Peer-rewieved medical journal for ophthalmology
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Artificial Intelligence: Applications in Ophthalmology. Part 2
Choroidal melanoma is a serious oncological disease that requires timely detection for effective treatment and saving the patient’s life. Traditional diagnostic methods have limitations in sensitivity and accuracy, especially in the early stages of the tumor process. Artificial intelligence (AI) promises to revolutionize ophthalmology, allowing for automated analysis of fundus images and the detection of subtle signs of tumors. This review article discusses the current capabilities of AI in the early diagnosis of choroidal melanoma. The advantages and limitations of using AI in ophthalmology are analyzed, and existing studies on the development and implementation of AI systems for the diagnosis of fundus tumors are described. The future of AI in ophthalmology and the prospects for the development of this area are discussed. The article is intended for ophthalmologists, researchers, and specialists in the field of artificial intelligence interested in increasing the efficiency of early diagnosis of choroidal melanoma and improving the vital prognosis of patients.
What an Ophthalmologist Should Know about the Side Effects of “Ozempic” and its Analogues
Modern notions of beauty, dominant in the media and online, persistently promote the idea of “eternal youth”, including the need for a slim figure. Consequently, medications originally developed for the treatment of various systemic diseases are often used without medical indications and without physician supervision for the purpose of weight loss and/or rejuvenation. A striking example is the widespread use of human glucagon-like peptide-1 (HGLP-1) analogs (“Ozempic”, “Munjaro”, etc.), which were developed for the treatment of type 2 diabetes and associated obesity. This has led to the use of these drugs not only for the treatment of the aforementioned condition but also for weight loss in otherwise healthy individuals. An analysis of scientific literature and our clinical observations indicate a high risk of a wide range of side effects with this group of medications. The most common complaints include nausea, diarrhea, vomiting, and constipation, occurring in 39–42 % of patients. Additionally, cases of pancreatitis have been described, as well as an increased risk of gallstones, renal failure, anesthesia-related risks such as aspiration of gastric contents into the respiratory tract, and carcinogenic effects such as thyroid and pancreatic cancer. A significant number of studies have documented the development of ophthalmic pathology associated with the use of “Ozempic” and its analogs, including non-arteritic anterior ischemic optic neuropathy — an acute condition characterized by sudden, painless, and irreversible vision loss. Other studies have documented cases of macular edema and progression of diabetic retinopathy. The “Ozempic face” effect — a change in facial appearance (wrinkles, a sunken appearance) due to the rapid loss of subcutaneous fat — is mentioned in the literature. It prompts patients to seek dermal filler injections from cosmetologists, which, consequently, increases the risk of ophthalmological complications, particularly central retinal artery occlusion. It should be noted that decreased appetite associated with this class of drugs is largely due to their mechanism of action on the central nervous system and is accompanied by changes in taste preferences (a decrease in intense taste sensations), as well as increased depression, anxiety, and, in some cases, suicidal ideation. Although the effectiveness of therapy with human glucagon-like peptide-1 analogues has been proven, further research is needed to assess the risk of severe side effects associated with their use, as well as to inform physicians and patients about potential complications to ensure timely medical care, including in ophthalmology.
Effects of Keratorefractive Surgery on Corneal Biomechanics: A Review of the Literature
This review article focuses on studying changes in corneal biomechanical properties following refractive surgeries. Objective: to analyze the literature on the effects of major laser vision correction techniques on the biomechanical properties of the cornea. Materials and Methods. For this review, we conducted a literature search in the databases PubMed, Scopus, and e-Library from 1992 to 2023 using the following keywords: “ametropia”, “corneal biomechanical properties”, “keratorefractive surgery”, “LASIK”, “FEMTOLASIK”, “SMILE”, “CLEAR”. Results. Studies indicate that the development of new myopia correction techniques with minimal damage to the superficial corneal layers represents a promising direction in ophthalmology. These methods provide better protection for corneal structural integrity, which is crucial for preventing postoperative complications. Conclusion. The choice of refractive method for myopia correction should account for changes in corneal biomechanical properties and demonstrate the best safety profile concerning the preservation of corneal mechanical stability.
Basic Principles of Treatment of Endocrine Ophthalmopathy. Literature review
Endocrine ophthalmopathy (EO) is one of the most common causes of exophthalmos in adults, as well as optic neuropathy resulting from orbital compartment syndrome. Complications such as persistent vision loss due to pathology of the anterior ocular surface and optic nerve involvement remain high. After compensation for the acute stage of the disease, cosmetic dissatisfaction becomes a primary concern due to significant changes in the periorbital tissues. Current diagnostics and the correct choice of treatment strategy based on the stage and activity of the pathological process are key factors in achieving a positive outcome, both in terms of clinical symptoms and aesthetic defects, particularly blepharochalasis and eyelid malposition. Various treatment methods exist, divided into medical and surgical. Each method has its own indications and contraindications, as well as side effects, which should be considered when choosing a strategy. The latter is especially important when selecting systemic drug therapy. In most cases, surgical treatment requires preliminary complete compensation of the thyroid gland’s hormonal and somatic status. Collaborative management with an endocrinologist is crucial. As noted above, the first step in treating EOP is drug therapy, which involves the use of glucocorticosteroidsin varying dosages, depending on the patient’s initial status and the endocrinologist’s recommendations. Further management is determined based on individual indications and includes various types of surgical treatment, among other options. A key aspect of the surgical approach is a properly developed step-by-step plan for the procedures. Each subsequent step should be a logical continuation of the previous stage of treatment.
Problems of Intraocular Correction in Patients after Radial Keratotomy
Widespread use of radial keratotomy (RKT) at the end of the last century determined numerous difficulties in planning intraocular correction in this group of patients associated with the calculation of the optical power of the intraocular lens (IOL), the choice of the type of intraocular correction and the specifics of surgical intervention. Postkeratotomic deformations are usually accompanied by irregular changes in the anterior and posterior surfaces of the cornea, and, despite the advent of new calculation formulas, make the refractive result difficult to predict. Modern research methods allow a detailed analysis of keratotopographic parameters in complex clinical situations when determining indications for implantation of toric IOLs. At the same time, a wide range of IOLs of various types and designs, with functionality of obtaining vision at different distances, allows not only implantation of monofocal IOLs, but requires systematization of existing knowledge, in relation to patients with complex corneal surface relief. Recommendations for implantation of multifocal IOLs (MIOLs) are in most cases of a cautionary nature due to the peculiarities of image formation when using the diffraction design of the optical part. The principle of splitting the light flux, accompanied by a high probability of photopic phenomena and potentially affecting the indices of contrast sensitivity, in combination with the difficulty of predicting the achievement of target refraction are among the main limiting factors. The group of lenses with extended depth of focus is free from many of the disadvantages of MIOLs, but also needs to be studied in patients with RKT. Thus, the question of choosing the type of optical correction is directly determined by a number of factors, the consistent study of which is of great practical importance for determining the optimal strategy when planning intraocular correction in patients with a history of RKT.
