Peer-rewieved medical journal for ophthalmology
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Occlusion of the Central Retinal Artery by Fillers Used in Cosmetology Practice: Mechanism of Development, Diagnosis, Treatment and Prevention
Currently, aesthetic medicine has become widespread in everyday clinical practice. With the increase in the number of cosmetic procedures, the number of complications associated with them has increased significantly, which often go beyond the scope of aesthetic medicine. One of the common forms of cosmetology is injection therapy, which involves the use of various derma fillers, botulinum toxin, and vitamin therapy complexes. This article describes the mechanism of development of one of the most severe complications of injection cosmetology — central retinal artery occlusion, an algorithm for providing emergency care to a patient in the event of this complication and methods for its prevention. Conclusion. Central retinal artery occlusion is an extremely rare but formidable complication that can occur during cosmetic injections with fillers, almost always leading to irreversible vision loss and blindness. To improve the prognosis, immediate recognition of signs of filler embolism and immediate initiation of intensive therapy within the “therapeutic window” (~60 minutes) are crucial. Adherence to safe injection techniques (taking into account anatomy, aspiration test, small doses and low pressure on the syringe plunger), the use of hyaluronic acid-based fillers in the periorbital area and the doctor’s readiness to provide emergency care in a timely manner can minimize the risk of such a complication.
The Relationship Between Cyclotorsion and Binocular Functions After Vision Correction with LASIK and SMILE: A Literature Review
Refractive surgeries have transformed vision correction, yet their effects on ocular dynamics — particularly cyclotorsion and binocular functions — require thorough examination. This review analyzes current evidence from PubMed, Google Scholar, and ResearchGate regarding the interaction between these factors following LASIK and SMILE procedures. Compensation of cyclotorsion is critical for optimal visual outcomes after LASIK and SMILE refractive surgeries. Promising solutions may include developments that include elliptical flap designs in LASIK (e.g. EAGLE Vision), improved cyclotorsion registration algorithms, and integration of artificial intelligence for real-time cyclotorsion compensation. While advanced LASIK tracking systems offer superior control of torsional movements, the valveless SMILE approach provides better preservation of corneal biomechanics and reduction of dry eye syndrome manifestations — key factors in the restoration of binocular functions.
Selection of the Antiglaucoma Component of Combined Surgery for Cataract and Primary Open-Angle Glaucoma
Due to the increase in life expectancy and the growth of the contingent of elderly and senile patients, the relevance of combined surgical treatment of diseases characteristic of this age group increases: cataracts and primary open-angle glaucoma. Considering that ultrasound phacoemulsification has become the standard of phaco surgery, when planning a combined surgery, the main task of the surgeon is an adequate choice of the antiglaucoma component of the operation in a patient with cataract and primary open-angle glaucoma. According to the literature the best results are achieved by pathogenetically oriented methods of the antiglaucoma component of the combined operation. In this case an important stage of the surgery is the intraoperative determination of the level of retention of the outflow of intraocular fluid based on the study of the phenomenon of retrograde filling of the Schlemm’s canal with blood during the combined operation, which allows for quick and accurate determination of the retention level and identification of the pathogenetically oriented antiglaucoma component of the operation.
The Impact of e-Sports on Visual Function: A Systematic Review
e-Sports, recognized by the International Olympic Committee in 2017, is a rapidly growing discipline that requires high levels of visual endurance. However, despite the growing popularity of e-sports, scientific researches on its impact on the visual system remains limited. The aim of this systematic review was to analyze the existing data on the impact of e-sports on visual functions, identify key risk factors, and determine the gaps in current knowledge. The study methodology followed the PRISMA principles. The search for publications was performed in Elibrary, PubMed/MED-LINE, Elsevier, and Springer Link databases using key terms related to esports and health. Of the 1069 articles initially identified, after excluding duplicates and manually screening according to the inclusion and exclusion criteria, 19 relevant studies published between 2005 and 2022 were included in the analysis. The studies were conducted by authors from 8 countries with a total sample size of 3191 people (2805 e-sports athletes and 386 people of the control group). The analysis showed that the most studied aspects of the visual system of e-sports athletes are oculomotor activity and visual-motor reactions, while basic parameters (visual acuity, contrast sensitivity, accommodation) remain virtually unexplored. Risks of visual fatigue, decreased blink rate, and dry eye syndrome have been identified, but the long-term effects of video game addiction and prevention methods remain unstudied. Some positive effects of gaming on the speed and accuracy of complex visual-motor reactions and reactions to a moving object, the speed of detecting objects in simple and complex visual search tasks have been noted. The analysis revealed significant gaps in research, including the lack of long-term observations, standardized protocols for assessing visual system strain, and a comparative analysis of e-sports athletes with other groups exposed to screen loads. The results highlight the need to develop standards for ophthalmological support of e-sports athletes and conduct further research aimed at the early diagnosis and prevention of visual impairment.
Algorithm for Intraoperative Prevention of Dry Eye Syndrome in Cataract Phacoemulsification
Purpose: to create a simple and effective complex method of prevention of dry eye syndrome (DYE) during cataract phacoemulsification. Patients and methods. The study was aimed at developing a complex intraoperative algorithm for the prevention of DES after cataract phacoemulsification in the postoperative period. For developing the algorithm, data from Russian and international sources of reviewed scientific literature, as well as clinical guidelines for cataracts were evaluated. The developed algorithm was applied for 291 patients (291 eyes) aged 45 to 75 years. The effectiveness of this intraoperative method of preventing Dry eye syndrome (DES) was evaluated during the early postoperative period, which lasted for 2 weeks. Patients were evaluated for the condition of their tear-producing system using the MediWorks Dixion S 350 slit lamp, and their quality of life was assessed with the SPEED scale. It allowed for the determination of the severity of SHS according to the 2024 classification of DYE severity. The developed algorithm is comprehensive, and all the techniques are interconnected and mutually influencing. The combination of all these techniques provides the effective prevention of DES in the postoperative period of cataract phacoemulsification, which improves the condition of patients by eliminating or reducing the manifestations of DES, which can significantly affect not only the patient’s quality of life but also the final visual acuity and, consequently, the patient’s satisfaction with the surgery.
