonidine non-fixed combination. Switching patients with glaucoma and ocular hypertension from monotherapy with brinzolamide or brimonidine to BBFC is accompanied by an additional hypotensive effect at the of 13% of the initial IOP. BBFC has a good additional hypotensive effect in combination with drugs of other pharmaceutical groups, and also effectively relieves the hypertension after laser capsulotomy, intravitreal anti-VEGF injections and phacoemulsification. The most common BBFC ophthalmological adverse effects are conjunctival hyperemia, conjunctivitis, allergic reactions and eye discomfort with a frequency of about 10–20 %.
Iris defects and methods for their corrections
Iris defects not only create cosmetic discomfort but also cause decreased visual acuity, complaints of double vision, glare, and photophobia. Today, there are various methods of their correction. The fundamental factor on which the choice of surgical treatment tactics depends is the area of the iris defect. If the defect area is less than 30%, iridoplasty is performed; if it is more than 30%, artificial iris implantation is performed. All surgical methods for eliminating defects have their advantages and disadvantages, therefore ophthalmic surgeons often have different views on treatment tactics. In addition, in some cases, combined methods are used. This review highlights the types of iris defects, their classification and clinical characteristics, and presents various methods of their surgical treatment.
Biomarkers in the assessment of diabetic retinopathy progression
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes mellitus (DM) and the leading cause of acquired blindness in people of working age. Due to the absence of obvious symptoms in the early stages of the disease, the identification of clinical biomarkers can play a crucial role in early diagnosis and in identifying prognostic factors for DR. Major risk factors do not explain the large variability that characterizes the evolution and rate of progression of DR in different individuals. Therefore, the identification of ocular and systemic biomarkers is crucial for facilitating risk stratification in patients with DM; furthermore, reliable biomarkers can also help predict patient response to therapy. Since existing treatments for proliferative DR are mostly applied in advanced stages of the disease, reliable progression criteria are necessary to ensure timely treatment and early and appropriate selection of therapy. This review discusses relevant systemic and local biomarkers of DR.