Prevention of Keratograft Decompensation after Penetrating Keratoplasty in Combined Optical-reconstructive Surgery for Combat Eye Trauma
Purpose: to evaluate the long-term results of penetrating keratoplasty (PK) as an element of optical reconstructive surgery (ORS) in combat eye injury (CEI), to identify risk factors for transplant decompensation and their prevention. Patients and Methods. The study included 39 patients (22–59 years old) divided into two groups: Group I — open globe injuries (OGI) with anterior and posterior segment structures failures (37 eyes) and Group II — anterior segment inflammation, complicating CEI with an intact posterior segment (6 eyes). All patients underwent PK, and in Group I ORS were performed also. Outcome measures included visual acuity, graft epithelialization rate, and graft transparency. Results. Postoperative visual acuity was significantly higher in group II — 0.23 ± 0.12 (from 0.05 to 0.3) versus 0.05 ± 0.08 (from 0 to 0.4) in group I. The epithelialization time in group I was significantly shorter than in group II — 8.05 ± 3.86 versus 25.24 ± 11.87 days. In group I, transparent engraftment was observed in 62.16 % of cases, semitransparent — in 35.14 % of cases, and cloudy — in 2.70 % of cases. In group II, transparent engraftment was observed in 83.33 % of cases, cloudy — in 16.67 % of cases, which was significantly higher. Keratograft contact prevention with the vitreous cavity contents in Group I reduced the rate of opaque graft engraftment from 61.5 % to 16.7 %. Correlations affecting the functional outcome after surgery were identified. Conclusions. Posterior segment surgery after PK decreases survival of corneal transplant due to endothelium contact with vitreous cavity contents. Therefore, the primary goal of multi-stage ORS is to distinguish anterior and posterior eye segments.
Anatomical and Functional Efficiency of a Modified Method of Autologous Retinal Transplantation for Large Full-thickness Macular Holes
Purpose. To evaluate the anatomical and functional efficacy of a modified autologous retinal transplantation (ART) technique in the surgical treatment of large full-thickness macular holes (FTMH). Material and Methods. The study included 41 patients (42 eyes) with a minimum FTMH diameter greater than 800 µm who had previously undergone vitrectomy with internal limiting membrane peeling and gas tamponade due to FTHM. Patients were divided into two groups. In the main group, a modified ART was performed using preoperative navigated flap planning, intraoperative optical coherence tomography guidance, and fixation with autologous platelet-rich plasma. In the control group, macular hole edges were closed using an aspiration technique followed by application of autologous platelet-rich plasma. Anatomical outcomes were assessed by optical coherence tomography, while functional outcomes included bestcorrected visual acuity and central retinal sensitivity. The follow-up period was 6 months. Results. Stable anatomical closure of the FTMH was achieved in all cases in the main group. In the control group, macular hole recurrence was observed in 22 % of patients (p = 0.049). Both groups demonstrated a statistically significant improvement in best-corrected visual acuity and retinal sensitivity as early as 1 month postoperatively, with no significant intergroup differences in cases with successful anatomical closure. Conclusions. Modified ART provides a higher and more stable anatomical success rate in the treatment of large FTMH compared with the edge approximation technique. Functional outcomes are characterized by early improvement followed by stabilization during follow-up.
Repeated Accelerated Local Corneal Collagen Crosslinking in the Treatment of Progressive Keratoconus
Study objective: To analyze the clinical, functional, and safety efficacy of accelerated local corneal collagen crosslinking (ALCCL) in patients with progressive keratoconus who had previously undergone crosslinking. Patients and methods. A retrospective analysis of treatment outcomes was performed in 11 patients (12 eyes) with progressive keratoconus stages I–III (age 27 ± 6 years). The initial best-corrected visual acuity was 0.65 ± 0.11, the mean corneal refractive power was 53.1 ± 2.42 D, and the minimum stromal thickness was 459 ± 19.6 µm. Surgical treatment consisted of personalized crosslinking: local de-epithelialization of the cone apex and photosensitization with a 0.1% riboflavin solution, followed by UV irradiation (6 mW/cm2) for 15 minutes. Postoperative care included standard antibacterial, anti-inflammatory, and long-term keratoprotective therapy. Results. This cohort of patients fully met the requirements for repeat crosslinking according to the UL-KRK protocol. Corneal condition was assessed at 6, 12, 18, and 36 months after the accelerated local crosslinking procedure. The uncorrected visual acuity (UCVA) increased from 0.32 ± 0.19 to 0.55 ± 0.15 by the 6-month follow-up and remained stable throughout the study. The BCVA did not change significantly (0.66 ± 0.16). According to the Pentacam HR device (Oculus, Germany), Kmax decreased from 53.1 ± 2.42 to 51.9 ± 1.09 D, and the cylindrical component (Cyl) decreased from –2.89 ± 1.02 to –1.95 ± 0.77 D. The formation of the demarcation line was visualized at a depth of 270–330 µm in the first 3 months according to corneal optical coherence tomography (optical coherence tomograph — Solix (Optovue Inc., USA)). Endothelial cell density (ECD) remained stable throughout the entire observation period (2327 ± 121 cells / mm2) (endothelial microscope Topcon SP-1P). Conclusion. Repeated crosslinking is an effective and safe method for stabilizing progressive keratoconus, providing a long-term refractive effect and preserving the morphofunctional parameters of the cornea.
Phacoemulsification in Eyes with Prior Glaucoma Surgery: Problems and Solutions
Glaucoma and cataract remain the leading causes of vision loss and blindness in Russia and worldwide. When these conditions coexist, sequential glaucoma surgery and phacoemulsification (PE) are often required. However, cataract extraction poses a threat to the long-term functionality of successful bleb. This is due to a local inflammatory reaction and scarring in the filtering bleb area, initiated by surgical trauma during PE. According to existing studies, PE leads to failed glaucoma surgery in most cases; however, quantitative assessments of intraocular pressure decompensation can vary significantly between studies. Optical coherence tomography of the filtration bleb after PE demonstrates its degeneration — a decrease in size and growth of hyperreflective tissue. Limited data on femtosecond laser assisted PE show promising results due to the reduction in surgical trauma. Possible promising approaches include pathogenetically based PE for angle-closure glaucoma and simultaneous performance of both procedures, with the possibility of using modern microinvasive techniques for glaucoma surgery. Optimization of postoperative anti-inflammatory therapy and the use of antimetabolites with angiogenesis inhibitors require further study. Clinical management of these patients requires a personalized approach, taking into account the level of intraocular pressure, the stage of glaucoma, the morphology of the anterior chamber angle, and individual susceptibility to inflammation and scarring.