Orbit Foreign Bodies in Modern Orbital Combat Trauma
Modern armed conflicts are accompanied by a large number of shrapnel wounds. The consequence of this was an increase in the incidence of combat trauma, including orbital and with foreign bodies of the orbit. The purpose of the research was to study the features of modern combat trauma with foreign bodies of the orbit. We performed a retrospective statistical analysis of the medical documentation of a large sample of patients treated at the V.V. Volkov Ophthalmology Clinic in the period from 2022 to 2023 for combat trauma with foreign bodies of the orbit. The material is presented as relative (in %) data. The following results were obtained: In combat trauma with foreign bodies of the orbit, in 54.4 % of cases, there is a combination of damage to the orbit (orbit and structures of the orbital organocomplex) with anatomical structures of adjacent areas (neurosurgical, otorhinolaryngological and maxillofacial). At the same time, combined neurosurgical injuries occurred in 54.3 % of cases. The combination of two or more profiles accounted for 35.1 % of the observations. Simultaneous damage to several bone walls of the orbit was recorded in 60.7 % of cases. Among foreign bodies of the orbit, the following prevailed: single — 50.6 %, medium (1–1.5 cm) size — 40.5 % and irregular geometric shape — 83.3 %. When evaluating the ferromagnetic properties of the removed foreign bodies of the orbit, it was found that in 51.2 % of cases they were magnetic. Surgical treatment to remove foreign bodies of the orbit was considered appropriate and performed in 58.1 % of cases. In 87.7 % of them, the goal of the operation was achieved. Сombat trauma with foreign bodies of the orbit is accompanied by open and closed eye injury in 71.2 % and 28.8 % of cases, respectively.
Laser Vitreolysis of Symptomatic Vitreous Floaters. Report 1. Retrospective Analysis
Purpose: To perform a retrospective study and evaluate patient satisfaction rates and the incidence of complications associated with YAG laser vitreolysis for symptomatic Weiss ring floaters, comparing early and delayed intervention timing following posterior vitreous detachment (PVD). Methods. A retrospective analysis of laser vitreolysis (LV) was conducted over the period from August 2016 to December 2024 (400 weeks) using outpatient records of 966 patients (1187 eyes, 1532 treatment sessions). Two study groups were identified based on the time from appearance of Weiss ring symptomatic floaters (SF): Group I (early vitreolysis) — 309 patients (355 eyes), treated within 3 months with complete PVD. Laser vitreolysis was performed using the Ultra Q Reflex laser system (Ellex Medical Lasers, Australia). Results: Retrospective studies of early and delayed vitreolysis showed high patient satisfaction rates (93.8% and 91.6%, respectively) and low incidence of laser vitreolysis complications (0.2% and 0.4%, respectively). Conclusion. YAG laser vitreolysis is a safe and effective method for treating symptomatic vitreous floaters with high patient satisfaction rates. Early vitreolysis of Weiss ring symptomatic floaters with complete PVD is the treatment of choice for laser therapy.
Combined Laser Surgical Treatment of Proliferative Diabetic Retinopathy in Combination with Diabetic Macular Edema
Purpose. To evaluate the clinical, functional and anatomical results of combined laser surgical treatment, including antiangiogenic therapy, panretinal laser coagulation (PRС) and precise YAG laser dissection in patients with proliferative diabetic retinopathy (DR) complicated by the development of epiretinal gliosis and diabetic macular edema (DME). Patients and methods. A total of 18 patients (18 eyes) with PDR in combination with epiretinal gliosis and DME were included in the study, who underwent step-by–step combined laser surgical treatment: 1 — antiangiogenic therapy, 2 — PRC, 2 — YAG-laser dissection of epiretinal gliosis. In the general cohort of patients, the average age was 60.7 ± 4.9 years. Before the treatment, as well as within 1, 3, 6, and 12 months after the intervention, all patients underwent uncorrected and best corrected visual acuity (UCVA and BCVA), computer microperimetry, optical coherence tomography, and digital photoregistration of the fundus on a wide-field fundus camera. YAG laser dissection of epiretinal gliosis was performed using an Ultra-Q Reflex Nd:YAG (Ellex) device. Results. The average value of the UCVA before surgery was 0.23 ± 0.14, and the best BCVA was 0.38 ± 0.13. In all cases, after the combined treatment, after 12 months of follow-up, there was a significant improvement in both UCVA (p < 0.05) and BCVA (p < 0.05). After 12 months of follow-up, the average UCVA value was 0.35 ± 0.11, and the BCVA was 0.47 ± 0.14. Before surgery, all patients underwent the CRT measurements, the average value was 529 ± 97 microns, which indicated the presence of macular edema. After 12 months of follow-up, the CRT significantly decreased (p < 0.05), averaging 344 ± 23 microns. According to the results of computer perimetry, retinal photosensitivity before treatment averaged 17.7 ± 2.7 dB, gradually increasing with treatment. After 12 months of observation, the photosensitivity was 19.6 ± 2.4 dB. During the indicated follow-up period, stabilization of anatomical and functional parameters was achieved. Conclusion. The obtained clinical and functional results indicate sufficient efficacy and safety of the proposed combined phased laser surgical treatment, including intravitreal antiangiogenic therapy, panretinal laser coagulation and YAG laser dissection, in patients with DR in combination with epiretinal gliosis and DME.
