Peer-rewieved medical journal for ophthalmology
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On the Possibility of Using Artificial Intelligence in Medicine: From Theory to Practice
Modern life is inextricably linked with the latest technologies. Artificial intelligence (AI) poses a new challenge to humanity, the application of which affects all areas of life, including medicine. This article examines the potential application of AI in medical practice, particularly in ophthalmology. It presents an example of how AI can be used to determine risk factors for dry eye syndrome in patients undergoing cosmetic procedures in the periorbital area. It also analyzes the limitations of AI in medicine. An analysis of the literature demonstrates that the use of AI in scientific and medical practice has opened up a wide range of opportunities for conducting research at a new technological level, such as screening examinations, image-based diagnostics, and disease prediction; selection of optimal drug dosages; mitigating the threat of pandemics; and automation and precision of surgical interventions. When integrating AI technologies into medical practice, it’s important to consider a wide range of ethical issues, including potential breaches of confidentiality, transparency, and the reliability of information received. Frequent use of chatbots can lead to errors and the dequalification of physicians, especially those with limited clinical experience, as well as disruption of doctor-patient communication. Furthermore, it’s important to consider legal and forensic issues, primarily the question of who will bear responsibility for making decisions. Given the above, in our view, a personalized approach to treating each individual patient remains a priority in everyday clinical practice. This approach takes into account not only objective indicators but also anamnestic data, the body’s individual responses to treatment, and psycho-emotional aspects, as well as the physician’s fundamental knowledge and experience.
Barley and Chalazion: A Modern Approach to the Problem. Literature Review
The relevance of studying the development of barley and chalazions is growing, as new high-tech treatments, including various physiotherapeutic procedures, are being developed in addition to standard treatment methods for these conditions. This literature review describes in detail the risk factors for developing these conditions, the mechanism of external and internal styes, primary and secondary chalazions, conservative and invasive treatments for barley and chalazions, and presents studies comparing the effectiveness of these treatments. The literature analysis presented in this review revealed that there are currently no clear indications for various treatment options, including both conservative treatments, which include anti-inflammatory medication and eyelid hygiene, and invasive treatments, which include long-acting corticosteroid injections and surgical chalazion removal. Clear indications for various types of physiotherapy treatments, depending on the time of chalazion development, have not been defined. To improve the effectiveness of barley and chalazions, larger studies are needed. They should include data about the age and gender of subjects, comorbidities, chalazion duration, treatment choice, and a longer post-treatment follow-up period. Further studies with a larger sample size are needed to determine the influence of chalazion size, structure, and duration on the choice of initial treatment.
Аcute Retinal Necrosis: Etiology, Risk Factors and Approaches to Treatment
The article presents an overview of publications devoted to acute retinal necrosis (ARN) — severe herpetic necrotizing retinopathy requiring emergency diagnosis and immediate treatment. The main causative agents of the disease are representatives of herpes viruses (most often herpes simplex virus and varicella-zoster virus). In addition, the article discusses the main risk factors for the development of ARN and its complications: old age, initially low visual acuity, extensive retinal damage, high viral load, immunosuppression. The diagnostic criteria for the disease (defined by the community of uveitis specialists) were identified. Based on the herpetic etiology of acute retinal necrosis, the key points in the treatment of the disease, both drug and surgical, are determined. Within the framework of this literature review, a clinical case of acute retinal necrosis associated with the herpes simplex virus is considered. Risk factors that contributed to the development of the disease and its severe course are determined.
Asymmetric Intrastromal Corneal Ring Segments in the Surgical Treatment of Keratoconus. Review
Keratoconus (KC) is a chronic progressive disease of the cornea characterized by thinning and cone-shaped protrusion, leading to a significant reduction in visual acuity. It is often difficult to correct optically using glasses or soft contact lenses. Surgical methods depend on the stage of KC and the rate of its progression. In the early stages, corneal collagen crosslinking (CXL) with various protocol modifications is most used, along with intralamellar keratoplasty (ILKP) with the implantation of corneal ring segments (ICRS) or rings. At later stages, penetrating (PKP) or deep anterior lamellar keratoplasty (DALK) may be required. However, despite the wide range of treatment options for KC, few methods are personalized and achieve high visual acuity outcomes. The issue of residual ametropia and irregular astigmatism remains unresolved, making the development of new approaches to the surgical treatment of KC a relevant and pressing challenge to this day.