Efficiency of Transscleral Micropulse Cyclophotocoagulation in Different Types of Glaucoma
Transscleral micropulse cyclophotocoagulation is a safe method for reducing ophthalmotonus, which has proven its effectiveness in various forms of glaucoma, including patients with high visual acuity. Рurpose: to study the effectiveness of transscleral micropulse cyclophotocoagulation (MP-TSCPC) in various types of glaucoma. Materials and methods. The data of 193 eyes of 192 patients with decompensated glaucoma (primary open-angle glaucoma, secondary glaucoma, neovascular glaucoma, including after IOL repositioning, primary angle-closure glaucoma) of various stages who underwent MP-TSCPC were analyzed. The observation period was up to 12 months. MP-TSCPC was performed on a Vitra A 810 device (Quantel Medical, France) with the following laser parameters: energy — W = 2000 mW, cycle exposure 31.3 %, total exposure time on four sectors — 160 sec. Results. The MP-TSCPC is effective in POAG, where the IOP reduction was 32 % from the initial value by the end of the observation period, as well as in PACG, where the reduction by the end of 6 months was 51–56 % from the initial values. In secondary glaucoma by the end of the observation period — 37.5 % of the initial IOP, but without achieving the target values, including in neovascular glaucoma — 29 %. The total effectiveness of MP-TSCPC in the POAG group was 76.5 %, secondary glaucoma — 61.5 %, PACG — 100 %, neovascular glaucoma — 70 %, after IOL repositioning — 76.5 %. At the same time, no difference in effectiveness was found between the groups (p = 0.117). MP-TSCPC is more effective in advanced glaucoma, where by the end of the observation the hypotensive effect was 40 % of the initial value, and in advanced glaucoma, where it was 38 % of the initial one. The total effectiveness of MP-TSCPC in the advanced glaucoma group was 73.3 %, in advanced glaucoma — 80.3 %, in terminal glaucoma — 75 %, with no difference in effectiveness between the groups (p = 0.938). After MP-TSCPC, the number of drops of local hypotensive therapy decreased from 3.09 ± 0.6 to 2.95 ± 0.67 (p = 0.011). When performing MP-TSCPC to relieve pain in 43 eyes, the result was achieved in all cases. Conclusion. MP-TSCPC has proven to be an effective and safe intervention for various types of glaucoma, with maximum effectiveness in the case of POAG and PACG at early and advanced stages. In various types of secondary glaucoma, the hypotensive effect is pronounced and persistent, but in a greater number of eyes without achieving compensation. Also, MP-TSCPC can be recommended for pain relief and reducing the drug load.
YAG-laser Dissection of Opacities of the Posterior Capsule of the Lens as a Possible Predictor of Formation of the “intraocular lens — capsular bag” Complex Dislocations
Purpose — evaluation of the effect of YAG-laser dissection of posterior lens capsule opacities on the stability of the anatomical position of the intraocular lens (IOL) in eyes after phacoemulsification (PE) of uncomplicated age-related cataracts with the initial absence of weakness of the Zinn support. Patients and methods. The clinical material is presented by 97 patients with a diagnosis of secondary cataract (97 eyes). All patients underwent YAG-laser dissection of posterior capsule opacities. The patients were assessed for the distance from the ciliary body processes to the edge of the intraocular lens at four points (12, 3, 6, and 9 hours) before dissection of the secondary cataract and 2 hours after. Statistical processing of the obtained data was performed in the IBM SPSS Statistics Version 20 program. Results. The patients’ age ranged from 60 to 75 years (68.0 ± 2.3 years). There were 52 men and 45 women. All patients had previously undergone PE of uncomplicated cataract with implantation of a posterior chamber IOL. In all cases, posterior capsule fibrosis developed within 1 to 5 years after PE (2.5 ± 1.5 years). The “corneal endothelium — anterior surface of the IOL” distance before and after YAG-laser dissection did not differ statistically significant — 4.22 ± 0.34 and 4.20 ± 0.26 mm (p > 0.05). In 20 eyes no changes in the “ciliary body processes — IOL edge” distance were observed after YAG-laser dissection. However, in 77 eyes a statistically significant decrease in the distance “ciliary body processes — IOL edge” at 6 o’clock was revealed: by 0.2–0.4 mm, which was combined with a statistically significant increase in this distance at 12 hours: 2.61 ± 0.21 versus 2.87 ± 0.22 mm (p < 0.05). Subsequent dynamic observation for three years revealed that in 5 eyes, dislocation of the “IOL — capsular bag” complex occurred. Conclusion. A statistically significant decrease in the distance “ciliary body processes — IOL edge” by 6 hours with a simultaneous increase of 12 hours after YAG-dissection of secondary cataract was revealed. Within three years after YAG-laser dissection of posterior capsule opacities, grade II dislocation of the “IOL — capsular bag” complex was recorded in 5 patients, which amounted to 5 %. In our opinion, YAG-laser dissection is a trigger for weakening of the Zinn support, which can subsequently progress, leading to dislocation of the “IOL — capsular bag” complex. This risk is more pronounced in eyes with significant fibrosis of the posterior capsule against the background of the initial weakness of the ligamentous apparatus of the lens.
The First Results of Assessing Changes in the Cornea Biomechanical Properties after Keratorefractive Surgery
Objective: to conduct a comparative analysis of the biomechanical consequences of keratorefractive surgery, depending on the laser treatment technique used on the corneal stroma in patients with moderate myopia. Materials and Methods. The study included 150 patients (150 eyes) with moderate myopia, who were divided into three groups according to the type of keratorefractive surgery (KRO) performed: group 1 — 50 patients underwent Femto-LASIK; group 2 — 50 patients underwent CLEAR surgery with a 1.5 mm incision; group 3 — 50 patients underwent CLEAR surgery with a 3.0 mm incision. All patients underwent both standard and specialized ophthalmic examinations before surgery and at various follow-up time points (1 week, 1 month, and 3 months post-surgery). Particular emphasis was placed on assessing the biomechanical properties of the cornea using the Corvis ST device. Results. The pre-operative assessment of corneal biomechanical properties revealed no statistically significant differences between the groups, with all parameters falling within the normal range. At the 3-month follow-up, the central corneal thickness (CCT) was found to be highest in group 2 (CLEAR with a 1.5 mm incision) and lowest in group 1 (Femto-LASIK) (p < 0.05). Similarly, the SP-A1 and ARTh parameters demonstrated the highest values in group 2 and the lowest in group 1 (p < 0.05). Furthermore, the IR parameter was found to be lowest in group 2 and highest in group 1 at both the 1-month and 3-month follow-up visits (p < 0.05). Conclusion. The observed dynamics of changes collectively demonstrate remodelling of the corneal biomechanical profile in the post-operative period, regardless of whether FS-LASIK or CLEAR surgery was performed. However, patients who underwent CLEAR surgery — particularly those with a 1.5 mm incision — exhibited less pronounced corneal changes. These findings underscore the critical importance of thorough pre-operative planning, which should include assessment of the initial corneal thickness, calculation of the residual stromal bed, analysis of individual biomechanical parameters, and selection of the most appropriate surgical technique to minimize corneal structural damage.