Peculiarities of Surgical Technique, Clinical and Functional Results of Keratoprosthesis Implantation in Patients after Ineffective Keratoplasty
Objective: To evaluate clinical and functional results of the surgical treatment in patients after ineffective penetrating keratoplasty. Patients and methods. The study enrolled 33 patients (33 eyes) aged from 26 to 79 years after ineffective penetrating keratoplasty. The first group included 15 patients (15 eyes), who underwent the first stage of keratoprosthesis implantation using manual technique of creating the intrastromal pocket under intraoperative AS-OCT control. The second group included 10 patients (10 eyes), who underwent the first stage of keratoprosthesis implantation with creating the intrastromal pocket using a femtosecond laser. The third group included 8 patients (8 eyes), who underwent penetrating rekeratoplasty. Results. Functional results in the study groups were comparable. There were no significant differences in the number of intra- and postoperative complications between three study groups (p < 0.05). However, in the first and third groups, there were more intraoperative complications than in the second group. The significant difference in the number of postoperative complications was also noted: in the first group — 46.7 %, in the second group — 30.0 % and in the third group — 62.5 %. In the first and second groups, the position of the keratoprosthesis intralamellar plate was stable at different follow-up periods. Also, in these groups, after the second stage of keratoprosthesis implantation, vision improved. Vascular leucoma thickness was stable in both groups at all follow-up periods. Conclusion. The first stage of keratoprosthesis implantation can be performed using manual technique of creating the intrastromal pocket or using a femtosecond laser. The standard surgical treatment of patients with vascular leucoma is penetrating keratoplasty, but the high risk of graft failure after each corneal transplantation should be taken into account, especially in patients with vascular leucoma due to burns.
Comparison of Kane and Barrett Toric Formulas using Different Keratometric Parameters
Purpose. To compare Kane and Barrett toric formulas using different keratometric parameters. Material and methods. The study included 31 patients (31 eyes) who underwent phacoemulsification (PE) with implantation of the Clareon® Toric CNW0T2-T9 TIOL (Alcon, USA). Biometry was performed on IOL-Master 700 (Carl Zeiss, Germany), and keratopography on CASIA OCT SS-1000 device (Tomey, Japan). TIOL was calculated using Kane and Barrett toric calculator (BTC) formulas using various keratometric data. Mean centroid error (MCE) and mean absolute centroid error (MACE), frequency of target cylinder hitting within ±0.25, ±0.50, ±0.75, ±1.00, and over 1.00 D were compared. Results. The lowest MCE (0.19 ± 0.92 D) and MACE (0.82 ± 0.43 D), as well as a higher frequency of target cylinder hitting (90%) were shown by Kane formula when IOL-Master keratometric values were used. BTC was slightly less accurate — MCE (0.27 ± 0.96 D), MACE (0.86 ± 0.48 D), the frequency of target cylinder hitting within ±1.00 D was 84% when anterior corneal surface data by IOL-Master and the posterior corneal values by CASIA topographer were used. Conclusion. Kane formula demonstrates the best refractive results for TIOL calculation using standard IOL-Master keratometry data.
Clinical Efficacy and Safety of Phacovitrectomy in Surgical Treatment of Rhegmatogenous Retinal Detachment
Purpose: to study the clinical efficacy and safety of phacovitrectomy (PhEV) in the surgical treatment of rhegmatogenous retinal detachment (RRD). Materials and methods. We observed 146 patients (146 eyes) aged 34 to 77 years (mean age 56.4 ± 1.9 years). The inclusion criteria for patients in the study were: total RRD, complicated proliferative vitreoretinopathy (PVR) stages “B-C”, the presence of a native lens, no history of previous surgeries for RRD. All patients were divided into two groups equal in age, RRD localization and severity of PVR: the main group (MG, 74 patients, 74 eyes) — eyes that underwent PhEV; the control group (CG, 72 patients, 72 eyes) — who underwent only vitrectomy (VE). Comparative assessment of surgical safety was performed based on the incidence of intraoperative, early (up to 10 days) and late (1–3 months) postoperative complications. Comparative assessment of clinical efficacy of surgical intervention was performed based on the following parameters: anatomical retinal attachment, development of cystoid macular edema, and formation of epiretinal membrane. Results and discussion. The developed PhEV technique provides a higher level of safety and clinical efficacy of surgical treatment in patients with RRD, which is proven (compared to the group of patients who underwent only VE) by a decrease (on average, by 13.7, 4.1, 10.3 %) in the probability of intraoperative, early and late postoperative complications, as well as the incidence of cystoid macular edema and epiretinal membrane (p < 0.01). The main factor in intraoperative complications is a decrease (up to loss) in intraoperative visualization associated with the development of transient lens opacity. An increase in the incidence of cataract development in the CG during dynamic observation was noted from 16.7 % with an observation period of 10 days to 27.8 % with an observation period of 1–3 months. An almost identical and high (94.4–96.0 %) level of probability of anatomical reattachment of the retina was determined in patients of both groups. The higher level of safety and clinical effectiveness of PhEV (compared to VE) established in this work is explained by the significant advantages of the developed technique. Conclusion. The proposed PhEV technique can be recommended for the practice of surgical treatment of patients with RRD in accordance with the established indications.
3D printing Metric Device in Deep Lateral Wall Decompression. Clinical Observations
There are the results of using a metrical device, manufactured using 3D printing, in performing deep lateral bone decompression of the orbit in the article. Clinical cases of the steroid-resistant form of Thyroid Eye Disease (TED) are presented, each of which was accompanied by optic neuropathy, exophthalmos, and decreased visual acuity.The device for intraoperative assessment of the depth of surgical intervention in EOP has proven to be an effective and safe tool, enhancing the efficacy of dLWD by increasing the volume of bone mass removed and reducing the potential risks of damaging the soft tissue structures of the orbit and the dura mater.