Posterior Lens Capsule Defects in Children with Congenital Cataract. Literature Review
Purpose: to present a review of publications devoted to defects of the posterior lens capsule in children with congenital cataracts, as well as approaches to surgical tactics in their presence. Materials and methods. A search was conducted for publications on posterior lens capsule defects in children with congenital cataracts from 1992 to 2024 using the electronic databases PubMed (https://www.ncbi.nlm.nih.gov/pubmed/), Google Scholar (https://scholar.google.ru/), eLIBRARY.ru (https://www.elibrary.ru/) and domestic journals (Ophthalmosurgery, Bulletin of Ophthalmology, Ophthalmology, Russian Children’s Ophthalmology, Modern Technologies in Ophthalmology). Results. Posterior capsule defects (PCDs ДЗК) of the lens are one of the most common anomalies of the posterior capsule, along with persistent fetal vasculature (PFV ПФСС) and posterior lenticonus (PL ЗЛК). There were a sufficient number of publications on persistent fetal vasculature (275 in the PubMed database as of 10/09/2024) and posterior lenticonus (86 in the PubMed database as of 10/09/2024) in the available literature. A limited number of articles on posterior capsule defects (11 in the PubMed database as of 10/09/2024), and therefore a review of publications devoted to posterior capsule defects in congenital cataract is relevant to expand knowledge about the role of posterior capsule defects in the diagnosis and surgical treatment of this pathology. Conclusion. Thanks to modern technologies, new opportunities are opening up for specialists to visualize, analyze and evaluate the posterior capsule of the lens, the condition of which can affect the effectiveness and safety of pediatric cataract surgery, as well as to plan surgical tactics and intraoperative prevention of complications, which guarantees the quality of surgical intervention in this category of patients.
Angle-closure Glaucoma Due to Ciliary Body Cysts and Ppseudoplateau Iris: A Systematic Review of the Literature and Clinical Case
The article is a review of domestic and foreign literature devoted to the problem of angle-closure glaucoma (ACG) associated with pseudoplateau iris due to multiple iridociliary cysts, in addition, diagnostic and treatment methods were considered. The analysis of 46 sources on current nosology was carried out on the basis of data from domestic and foreign literature. Timely clinical examination and detection of a high index of suspicion in patients with an atypical structure of narrow or closed corners of the anterior chamber, especially in young patients without previous trauma or surgery, to identify ciliary body cysts is necessary. Based on the pathogenetic mechanisms of the disease, it is natural to make the statement, that laser iridectomy in most cases does not lead to the opening of the anterior chamber angle and cannot be recommended as the therapy of choice. According to published sources, there is currently no consensus on the most effective and safe treatment methods, and the therapy of choice for these patients is a wide range of interventions, including medication, laser and surgical treatment, depending on the extent of damage to the ciliary body by cysts and the stage of the disease. According to the literature data, we were unable to find recommendations for the prevention of the development of angle-closure glaucoma on the background of high risk and predictors of this disease. We present a clinical case of genetic bilateral ophthalmohypertension caused by bilateral multiple cysts of iridociliary processes. Changes in ultrasound parameters of biomicroscopy of the anterior segment of the eye and clinical observations after refractive lancetectomy suggest, that timely surgical intervention can improve the quality of life and reduce the risk of glaucoma in this category of patients. Longer observation periods are required for final conclusions.