Influence of the Middle Nasal Meatus Anatomy on the Outcomes of Various Osteotomy Techniques in Endoscopic Dacryocystorhinostomy
Рurpose. Comparative analysis of the results of endoscopic endonasal dacryocystorhinostomy (EEDCR) using a high-speed drill and a piezosurgical device, assessing the impact of the degree of middle meatus narrowing on the complication rate and functional success. Material and methods. This retrospective cohort study included 240 patients with obstruction of the vertical portion of the lacrimal drainage system, divided into two equal groups depending on the osteotomy method (drill vs. piezosurgery). Based on preoperative CT, all patients were stratified by the degree of middle meatus narrowing: grade I (>4 mm), grade II (≤4 mm), grade III (≤2 mm). The groups were comparable in anatomical characteristics. Outcomes were assessed 6 months after surgery. Results. The use of piezosurgery significantly reduced the incidence of intraoperative bleeding (p ≤ 0.01), synechiae (p = 0.040), granulations (p = 0.035), and ostium closure (p = 0.049). The recurrence rate in the piezosurgery group was 3.2 % versus 10.0 % in the drill group (p ≤ 0.05). Subgroup analysis demonstrated that the greatest differences between the methods were achieved in patients with grade III narrowing (≤2 mm), where the risk of iatrogenic mucosal injury and subsequent scarring is highest. The selectivity of ultrasonic impact, which preserves soft tissue integrity, prevents the formation of a “wound mirror” and the development of the synechial process. Conclusion. Piezosurgical osteotomy is the preferred method for primary EEDCR in patients with a narrow middle meatus (grade II–III narrowing), providing a significant reduction in the rate of complications and recurrence of epiphora.
Laser Vitreolysis of Symptomatic Vitreous Floaters. Report 2. Prospective Analysis
Objective: to conduct a prospective assessment of the safety and clinical efficacy of early laser vitreolysis for symptomatic Weiss ring vitreous floaters in the presence of complete posterior vitreous detachment (PVD) over a 12-month period. Methods. The study included 160 patients (160 eyes) with symptomatic Weiss ring vitreous floaters and complete posterior vitreous detachment. Patients were divided into groups based on the timing of treatment: early laser vitreolysis (ELV) — within 3 months, delayed laser vitreolysis (DLV) — 3 months or more, and a control group (no treatment). Laser vitreolysis was performed using the Ultra Q Reflex YAG laser system. Results. Safety analysis of ELV showed no statistically significant differences with the DLV and control groups in the rate of intra- and postoperative complications, intraocular pressure level, or ocular morphometric parameters. Analysis of the efficacy of ELV for Weiss ring revealed complete elimination of the floater in 74.5 % of cases after laser vitreolysis, comparable to the DLV group — 63.5 % (p > 0.05); a high functional outcome — improvement in best-corrected visual acuity (BCVA) by 0.176 vs. 0.048 in the control group (p < 0.001) and comparable to the DLV group — 0.123 (p > 0.05); subjective improvement in “quality of life” across all categories (overall QoL score — 66.15 % vs. 8.24 % in controls (p < 0.001) and comparable to the DLV group — 65.49 %, p > 0.05); a high self-assessed satisfaction rate with the ELV result — 72.7 % reported “complete success”, comparable to the DLV group — 59.6 %; a reduction in complaints of visual discomfort by 79.9 % vs. 8.7 % (p < 0.001) in the control group, comparable to the DLV group — 77.3 % (p > 0.05). Conclusion. Based on the study data, performing early YAG laser vitreolysis for symptomatic Weiss ring vitreous floaters in the presence of complete PVD is a safe and highly effective method and can be considered a justified alternative to observational management in patients with clinically significant symptomatic floaters.
Basic Approaches to Standardizing the Method of Orbital Computed Tomography in Thyroid Eye Disease
Thyroid Eye Disease (TED) is an autoimmune condition requiring precise imaging for diagnosis, assessment of severity/activity, and treatment planning. The lack of unified orbital Computed Tomography (CT) protocols leads to variability in results and unjustified radiation exposure. Currently, Multi-Slice Computed Tomography (MSCT) is widely used due to its high resolution, short scanning time, low artifact generation, and cost-effectiveness. Standardization of orbital CT is essential to improve reproducibility, diagnostic accuracy, and minimize risks. The aim of the study is to optimize the orbital CT protocol to ensure reproducible and accurate measurements with minimal radiation exposure, in order to obtain reliable data for diagnosing TED, assessing the severity and activity of the process, and for planning and monitoring treatment. The article clearly outlines the indications for orbital CT in TED. Standardized parameters for performing orbital MSCT are presented. A unified setup of key technical scanning parameters, such as tube voltage and current with mandatory use of automatic modulation, along with optimized slice thickness and reconstruction interval, ensures not only high reproducibility and image detail but also guarantees strict adherence to the principle of minimizing radiation exposure for each individual patient. A comparative characteristic of alternative diagnostic methods without radiation exposure (magnetic resonance imaging and ultrasound examination of the orbits) is provided. Parameters for assessment and criteria for evaluating the orbital structures during CT are described in detail. The role of specialized software and deep learning for automating segmentation and volumetric analysis is noted. A structured protocol for a radiologist’s report is proposed. The article presents a comprehensive approach to standardizing orbital CT examination in TED, focusing on optimizing scanning parameters to balance image quality and radiation dose, clear criteria for describing pathology, and the integration of modern technologies. This is necessary to improve diagnosis, prognosis, treatment planning (especially decompression), and minimize risks for patients.