Surgical Treatment of Primary Open-angle Glaucoma Using Micropulse Laser Exposure
Purpose. Analysis of the results of micropulse transscleral cyclophotocoagulation in patients with primary open-angle glaucoma. Materiales and methods. The study analyzed medical records of 91 patients with primary open-angle glaucoma (POAG) stages II–IV in 93 eyes. Of these, 42 (46 %) were men and 49 (54 %) were women. The average age of the study participants was 70 ± 15 years. Stage II of the disease occurred in 28 % of cases, stage III — in 59 %, and stage IV — in 13 %. The initial intraocular pressure (IOP) averaged 29.0 ± 4.2 mm Hg. Corrected visual acuity was 0.2 and higher in half of the cases. All patients used two or more antihypertensive drugs, three on average. The follow-up period after micropulse transscleral cyclophotocoagulation (mCPC) was 15 months. Results. No intraoperative complications were recorded. In the early postoperative period, complications were observed in 7.6 % of patients: short-term pain syndrome — 4.3 %, an increase in IOP above the preoperative level — 3.3 % of cases. The target IOP level was achieved in 94.7 % of cases. On average, IOP after surgery was 19.0 ± 3.5 mm Hg (p = 0.04). The number of antihypertensive drugs used decreased by 27 % (to 2.2 on average). Visual acuity remained stable in 100 % of cases, and subsequently increased in 6 patients (6.5 %), after cataract phacoemulsification with intraocular lens implantation. Conclusion. Our experience with mCFC has confirmed the effectiveness of the method in reducing and maintaining IOP at target values, as well as in reducing the number of antihypertensive drugs used. The method has proven its safety and effectiveness with a low number of complications.
First Experience of Using Segmental Optical Biometry for IOL Power Calculation in the Russian Federation
Purpose. To evaluate the results of segmented optical biometry for IOL power calculation in a short-term follow-up period. Patients and methods. 68 patients (90 eyes) after implantation of various IOL models were included in the study. The mean age was 70.43 ± 9.55 years (44–89 years). Women predominated in the sample (n = 49; 72 %). Optical biometry was performed with the Argos device (Alcon, USA) and IOLMaster 700 (Zeiss, Germany). IOL calculation was performed based on Argos data using the formulas: Barrett Universal II, Cooke K6, EVO, Hill-RBF, Hoffer QST, Kane, Pearl DGS. Phacoemulsification with IOL implantation was performed using the standard technique. The observation period was 1 month. Results. One month after the operation there was a significant increase in the distance UCVA (from 0.1 (0.04; 0.20) before the operation to 0.7 (0.188; 1.00)), distance BCVA (from 0.5 (0.3; 0.8) to 1.0 (0.9; 1.0)), and a decrease in IOP from 15 (13; 16.25) to 13 (11; 15) mmHg. The absolute error was significantly lower for the Cooke K6 formula compared with Kane (0.230 (0.130; 0.389) and 0.268 (0.143; 0.405) D, respectively, p = 0.0005) and for the Hill-RBF formula compared with Hoffer QST (0.190 (0.086; 0.399) and 0.248 (0.133; 0.478) D, respectively, p = 0.0007). The share of eyes with refraction within ±0.25 D of the predicted value was significantly higher for the Hill-RBF formula compared with Kane (62.22% and 45.56%, respectively, p = 0.002). The proportion of eyes with refraction within ±0.5, ±1.0, and ±1.5 D of the predicted value did not differ significantly between the formulas. Axial length (AL) measured with Argos, was significantly longer in “short” eyes (AL≤ 22.0 mm) and shorter in “average” and “long” eyes (AL≥ 26.0 mm) compared to IOLMaster 700. Conclusion. This work presents an analysis of the first experience of using segmented optical biometry for calculation of various types of IOLs in the Russian Federation. A favorable clinical and functional effect and a high frequency of achieving target refraction values were noted. The Hill-RBF formula demonstrates some advantage over the Kane and Hoffer QST formulas, and the Cooke K6 formula over Kane.
Comparison of the Effectiveness of Different Formulas for Toric IOLs Optical Power Calculating at Lens Surgery in Patients after Penetrating Keratoplasty
Purpose. To compare the effectiveness of 9 calculating the IOL optical power formulas for toric monofocal IOL and wavefront formation mechanism IOL at cataract surgical treatment in patients after penetrating keratoplasty (PK). Patients and methods. The study included 68 patients (68 eyes) underwent cataract surgery after PK. 32 patients (32 eyes) were implanted with the EDOF IOL AcrySof IQ Vivity DFTx15 (group A), and 36 patients (36 eyes) were implanted with the monofocal IOL AcrySof IQ Toric SN6ATx (group B). The average period after the PK procedure in group A was 49.06 ± 18.48 months, in group B — 53.25 ± 17.19 months. The average age was 45.71 ± 13.65 years, 27 men, 41 women. The optical power of the IOL was calculated using the Holladay 1, Hoffer Q, SRK/T, Haigis, Kane, Barrett Toric Calculator, EVO formulas. The last two formulas were calculated with the predicted (PPC) and measured posterior corneal surface (MPC). Results. The lowest values of the median absolute error (MedAE) were noted for formulas that take into account the measured posterior surface of the cornea — Barrett Toric Calculator (in group A MedAE = 0.778; in group B MedAE = 0.805) and EVO (in group A MedAE = 0.799; in group B MedAE = 0.801). In group A, the highest percentage of hits within ±0.5 D and ±1.0 D were obtained for the Barrett (MPC) formulas (±0.5 D — 34.4%; ±1.0 D — 59.4%), Kane (±0.5 D — 31.3%; ±1.0 D — 56.3%) and EVO (MPC) (±0.5 D — 31.3%; ±1.0 D — 56.3%); in group B, within ±0.5 D for the Barrett (MPC) (16.7%) and EVO (MPC) (16.7%) formulas, within ±1.0 D for the Barrett (MPC) (41.7%), Kane (38.9%) and EVO (MPC) (38.9%) formulas. Conclusion. Using the posterior corneal surface parameters in the IOL optical power calculating allows more accurate target refraction in patients with PK. The Barrett Toric Calculator and EVO formulas with the introduction of posterior corneal surface parameters can be recommended for use in clinical practice of aphakia surgical correction in patients with previously performed PK.