On the Possibility of Femto-DALK Performing in Open Globe Eye Injury with Corneal Localisation
Purpose: to evaluate the feasibility of femtosecond-assisted deep anterior lamellar keratoplasty (DALK) for corneal open eye injury (OEI), to describe its technical features and to present postoperative outcomes. Patients and methods. Femto-DALK was performed in 6 male patients (6 eyes) aged 27.13 ± 5.17 years with corneal scars, the outcomes of combat-related ocular trauma with corneal localization (zone I). Endothelial cell calculation, keratotopography, optical coherence tomography (OCT) of the eye anterior segment, and electrophysiological studies were performed. The surgeries were provided on the Femto-LDV Z8 (Ziemer, Switzerland) using non-standard laser parameters. In the postoperative period, the data of visometry, biomicroscopy, and OCT of the anterior segment were assessed. The observation period was 12.1 ± 1.1 months. Results. In all cases, the corneal interface was formed. Further exposure of the Descemet membrane (DM) was carried out in two ways: in 3 cases it was possible to form a “Big bubble” (50 %), and in 3 cases this technique did not produce results, and the removal of deep layers of the stroma was carried out manually. During manual stroma dissection, macroperforation of the Descemet membrane (DM) occurred in 16.7 % of cases, which required conversion to penetrating keratoplasty. During the formation of the “Big Bubble”, microperforation also occurred in 1 case (16.7 %), which allowed completing the anterior lamellar deep keratoplasty. Intraoperative detachment of the DM was observed in 1 case (16.7 %). In the postoperative period, corneal graft failure was not detected in any case, by the 12-th month, the thickness of the central cornea was 480 ± 50 µm. Best corrected visual acuity increased to 0.3 ± 0.2 by the first month after the surgery and to 0.4 ± 0.2 by the end of the first year of observation. Conclusions. Femto-DALK in corneal OEI allows achieving good anatomical and functional results. The features of the femto-DALK technique in corneal OEI are high laser radiation power and reduced femto-laser speed. The presence of scars in recipient’s stroma does not exclude the impossibility of implementing the “Big bubble” technique, but in half of the cases it is necessary to switch to manual detachment and removal of residual stroma. Conversion to penetrating keratoplasty is also possible.
Purpose: tо analyze the possibility and effectiveness of laser surgery for glaucoma in children. Materials and methods. An analysis of 679 different types of laser surgeries for glaucoma in children was performed: iridotomy, iridectomy, goniosynechotomy, anterior and posterior synchotomy, destruction of pupillary membranes, anterior hyaloidotomy, continuous-wave and micropulse diode laser transscleral cyclophotocoagulation. Laser surgeries were performed in the Department of Pediatric Eye Pathology of the Helmholtz National Medical Research Center of Eye Diseases. The age of children ranged from 2 months to 17 years (including 1/3 of children under 3 years of age). Results. The main indications for YAG laser reconstructive surgery are: pupillary block, internal fistula block after trabeculectomy, goniosynechia, iridocorneal adhesions, pupillary membranes. The most popular and effective YAG laser interventions for childhood glaucoma are determined: iridectomy, refistulization after trabeculectomy (synechectomy, correction of internal fistula and iris coloboma), destruction of pupillary membranes. Conclusion. Clinical polymorphism of glaucomas in children determines the diversity of types of blockade of the outflow tract of the intraocular fluid, some of which can be eliminated by laser. YAG laser surgery is an effective non-invasive low-traumatic means of correcting complications of hypotensive operations (usually trabeculectomy), cataract removal, uveitis and their consequences. Laser glaucoma operations are a worthy alternative to repeated instrumental glaucoma surgery with opening of the eyeball. Our experience allows us to recommend widespread implementation of these operations into clinical practice.