Management of Limbal Stem Cell Deficiency by Using Scleral Contact Lenses for Optical Correction and as a Treatment of Dry Eye Syndrome
Objective: to describe the clinical and functional results of using scleral contact lenses (SCL) in patients with limbal stem cell deficiency (LSCD) to correct refractive errors, also as a therapeutic system to manage chronic dry eye syndrome. Materials and methods. The study included 22 patients, 25 eyes with diagnosed LSCD with various etiology and laterality, who had undergone SCL fittings for daily use. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer test 1 and lens parameters: diameter (D), base curvature radii (BC), average ratio of lens thickness to apical clearance (AK), duration of lens wear before and after fitting SCL were analyzed. Subjectively, the severity of complaints to redness, lacrimation, photophobia, and dryness in the eyes was assessed on a 5-point scale in all patients before and after fitting. Results. BCVA before fitting SCL was 0.10 (0.05; 0.50), in the SCL 0.60 (0.20; 0.70), the average sphere is 0 dpt, and the cylind is -0.5 dpt, the significance of the difference between pre- and post-SCL wear was assessed by the paired t test (p < 0.05) which is considered statistically significant. The average D was 15.2 mm, BC 8.35 mm, the average ratio of lens thickness to AK after “shrinkage” was 1:1. The average time of wearing lenses during the day was 7 hours. There was a statistically significant decrease in the intensity of complaints to lacrimation, photophobia, dry eyes, and redness before SCL fitting and after 1 month of active wear (p < 0.05). The severity of dry eye syndrome was assessed using the Schirmer-1 test, according to which the average tear production before SCL fitting and 3 months after increased from 4.0 (2.0; 5.0) mm to 7.0 (5.0; 8.0) mm, respectively. Conclusion. The use of SCL, considering the anatomical eye’s features and ocular surface in patients with stable LSCD or with LSCD after surgical treatment provides a double effect — increased visual acuity and constant moistening of the ocular surface.
Changes in Volumetric Intraocular Blood Flow Parameters in Rhegmatogenous Retinal Detachment
Rhegmatogenous retinal detachment (RRD) is one of the most severe diseases of the visual organ. There is an opinion about the key importance of changes in intraocular hemodynamics on morphofunctional changes in the macular zone in RRD. Objective: to evaluate changes in the volumetric intraocular blood flow in rhegmatogenous retinal detachment. Materials and methods. The study included 11 patients (22 eyes) with a diagnosis of primary RRD macula-off up to 30 days old. The main group consisted of eyes with RRD, the control group included paired eyes of the same patients. Results. In the correlation analysis of the duration of retinal detachment with other studied features, a very high negative correlation was observed with the PA parameter (p = 0.002), a high negative correlation with OFB (p = 0.04) and PV (p = 0.01). No reliable correlation was found with the IOP and PR variables. Conclusion. As a result of this study, disturbances in the OBF system in patients with primary RRD were established, however, further studies are required to identify and exclude factors contributing to the aggravation of pathological microvascular disturbances in RRD.
The Effectiveness of Restorative Treatment of Children after Surgical Treatment of Concomitant Convergent Alternating Strabismus using Low-frequency Magnetic Therapy and Photostimulation
The aim of the study was to develop and evaluate the efficacy of combined use of transcranial and orbital low-frequency magnetic therapy and photostimulation in children after surgical treatment for convergent alternating partial accommodative strabismus. Methods. A randomized prospective, controlled, parallel-group trail was conducted in 66 children (132 eyes), male and female, aged 5 to 11 years, in the early postoperative period following strabismus surgery. The control group received basic treatment: orthoptic and training exercises. The comparison group received complex low-frequency magnetic therapy and retinal photostimulation alongside basic treatment. The main group received combined transcranial and orbital low-frequency magnetic therapy and retinal photostimulation alongside basic treatment. Magnetic therapy and photostimulation procedures were performed using the “AMO-ATOS” device. The treatment duration in all groups was 10 sessions performed daily. Research methods included collecting complaints, medical history, autorefractometry, visometry, determining absolute and relative accommodation, strabismus angle, vision characteristics and studying hemodynamic parameters in the ocular vessels. Statistical processing was performed using “STATISTICA 12.0” software. Results. The combined use of transcranial and orbital low-frequency magnetic therapy and photostimulation in the early postoperative period in children who have undergone surgery for convergent alternating partial accommodative strabismus allows for a significant increase in visual acuity, a reliably significant increase in absolute and relative accommodation, hemodynamic indicators in the posterior long ciliary arteries, an increase in the number of patients with binocular stable vision to 54.5 %, surpassing in effectiveness the complex use of orbital magnetic therapy and photostimulation and basic treatment, as well as improving the obtained indices in the long term.
Digital Accommodative Asthenopia. Message 2: Accommodative Response Indicators in Adolescents with Different Screen Times
Purpose: to study the accommodative response indicators in adolescents with different screen time durations. Patients and methods. A clinical and experimental study involving 86 participants (16 males, 70 females; mean age 16.6 ± 0.17 years) consisted of two blocks of research. The psychometric block included the determination of internet-addiction (IA) and the nature and duration of digital information technology (DIT) use. The ophthalmology assessment included the determination of the accommodative response coefficient (ARC) and the accommodation lag (AL) using a Speedy-K autorefractometer (Right MFG, Japan); the data were analyzed using nonparametric statistical methods. This experimental approach allowed us to identify the relationship between the nature of DIT use, screen time (ST), and accommodation, as well as to gain insight into the neuro-ophthalmological mechanisms underlying digital accommodative asthenopia. Results. In the overall group of adolescents, the average level of IA was 50.0 (43.0; 60.0) points; signs of IA were not detected in 22.1 % (n = 19), 61.6 % (n = 53) showed IA in the formation stage; Internet addiction was identified in 16.3 % (n = 14), but we did not find any statistically significant patterns between IA and accommodative response indicators. Subjects had been using computers for 9.5 (8.0; 11.0) years, smartphones for 7.0 (5.0; 9.0) years, and the Internet for 8.0 (7.0; 10.0) years. Based on screen time duration (hours per day), subjects were divided into 4 groups: short (≤1 hour, n = 11), medium (1–3 hours, n = 26), long (4–6 hours, n = 20), and excessive (>6 hours, n = 17). Analysis of the obtained results revealed significant differences between the groups with different screen time durations for stimuli ranging from –1.5 to –3.0 D (p < 0.001 for most stimuli). A clear dose-dependent effect of screen time on the studied accommodative response parameters was demonstrated: with increasing screen time, the lag increases, and, accordingly, the accommodation coefficient decreases. The data are discussed from the perspective of modern neuro-ophthalmological approaches to the development of digital accommodative asthenopia (DAA), and taking into account the neurophysiological mechanisms of accommodation regulation.