Local Radiation Complications Following Proton Therapy for Uveal Melanoma
Purpose: to study the frequency and clinical symptoms of local radiation complications that occur after proton therapy in patients with uveal melanoma using pencil beam scanning technology. Patients and methods: The retrospective analysis included 35 patients with uveal melanoma who received proton therapy using pencil beam scanning technology in hypofractionation mode at a dose of 49 Gy in 7 fractions. The initial tumor prominence was 9.2 mm (Me 9.7; IQR 2.75), the base diameter was 16.1 mm (Me 16.5; IQR 11.25), and the follow-up period was 3 to 54 months (Me 13.0; IQR 9.5 months). Results. In the study group, sustained local tumor control was achieved in all patients, and complete tumor regression was observed in 3 patients in 22–26 months after the start of treatment. With a median follow-up of 13.0 months, a wide range of various radiation-related complications was observed, with the most common being ophthalmic hypertension (54.3 %), cataract (51.4 %), and neovascular glaucoma (34.3 %). In addition, dermatitis (34.4 %), dry eye syndrome (17.1 %), post-radiation retinopathy (14.3 %), hemophthalmus (8.6 %), and scleromaly (2.9 %) were recorded at various times. Secondary enucleation was performed in 6 (17.1 %) of the treated patients due to the development of secondary neovascular glaucoma or corneal ulcer with a risk of perforation. Conclusion. Proton therapy with a scanning pencil beam in hypofractionation mode in the treatment of UM is characterized by the same effectiveness of the local effect on the tumor and the range and frequency of post-radiation complications as the literature data. Not only the improvement of technology, the development of preventive measures, but also the definition of clear criteria for indications and limitations for the use of this treatment method are required to reduce the risk of developing post-radiation damage.
Results of Retinal Microcirculation Analysis in Patients with Diabetes Mellitus after COVID-19
Objective. Monitoring ophthalmological parameters and retinal microcirculation in patients with diabetes mellitus after COVID-19. Patients and methods. Traditional ophthalmological methods, including optical coherence tomography with angiography. Results: 86 patients (86 eyes) were examined and divided into 4 subgroups depending on the presence or absence of diabetes and COVID-19: subgroup Ia: T2DM (–) + Covid-19 (–) — 22 patients (22 eyes) — control; subgroup Ib: T2DM (+) + COVID-19 (–) — 21 patients (21 eyes); subgroup Ic: T2DM (–) + COVID-19 (+) — 20 patients (20 eyes); subgroup Ig: T2DM (+) + COVID-19 (+) — 23 patients (23 eyes). All patients had COVID-19 at home and were not hospitalized. BCVA in all patients was 0.9–1.0. A statistically significant increase in the foveal avascular zone and its highest values were found in the diabetes and COVID-19 subgroup. Thus, the foveal avascular zone area values in the T2DM + COVID-19 group (0.301 ± 0.004 mm2) were statistically significantly higher than in the COVID-19 group (0.260 ± 0.003 mm2) (p < 0.05), than in the T2DM group (0.244 ± 0.004 mm2) (p < 0.05), than in the control group (0.216 ± 0.005 mm2) (p < 0.05), and a statistically significant increase in C-reactive protein (p < 0.05) and D-dimer (p < 0.05) was also found. Treatment of the identified retinal microcirculation disorders in the diabetes and COVID-19 subgroup was carried out according to the new proposed method using drug therapy with Sulodexide at a dosage of 250 LE 2 times a day for forty days, when the values of the area and perimeter of the foveal avascular zone statistically significantly decrease (p < 0.05), which confirms the effectiveness of the proposed treatment method. Conclusion. It was revealed that in patients with diabetes mellitus after suffering COVID-19, there is a violation of retinal microcirculation, which is proven by the size of the foveal avascular zone, which is statistically higher in comparison with patients with diabetes mellitus (p < 0.05). It has been proven that against the background of treatment with Sulodexide at a dosage of 250 LE 2 times a day for forty days, the values of the area and perimeter of the foveal avascular zone of the retina statistically significantly decrease (p < 0.05).
Experience of Xenoplast Drainage Using in Non-penetrating Surgery of Primary Open-angle Glaucoma
Purpose: to evaluate the hypotensive efficacy and safety of Xenoplast drainage in non-penetrating surgery of primary open-angle glaucoma. Materials and methods. The analysis of the medical records of 157 patients (157 eyes) with primary open-angle glaucoma who underwent hypotensive non-penetrating surgery (non-penetrating deep sclerectomy — NDSE) using Xenoplast drainage (group 1) and without drainage (group 2). The results were evaluated for up to 36 months. Results. The positive effect of the operation, including absolute and relative success, was 96% in group 1 on day 6, then gradually decreased and was 74 % after 36 months. In group 2, the positive effect was 100 % and decreased to 58 % at the appropriate time of follow-up. In both groups, in the early postoperative period, there was a low percentage of eye complications (5.4 % and 4.8 %), typical for non-penetrating antiglaucoma surgeries. The number of descemetogoniopunctures, performed as the second stage of NDSE, was insufficient, both in the 1st group — 42 %, and in the 2nd — 51 %. Conclusion. All of the above points to the advantage of using Xenoplast drainage during non-penetrating deep sclerectomy.