Clinical case report: Behcet’s Uveitis: Diagnostic Challenges and Modern Treatment Approach
The article analyzes the clinical observation of a 22-year-old patient with severe recurrent bilateral uveitis complicated by neuroretinitis, probably caused by Behcet’s disease. The presented data demonstrate significant diagnostic difficulties associated with the lack of pathognomonic laboratory markers of Behcet’s disease and the need for a comprehensive assessment of clinical and anamnestic data. The key role was played by the identification of the Human Leukocyte antigen (HLA) B51 allele, a genetic marker of predisposition to Behcet’s disease, in a patient from the Astrakhan region. Taking into account the resistance to glucocorticoids and the high risk of irreversible vision loss, a genetically engineered biological therapy with tumor necrosis factor (TNF)-alpha inhibitor adalimumab was initiated. As a result of the treatment, positive dynamics was achieved with complete restoration of visual acuity, regression of macular edema and signs of neuroretinitis according to optical coherence tomography. The observation highlights the importance of including Behcet’s disease in the differential diagnosis of recurrent uveitis in young patients, the importance of genetic testing for HLA-B51, and the expediency of early prescribing modern targeted drugs, primarily TNF-α inhibitors, to preserve visual functions. The key factor for successful treatment in this case was the coordinated interaction of ophthalmological and rheumatological specialists.
Surgical Treatment of the Ophthalmological Complications in Lyell’s Syndrome. A Clinical Case
Lyell’s syndrome is a severe toxic allergic reaction that occurs in 0.3 % of cases of drug allergies. Currently, Lyell’s syndrome is considered as a proteolytic reaction with damage to the skin and mucous membranes. A clinical case of treating a patient with ophthalmic complications of Lyell’s syndrome was described. During the illness and treatment of pneumonia, a corneal ulcer appeared with perforation in both eyes, which was not stopped by medical treatment. The patient underwent keratoplasty with a biological coating of the cornea according to Kunt and bloody blepharorrhaphy, which made it possible to stop the inflammatory process. The long-term effects of damage to the eyes that have undergone toxic epidermal necrolysis syndrome lead to severe cicatricial-dystrophic changes in the eyelids, conjunctiva and cornea, decreased vision, despite the fact that the intraocular media remained transparent and the retina was intact. The problem of rehabilitation of patients who have undergone toxic epidermal necrolysis is relevant. This article describes the treatment of the consequences of ocular damage in Lyell’s syndrome (elimination of symblepharon, eyelid inversion and trichiasis).
Cataract as an Occupational Pathology of the Organ of Vision. Clinical Cases
Currently, occupational pathology is a serious medical and social problem. One of the nosological forms of occupational pathology is cataract — an eye disease characterized by a gradual loss of transparency of the lens. The purpose of the study was to describe clinical cases of cataracts as an occupational disease among workers of foundries in the Voronezh region, to carry out hygienic characteristics and analysis of their working conditions, to develop proposals for minimizing the degree of exposure to harmful production factors on the organ of vision. The material of the study were state reports on the sanitary and epidemiological well-being of the population, statistical forms on the registration of occupational diseases, materials on sanitary and hygienic characteristics of workplaces. Occupational risk assessment and working conditions criteria were determined according to hygienic classification in accordance with R 2.2.2006-05. Results. Cases of cataracts diagnosed as a result of exposure to thermal radiation are described in 2 men aged 77 and 46 years. A standard clinical examination was performed. The work of foundries is exposed to a complex of unfavorable production factors, the leading of which is physical: increased air temperature, increased parameters of infrared (thermal radiation). The foundry worker’s working conditions are classified as hazardous class 3.3 according to the hygienic classification. The imperfection of the technological process, low mechanization and automation of the labor process, as well as non-compliance by workers with safety measures are the main reasons for the occurrence of occupational cataracts. In order to prevent occupational diseases of the organ of vision, it is necessary to improve the organization of work, personal protective equipment, as well as conduct sanitary and educational work with employees of enterprises on issues of maintaining health.
Subclinical Progressive Course of Orbital Cholesteatoma. Clinical Case
A clinical case of subclinical orbital cholesteatoma is presented, where disease progression was diagnosed using dynamic magnetic resonance imaging (MRI) over 14 years. Considering the localization of the lesion, a transcutaneous subperiosteal exploratory orbitotomy was performed, involving the complete removal of tumor masses followed by histopathological and immunohistochemical examination of the surgical material. The importance of assessing the tumor’s histopathological characteristics lies in the need for differential diagnosis between cholesteatoma and cholesterol granuloma of the orbit, which significantly impacts prognosis and followup strategies. Given the risk of recurrence, the patient in this case was informed about the necessity of regular check-ups and orbital computed tomography (CT) for monitoring.
Congenital Dystrophy of the Epithelial Basement Membrane in a Child. Clinical Case
Corneal dystrophy (CD) is a large group of genetically determined diseases involving one or more corneal layers. It has a progressive course and is not associated with external or systemic factors. However, this definition cannot fully describe all pathologies related to the dystrophic process. For example, epithelial basement membrane dystrophy and François central cloudy dystrophy are degenerative conditions and are not hereditary in most patients. Despite this, epithelial basement membrane dystrophy and François central cloudy dystrophy are included in the modern classification of corneal dystrophies. We present a clinical case of a child with congenital hereditary basement membrane dystrophy (previously known as Kogan microcystic epithelial dystrophy, anterior basement membrane dystrophy, or “fingerprint” dystrophy). The child presented with photophobia and lacrimation from birth. At 5 months of age, the child underwent lacrimal duct probing due to lacrimal duct obstruction, with slight improvement noted. During an anesthetic examination, the biomicroscopic findings were characterized by map-like lines and round intraepithelial microcysts in the optical zone of the right eye and dots in the left eye. In the right eye, the changes were more pronounced, with a delicate cicatricial opacity of the superficial stromal layers resembling a “map” with paralimbal areas of fluorescein staining. Congenital basement membrane dystrophy (CBD) is a condition caused by mutations in the TGFB1 gene on chromosome 5q31 and is one of the most common anterior corneal dystrophies. It occurs in 5 % of the population, typically in the second and third decades of life, and is very rare in children. CBD in children is a slowly progressive, non-inflammatory corneal lesion. It must be differentiated from acute inflammation requiring urgent surgery, lacrimal obstruction, and keratitis. Conservative treatment, including the continued use of keratoprotectors and artificial tears, is sufficient in the initial stage. If conservative therapy is ineffective, therapeutic soft contact lenses, PTK, and lamellar keratoplasty are recommended.
Restorative Treatment of Functional Accommodation Disorders in Patients with Visually Stressful Work and Mild Traumatic Brain Injury. Case Studies
This article presents an analysis of two clinical cases illustrating variations in the accommodative system of the eye in patients with mild traumatic brain injury (MTBI) and visually demanding work. It has been established that MTBI is accompanied by disturbances in the accommodative system of the eye, manifested by characteristic signs of accommodative asthenopia (asthenic form or habitual excessive accommodative strain), diagnosed using objective accommodation imaging based on the ciliary muscle microfluctuation coefficient and “quality of life” using the «KZS-22» questionnaire. Based on the medical and social model of health, it seems appropriate for this patient population to undergo restorative treatment based on the selection of physical factors affecting the visual organ, as well as the amplitude and temporal parameters of the stimulation itself. The practical application of functional correction of asthenopia leads (compared to the traditional approach) to a significantly faster restoration of accommodation, which generally ensures the achievement of the required level of visual performance and prolongation of professional longevity.
Scleral Fixation of a Toric Intraocular Lens. Clinical Case
Purpose: to present a clinical case of suturing a toric intraocular lens (tIOL) in a patient with lens luxation into the vitreous body and corneal astigmatism. Patient K., 78, presented with complaints of deteriorating vision. His objective status at presentation was as follows: visual acuity OS 0.02 with correction sph +11.0 cyl –1.25 ax 26° = 0.4. Keratometry OS: strong meridian 45.60 D ax 129, weak meridian 44.43 D ax 39. Biomicroscopic examination of the left eye revealed a clear cornea, deep anterior chamber, clear aqueous humor, subatrophic iris, and lens luxation into the vitreous cavity. The patient was referred for surgical treatment. Scleral fixation of the TIOL was performed, which provided correction of aphakia and compensation for corneal astigmatism. The presented method of scleral fixation of TIOLs allows achieving high visual acuity in patients with luxation of the lens combined with corneal astigmatism.
The Validity of Antibacterial Therapy in Chronic Keratitis and Herpes Virus Corneal Ulcers
Purpose: by microbiological study, to analyze the frequency of secondary bacterial infection in patients with primary and recurrent herpetic keratitis, taking into account antibiotic sensitivity. Material and methods. A retrospective study of bacteriological analysis with antibiotic sensitivity testing was conducted at the S. Fyodorov Eye Microsurgery Federal State Institution. The study included 129 patients (129 eyes) with acute herpetic keratitis and 129 patients (129 eyes) with chronic herpetic keratitis. The sensitivity to gentamicin, levofloxacin, moxifloxacin, ciprofloxacin, chloramphenicol, and erythromycin was determined. Results. Of the 129 patients with acute primary herpetic keratitis, 61.25 % had a secondary bacterial infection, with St. epidermidis being the most common (48.06 %). The highest resistance was observed for erythromycin (44.3 %), while the lowest resistance was observed for moxifloxacin (12.65 %). In patients with chronic recurrent infection, bacterial growth was detected in 56.58 % of cases (also with a predominance of St. epidermidis), and the resistance to all antibiotics was higher, particularly to erythromycin (50.68 %) and levofloxacin (39.72 %). Conclusion. Prescription of initial antibacterial therapy in acute herpetic keratitis is due to the high risk of secondary infection. In case of recurrent course of the disease, given the variety of potential pathogens, it is advisable to perform a preliminary microbiological study to select an antibiotic based on sensitivity. The addition of bacterial flora significantly complicates the course of the herpetic process and worsens the prognosis for patient recovery.
Clinical and Functional Significance of Ophthalmic Nutraceuticals in Elderly Patients at Different Stages of Age-related Macular Degeneration
Purpose. To evaluate the clinical and functional significance of the use of ophthalmic drugs in elderly patients at different stages of AMD development. Patients and methods. The study included 23 patients (46 eyes; 65.8 ± 6.3 years; 5 men, 18 women) with “dry” (AREDS-2 and AREDS-3 categories) and “wet” (AREDS-4 category) forms of AMD, who took the vitamin and mineral complex with antioxidant and neuroprotective properties “Oftolik®” for a month (2 capsules daily with meals) in combination with a dietary supplement from sea urchin caviar “The power of the sea: longevity” (1 capsule 3 times a day with meals). Standard ophthalmological examination was performed; optical coherence tomography (OCT; OPTOPOL), computer perimetry (Octopus 600 Haag-Streit) took into account the presence of possible systemic side effects of exposure and the comfort of taking ophthalmic drugs. Effectiveness criteria: stabilization of AMD manifestations (based on OCT data), stabilization of corrected visual acuity (COC). Statistical analysis: arithmetic mean (M), standard deviation (σ), Me — median, lower (LQ) and upper (UQ) quartiles, Student’s t-test, W-Wilcoxon criterion, MannWhitney criterion. Results. The use of the vitamin and mineral complex “Oftolik®” by AMD patients in combination with the dietary supplement from sea urchin caviar “Sea Power: longevity” helps to stabilize visual functions — visual acuity, ophthalmotonus, improve the functional state of the retina (reduce visual field defects, improve photosensitivity) and is accompanied by an increase in the total activity of antioxidant systems of blood plasma, normalization increased levels of lipid and carbohydrate metabolism. The level of proinflammatory cytokines in the blood serum of patients with the “dry” form of AMD is not a significant diagnostic feature. VEGF concentration can be used in clinical laboratory diagnostics as an additional diagnostic marker of the severity and prognosis of the disease course. Conclusion. The use of the vitamin and mineral complex “Oftolik®” in combination with the dietary supplement from sea urchin caviar “Sea Power: longevity” helps to stabilize visual functions and improve the functional state of the retina of patients with AMD.