The Clinical Significance of Changes in the Precorneal Tear Film in Keratoconus in the Interpretation of Tomographic Methods of Corneal Examination
Relevance. Modern methods of corneal keratotopography and tomography play a key role in the diagnosis, monitoring, and surgical treatment planning of keratoconus (KC). However, the accuracy of measurements in KC may be affected by instability of the precorneal tear film (PTF) induced by dry eye syndrome (DES). Purpose: to evaluate the clinical significance of PTF changes in KC on the interpretation of corneal tomographic data and to develop an optimized diagnostic protocol for minimizing their impact. Patients and methods. The study included 115 patients (230 eyes) with bilateral non-operated KC. A comprehensive assessment of PTF status was performed (biomicroscopy of the anterior segment using vital dyes, tear film break-up time — Norn’s test, total and basal tear secretion — Schirmer’s and Jones’ tests), followed by Scheimpflug tomography (evaluating key topographic indices, kerato- and pachymetry, as well as elevation, asphericity, and wavefront aberrations) before and after instillation of sodium hyaluronate-based artificial tears. Results. The results revealed significant PTF instability in KC patients, manifested by reduced tear film break-up time and high corneal staining intensity. After temporary PTF stabilization with artificial tears, a significant decrease was observed in anterior corneal surface indices (ISV, IVA, KI, CKI, IS, IHD), keratometry values (K1, K2, Kmean, Kmax), and aberrations (RMS total, LOA, HOA). Strong correlations were found between PTF status and topographic parameters: positive with staining (r = 0.621–0.787) and negative with tear film break-up time (r = –0.334 to -0.787). Conclusion. PTF impairment in KC significantly distorts tomography results, potentially leading to misdiagnosis of disease progression. Instillation of artificial tears prior to examination improves measurement accuracy by minimizing PTF instability-related artifacts. Implementing standardized PTF assessment and correction in the diagnostic algorithm for KC patients enhances data reproducibility and clinical decision-making reliability.
Giant Cell Arteritis in Combination with Posterior Capsular Cataract. Clinical Case
Giant cell arteritis (GCA) is an immune-mediated systemic granulomatous vasculitis that affects medium-sized and large arteries that have an internal elastic lamina. GCA occurs 3 times more often in women than in men because women are much more susceptible to autoimmune diseases, which can be caused by a number of biological factors, including the hormone estrogen. Data on the signs and symptoms of GCA are conflicting. Patients with GCA may complain of one or more of the following symptoms: headache, scalp tenderness, neck pain, malaise, myalgia, anorexia, weight loss, anemia, pain during chewing. Symptoms of polymyalgia rheumatica, temporal artery abnormalities, flu-like symptoms, fever of unknown etiology, and other unspecified systemic symptoms may also be present. Ischemic lesions that may develop in GCA include ischemic stroke, coronary arteritis and myocardial infarction, mesenteric lesions and scalp necrosis. Occult GCA is described, in which patients do not have systemic symptoms of this disease despite a positive temporal artery biopsy, increased ESR and CRP. Occult GCA is a potential cause of blindness. The review also describes the diagnostic criteria and ophthalmologic manifestations of GCA.
A Case of Mucogenic Iris Cyst with Ophthalmohypertension Followed by Iridectomy with Iridoplasty
There is a clinical case of mucogenic iris cyst with ocular hypertension. The patient had noticed an iris spot since childhood. At the age of 33, she was diagnosed with iridocorneal syndrome and iris cyst. At the age of 38, an IOP decompensation was the reason for fistulizing surgery. At 41 years, progression of the iris cyst was noted, which was an indication for iridectomy with iridoplasty. According to the histological examination, the cyst wall is presented by sclerotic iris stroma, as well as dense unformed fibrous tissue fused with Descemet's membrane. In the lumen of the cyst, mucous contents are determined with the formation of mucous globules and an admixture of native and hemolyzed erythrocytes, clusters of macrophages with abundant light vacuolated cytoplasm. The inner surface of the cyst is lined with mature multi-row cylindrical intestinal-type epithelium and numerous goblet cells.
Surgical Treatment of Terrien Marginal Corneal Degeneration: A Case Report
Terrien's marginal degeneration is an infrequent, idiopathic degenerative disease that causes thinning, neovascularization, and lipid infiltration at the corneal periphery. It is usually bilateral but asymmetric. The classic form occurs predominantly in male patients over the age of 40 years and demonstrates extremely slow asymptomatic progression associated with minimal clinical and histological inflammation. However, an inflammatory type of the disease has been described, associated with sings of ocular inflammation (episcleritis, marginal keratitis). We present a clinical case of successful surgical treatment of a rare complication of Terrien's marginal degeneration with the formation of intracorneal cavities with spontaneous formation of a filtering bleb. Lamellar keratoplasty was performed in this case considering progressive cornea thinning and imminent corneal perforation. Surgical intervention allowed to restore the cornea integrity and preserve high visual acuity. The use of systemic and local immunosuppressive therapy was required to suppress inflammation and prevent recurrences.
Corneal Crosslinking in Keratoconus in Children, Evaluation of Efficiency in the Remote Period. Clinical Case with 5-year Follow-up
Keratoconus in children has been diagnosed relatively recently, which is explained by the difficulties of examination (low compliance, concomitant diseases). The peculiarity of keratoconus in children is that it can develop unnoticed, often remaining unrecognized until adolescence, which creates additional difficulties in early diagnosis and treatment. The corneal collagen crosslinking (CXL) method, as a minimally invasive method, is a priority in the treatment of pediatric patients. Despite the confirmed effectiveness in short-term studies, long-term results remain a key aspect for assessing the sustainability of the therapeutic effect. This article presents a clinical case of a patient with keratoconus, observed for 5 years after crosslinking. Objective: To assess the condition of the cornea and ocular surface in a pediatric patient diagnosed with: OU High myopia, myopic astigmatism. OD Keratoconus stages 2-3 operated (corneal crosslinking was performed in 2020), OS Keratoconus stages 1-2. Results: Patient N., 17 years old, was observed with a diagnosis of keratoconus stages 2-3 in the right eye. Crosslinking was performed 5 years ago, currently showing stable remission. A standard and specialized ophthalmological examination was performed. Conclusion: Corneal cross-linking is an effective technique that allows for the stabilization of progressive keratoconus in children (5-year follow-up). The effectiveness of the method has been confirmed using modern high-tech methods, such as corneotopography and the Ocular Response Analyzer (ORA).