Results of an in vitro Experimental Study of a New Eye Corneal Prosthesis Model for Penetrating Single-stage Keratoprosthetics
Objective: To study the cellular and tissue response to the integration and fixation of a new keratoprosthesis design for penetrating keratoprosthetics using the method of organotypic cultivation of human cadaveric cornea in comparison with one-stage implantation of the Fedorov-Zuev keratoprosthesis. Material and methods. Together with the engineers of the company “Reper-NN” and researchers of the S. Fyodorov Eye Microsurgery Federal State Institution, a new model of keratoprosthesis for one-stage keratoprosthesis has been developed. It consists of two main parts: an outer plate with an optical cylinder and an inner plate with a central threaded sleeve for subsequent tightening of the optical cylinder. In this study, a series of experimental and morphological studies were conducted, including in vitro experiment, immunohistochemical and histological studies, and electron microscopy, in which two experimental groups were compared: Group 1 (n = 5) — corneas with an implanted new penetrating keratoprosthesis; and Group 2 (n = 5) — corneas with an implanted Fedorov-Zuev keratoprosthesis together with an optical cylinder. Results. During a series of experimental studies, the biointactness of the new keratoprosthesis model was confirmed, the biocompatibility of the material and the admissibility of using this model for single-stage keratoprosthetics in clinical practice were proven, in contrast to the Fedorov-Zuev keratoprosthesis, which is intended primarily for staged implantation. Conclusion. Finding an optimal keratoprosthesis model for patients with degenerative leukomas, with the aim of conserving donor material and accelerating visual rehabilitation, is an important and relevant area of research. The developed model of penetrating keratoprosthesis for single-stage keratoprosthetics demonstrated its effectiveness, biocompatibility and safety of the design during the experimental study, which is a safer and more predictable in terms of postoperative stability and the likelihood of complications, compared to the existing Fedorov-Zuev model.
Normal Corneal Microstructure in Chinchilla Rabbits According to Confocal Microscopy
Purpose: to evaluate the normal microstructure of the cornea in Chinchilla rabbits using confocal microscopy data. Material and methods. Confocal microscopy of the cornea was performed on 10 male Chinchilla rabbits. The weight of rabbits is from 3500 to 4200 grams. One (right) eye of the animal was included in the study. Confocal microscopy of the cornea was performed on a laser scanning microscope HRT-3 (Heidelberg Engineering, Germany) using a special corneal module Rostock Cornea Module (RCM). The scanning area is 400×400 µm, with transverse and axial resolutions of 1–2 and 4 µm, respectively, the scanning speed is 30 frames per second, and the size of the resulting images is 384×384 pixels. Results. During confocal microscopy of the cornea, it was possible to obtain images with differentiation of its substructures in all animals. The corneal thickness of rabbits varied within the range of 340–359 µm. The obtained data from confocal microscopy have showed that the structure of the cornea of the Chinchilla rabbit does not differ significantly from the normal structure of the human cornea. Conclusion. The use of Chinchilla rabbits is advisable in experimental models associated with the imitation of diseases of the epithelium, stroma and endothelium of the cornea. When modeling diseases and studying the pathogenetic mechanisms of their development in animals, it is necessary to remember that the same diseases in the body of laboratory animals and humans can develop according to different scenarios due to differences in cellular metabolism.
The First Experience of Hereditary Epithelial-stromal Corneal Dystrophies Combined Treatment
Purpose: to evaluate the results of combined treatment of hereditary epithelial-stromal corneal dystrophies. Patients and methods. The study included 5 patients with hereditary epithelial-stromal corneal dystrophies (HESCD), 8 of whom underwent phototherapeutic keratectomy (PTK) and laser-induced corneal crosslinking. All patients were women aged 27 to 63 years. Two of the patients were directly related (mother and daughter), while the remaining three patients had a family history of similar corneal pathology. Two patients had lattice dystrophy, two more patients had Reis-Bucklers dystrophy, and one patient had granular type II HESCD. The inclusion criterion for the study group was corrected visual acuity of no more than 0.3. In all cases, PTK was initially performed using a MEL 90 excimer laser (ZEISS, Germany) with an ablation diameter of 7.5–8.0 mm. Ablation of the epithelium and altered stroma was performed in two stages. The depth of the first stage of PTK was calculated based on the total depth of pathological changes minus 100 µm, but not less than the maximum epithelial thickness. The cornea was then saturated with riboflavin by instilling “Dextralink” for 30 minutes. At the final stage of treatment, the second stage of PTK was performed to ablate the stroma to a depth of 100 µm and induce photopolymerization of corneal collagen. When calculating the total ablation depth, the minimum thickness of the residual stroma was at least 450 µm. Results. The total ablation depth ranged from 170 to 215 µm. One month after surgery, uncorrected and best-corrected visual acuity improved in all eyes. These values increased further six months after treatment and remained virtually unchanged at the final follow-up (one year). Conclusion. The results of the combined treatment for HESCD demonstrated its safety and high efficacy, as all treated eyes demonstrated improved visual acuity due to improved corneal transparency and the absence of significant induced ametropia. Corneal condition remained stable for one year after surgery in all eyes, and for three years in four eyes of two patients.
Development and Testing of a Mentoring Model for Resident Physicians in the Clinical Practice of the Institute
Mentoring is often viewed in terms of its benefits for mentees. However, we must understand the benefits and challenges from the perspective of mentors. Higher education institutions and research organizations recognize the importance of peer mentoring in preparing residents for the transition from academia to clinical practice. However, there is limited research examining mentees’ perceptions of mentors. The purpose of this study was to identify the characteristics of perception, interaction, and professional development among participants in mentoring relationships in the healthcare system. Methods. A qualitative descriptive study was conducted at the M.M. Krasnov Research Institute of Eye Diseases. Fourteen residents participating in the peer mentoring program were recruited for the study. Data collection was conducted from December 2024 to January 2026. Face-to-face group discussions were conducted using a semi-structured interview guide; written feedback was collected; and a thematic analysis was conducted. The study received ethical approval. Results. Physician mentors experienced personal and professional growth alongside their mentees through mentoring interactions and self-reflection. Conclusions. This study provides insights into the experiences and perceptions of mentoring among physician residents, consistent with existing research. Overcoming the challenges faced by mentors requires faculty support, such as resource provision and mentor-mentee matching. In physician resident training programs, peer mentoring is critical for effective learning and professional development. Academic institutions and research organizations should implement formal mentor-mentee matching to foster constructive professional connections. Studying how mentors integrate their mentoring after completing their training can shed light on its positive impact on patient care in their clinical practice. Future research should focus on different groups of young specialists and utilize longitudinal studies to gain insight into the evolution of mentoring and its long-term impact. Thus, the experience gained through mentoring is an important milestone. Mentoring programs can significantly improve residents both personally and professionally, ensuring they become better specialists in ophthalmology and healthcare in general.
On the Anniversary of the Award to the Pavel Ivanovich Chistyakov Perm Medical University Eye Diseases Clinic
The article is devoted to a significant event in the history of Russian ophthalmology, namely the 65th anniversary of the awarding of the Eye diseases clinic of Perm State Medical University named after an outstanding figure, doctor and scientist Pavel Ivanovich Chistyakov. The paper examines the main stages of his professional activity and his contribution to the development of the Perm School of ophthalmology.
Retraction of the article “Features local interlacing status of elderly patients with primary angle-closure glaucoma”