Managing of Dry Eye Disease During Pregnancy: Use of Sodium Hyaluronate 0.21 %
Introduction. Pregnant women are objects of special attention of physicians due to two main reasons. The first one is that the fetal life depends on the health and quality of life of a future mother. The second is associated with increased load on all organs and systems of the female body, including the organ of vision. However, manifestations of dry eye syndrome (DES) in this contingent are often not given due attention and often remain untreated, which has a negative impact on the quality of life of women during this difficult period and can lead to diseases of the anterior segment of the eye. The aim of the study was to evaluate the effectiveness of a drug based on sodium hyaluronate 0.21 % in pregnant women with dry eye syndrome due to dysfunction of the meibomian glands. Рatients and methods. The study included 60 patients (120 eyes) with dry eye syndrome with an average age of 31.45 ± 5.98 years and a follow-up period of 3 months. There were 2 groups of patients: the main group (pregnant women with DES) and the control group (non-pregnant women with DES). Patients of both groups were administered a preservative-free form of 0.21 % sodium hyaluronate three times a day for 3 months. All studied patients underwent standard methods of examination, indicators of DES were assessed along with an objective valuation of tear film parameters and meibomian glands condition by digital biomicroscopy on a MediWorks slit lamp (Precision Instruments Co., Ltd., Shanghai) at the time of first visit and at 1 and 3 months of follow-up. Results and discussion. A comparative analysis of therapy effectiveness in the main and control groups showed that OSDI scores (ocular surface disease index), non-invasive tear breakup time (NITBUT) and meibomian gland function improved after treatment in both groups. Early diagnosis and timely correction of DES manifestations in pregnant women by administration of tear replacement therapy with preservative-free sodium hyaluronate 0.21 %, as well as eyelid hygiene can improve the quality of life of this group of patients and prevent associated with DES complications. Conclusion. The selected preservative-free tear replacement therapy with sodium hyaluronate 0.21 % (Optinol® Express moisturizing) provided a combination of ocular surface moisturizing and reducing the risk of inflammatory lesions with facilitating the release of meibomian gland secretion, contributing to the effectiveness and prolongation of therapy.
Medication Treatment for Presbyopia, Practical Experience
Relevance. Presbyopia is a decrease in the amplitude of accommodation, when it can no longer provide comfortable work at the required working distance. In the context of progressive aging of the population, uncorrected presbyopia leads to economic losses due to decreased labor productivity. The pathogenesis of presbyopia is associated with an increase in the thickness and density of the lens, the accumulation of cross-links between crystallin proteins and a decrease in the elasticity of the capsule, which leads to a loss of the ability of the lens to change shape to provide accommodation. Pharmacological treatment of presbyopia can be an alternative for those who want a scenario without glasses and surgery. There are two main pharmacological strategies for correcting presbyopia: increasing the depth of focus (myoptics) and increasing the amplitude of accommodation (drugs that preserve the elasticity of the lens). One of the drugs that can affect the preservation of the elasticity of the lens is pirenoxine. Purpose: to gain experience in using Pirenoxine (Catalin) to prevent the development and progression of presbyopia. Materials and methods: An experimental group of 20 patients (14 women and 6 men) was recruited, to whom Catalin was prescribed according to the scheme: 4–5 times a day. The average age of the subjects was 45.4 years. The amplitude of absolute accommodation was determined; the reserve of relative accommodation was determined and addition was determined in two ways. A repeat study was conducted 8 months after the start of treatment. Results. As a result of the study, the volume and reserve of accommodation did not decrease, as did the amount of addition. The data obtained are comparable with the results of other similar studies. It can be assumed that against the background of the use of pirenoxine, the elastic properties of the lens and accommodative capabilities are preserved in the studied age group. Conclusion. A pharmacological strategy for the treatment and prevention of presbyopia aimed at maintaining the elasticity of the lens by instilling drops of pirenoxine is safe and promising.
Modeling the Economic Burden of Disease during Dry Eye Syndrome Prophylaxis in Patients after Cataract Phacoemulsification
The evaluation the burden of disease is an important aspect of modern medical science, such studies clearly illustrate the need for preventive measures aimed not only at improving the quality of life of patients, but also at the possibility of saving the state budget. It can become a reason for additional investments in the healthcare system from the state. A comprehensive analysis of the preventive treatment’s impact on dry eye syndrome for preparing patients for cataract phacoemulsification in accordance with the developed algorithm, which involves a differentiated approach based on the severity of dry eye syndrome, allowed us to determine the following indicators. In the absence of preventive treatment for dry eye syndrome (DES). Тhe duration of the disease is extended by an average of 35 %. It means that the patient will receive 38.64 % less money than the minimum level for living in Moscow. At the population level, assuming that only 1/3 (33 %) of 14,000 patients with severe dry eye syndrome complications are employed, i.e., 4,620 persons, the loss of wages amounts to up to 46,200,000 rubles from the patient’s perspective. It has been established that from the government’s point of view, financial expenses for temporary disability payments can reach up to 75,679,800 rubles per year. A course of therapy aimed at preventing the development of severe DYS in the postoperative period in patients with cataract phacoemulsification during their preparation for surgical treatment will reduce the total burden of the disease (direct and indirect costs) by 115,416,000 rubles per year. The obtained data indicate the needs of the ophthalmologists’ attention to the importance of timely diagnosis of DYS at the stage of patient rehabilitation for planned ophthalmic surgery, in particular, for cataract phacoemulsification. It’ll reduce the incidence of severe forms of DES, improve the quality of life of patients, and decrease costs for both the patient and the government.
Diagnostic Significance of Questionnaires in Patients with Nasolacrimal Duct Obstruction
Tearing is a common complaint that reduces the quality of life and can lead to social desadaptation of the patient. To objectively assess the patient’s condition and personalize medical care, it is necessary to take into account the physiological, psychological and social factors that determine the effect of tearing on the quality of life. The tool for such an assessment is a questionnaire. Currently, the most widely used questionnaires for determining the effect of tearing on the patient’s quality of life are the Lac-Q and WEQOL questionnaires. Most often, they are used to evaluate the effectiveness of surgical treatment. However, there is no data related to patient questioning for detection of nasolacrimal duct obstruction. Purpose: Determination of the diagnostic significance of questioning patients with nasolacrimal duct obstruction. Material and methods. Two groups of patients (93 people) were interviewed using the Lac-Q and WEQOL questionnaires translated into Russian. The first group consisted of 55 patients with confirmed nasolacrimal duct obstruction. The second group included 38 patients with proper tear drainage. The results of interviewing were analyzed: ROC analysis was carried out to determine the threshold score for predicting nasolacrimal duct obstruction, as well as the sensitivity and specificity of the questionnaires. In addition, we performed correlation and comparative analysis. Differences were considered significant at p ≤ 0.05. Results. Analysis of the obtained results showed that the threshold score for inclusion of the patient in the “nasolacrimal duct obstruction” group for both questionnaires is at least 6 points. The WEQOL questionnaire demonstrated a higher level of correlation between questions and the total score and higher sensitivity and specificity (97.4 % and 98.2 %; AUC = 0.993) compared to the Lac-Q questionnaire (94.7 % and 98.2 %; AUC = 0.921). Conclusion. The Lac-Q and WEQOL questionnaires are admissible to predict the presence of nasolacrimal duct obstruction. Development of a more specific and less excessive questionnaire for prediction of nasolacrimal duct obstruction requires further research.
Clinical and Functional Criteria for the Vital Activity of Patients and Disabled People Suffering from Presbyopia
The purpose: to evaluate the therapeutic effect of Quinax, administered by the method of triple instillations for 6 months to patients with presbyopia in order to determine its effect on the development of refractive errors in this category of patients. Patients and methods. The treatment was carried out in 60 patients with an average age of 43 ± 2 years, suffering from presbyopia. At the same time, the main group consisted of 30 patients who were treated with Quinax when it was administered by the method of triple instillations for 12 months. The comparison group consisted of 30 people who underwent treatment of presbyopia by other conservative methods. Each patient underwent an ophthalmological examination, which included: visometry, perimetry, refractometry, biomicroscopy, ophthalmoscopy, visual performance study, dark adaptation, and complaints were analyzed in order to establish their impact on the quality of life in patients and disabled people with cataracts and presbyopia. Results. The results of the study showed the effectiveness of the use of Quinax when administered by the method of three instillations for 12 months and revealed stabilization of changes in visual acuity and visual field to white, red and green colors, reduction of visual fatigue due to reduction of glare, stabilization of dark adaptation and refraction. Conclusion. From the above research data, it can be seen that treatment with Quinax drops gives positive results both functionally and subjectively. The results obtained during the study provide the basis for the recommendation of the drug “Quinax” to all patients with presbyopia.
Innovative Approaches in Corneal Surface Regeneration: Clinical Evaluation of the Use of Cultured Epithelial Cells of the Oral Mucosa in the Treatment of Limbal Stem Cell Deficiency
Purpose. To evaluate the effectiveness and safety of the transplantation of cultured epithelial cells of the oral mucosa for the treatment of limbal stem cell deficiency. Materials and methods: The study was conducted at the Ismailov Center for High Technology Medicine from February 2023 to October 2024. The study involved 10 patients who underwent CAOMECS transplantation. Efficacy was assessed based on the condition of the epithelium and corneal parameters 180 days after the procedure. Results. 75 % of the participants had a clinical improvement in the condition of the cornea. At the same time, three patients had serious side effects requiring modification of therapeutic approaches. Conclusions. The CAOMECS method has demonstrated encouraging results in the treatment of limbal stem cell deficiency (LSCD), which allows it to be recommended as a promising direction in ophthalmic therapy. The main conclusions of the study emphasize a significant clinical improvement in the condition of the cornea in the majority of patients who underwent therapy using cultured epithelial cells of the oral mucosa.
Investigation of the Stem Cells Potential in the Regeneration of Damaged Eye Structures. Review
The purpose of this study was to analyze the role of stem cells in the treatment of ophthalmic diseases, with an emphasis on corneal regeneration and treatment of retinal degenerative conditions. For this purpose, a comprehensive review of publications from a number of databases, such as MEDLINE, PubMed, and Web of Science, was conducted. Materials and methods. The main focus was on a critical analysis of scientific papers related to the use of stem cells in ophthalmology. Inclusion criteria were formulated that covered various types of scientific publications, including clinical trials and meta-analyses. Results. The analysis showed that stem cells, especially limbal stem cells, have a high regenerative potential in restoring the corneal epithelium. Mesenchymal stem cells also demonstrate the possibility of transformation into epithelial cells, although the mechanism remains unclear. The study showed that LMSC and other types of stem cells increase corneal transparency and improve patients’ eyesight. Conclusions. Despite the encouraging results, questions remain about the ethical and technological aspects of stem cell use, especially in the context of allogeneic transplants. The results of the study highlight the need for further research to improve stem cell transplantation and differentiation methods. This may lead to the development of safer and more effective therapies for patients with ophthalmological pathologies.