Algorithm for Calculating the Dioptric Power of an Optical Cylinder for the Optical Stage of Keratoprosthesis Implantation
Objective: to analyze the clinical and functional outcomes of the optical stage of keratoprosthesis implantation and to develop the machine learning model for calculating the optical cylinder power. Patients and methods. The study enrolled 90 patients (90 eyes) with burn injuries and terminal dystrophic corneal opacities who underwent the surgical treatment. The average age of the patients was 59.5 years (40.75; 70.5), of whom 65 were men and 25 were women. The patients underwent keratoprosthesis implantation in two stages. The first stage involved the implantation of the intralamellar plate into the corneal leucoma or corneal-prosthetic complex implantation. The second stage involved the implantation of the optical cylinder, which was selected considering axial length, total corneal leucoma thickness, the thickness of autograft covering and the presence or absence of the native lens/intraocular lens/lens-iris diaphragm. Outcomes. Considering the results for the quality metrics (MAE and R2) and the achieved predictability within ±0.50 D in 30.0 % of cases and ±1.00 D in 50 % of cases on the test sample, it was decided to develop the model based on two features: axial length and total leucoma thickness. The model with two features demonstrated better quality than the model with one feature on the test sample across all quality metrics (MAE and R2) and the predictability within ±0.50 D and ±1.00 D, which were 30.0 % and 70.0 % respectively. Conclusion. The linear regression model was developed to calculate the dioptric power of an optical cylinder based on the axial length and total leucoma thickness. It demonstrated predictability within ±1.00 D in 70.0 % of cases. Further observations are required to improve the model.
Analysis of Cases of Decompensation of Intraocular Pressure in Patients after Antiglaucoma Surgery
Objective. Evaluation of the effectiveness of reducing intraocular pressure (IOP) in patients after antiglaucoma surgeries (AGO) using the Healaflow viscodrainage device based on a retrospective analysis of the timing and frequency of IOP decompensation. Material and methods. A retrospective analysis of 438 medical records of patients with primary open-angle glaucoma (POAG) who underwent glaucoma surgery using micro-non-penetrating deep sclerectomy (NPDS) technology was performed at the Yekaterinburg Center of the Scientific and Technical Complex “Eye Microsurgery”. The patients were divided into 2 groups: with primary antiglaucoma surgery — 315 and 123 with repeated surgery. In each group, 2 subgroups were identified: 285 patients using Healaflow viscodrainage and 153 patients without Healaflow. Achievement of target IOP in the early and late postoperative periods was assessed. The observation period was 5 years. Results. The absolute success in IOP compensation after primary micro-NPDS in patients using Healaflow was 59.7 % and 54.2 % without it. Repeated micro-NPDS resulted in a lower frequency of absolute success in IOP compensation — 31.5 % in patients using Healaflow and 24 % without it, with an observation period of 40 months. The relative failure in IOP compensation after micro-NPDS was 40.3 % in patients using Healaflow and 45.8 % without it, with an observation period of 40 months. The frequency of absolute failure (AF) did not depend on the stage of glaucomatous optic neuropathy (GON). In patients after primary micro-NPDS, the incidence of AF was 36.2 % in patients using Healaflow and 57.1 % without it, and 34.1 and 53.1 % after repeated AGO, with an average decompensation period of 19.3 ± 12.6 months and 13.5 ± 11.2 months, respectively. The use of Healaflow viscodrainage increased the time to repeated surgery by 26.8 % in the primary AGO group and by 37 % in the repeated AGO group. Conclusion. The effectiveness of AGO decreases over time, despite the use of minimally invasive surgical treatment technologies and the use of modern anti-scarring agents. A retrospective comparative study conducted to evaluate the long-term results of intraocular pressure (IOP) reduction after micro-NPDS using Healaflow viscodrainage revealed a longer period of achieving target IOP values both during primary and repeated surgical intervention.
PRESERFLOTM Microshunt Implantation and Multiple Non-penetrating Deep Sclerectomy in Primary Open-angle Glaucoma Surgery
Purpose: сomparative analysis of the effectiveness of PRESERFLO™ microshunt implantation and multiple NPDS in patients with refractory glaucoma. Patients and methods. A total of 64 patients (67 eyes), including 27 male and 37 female with primary open-angle glaucoma (POAG), were examined and operated on as part of an open prospective study. All patients underwent implantation of the Preserflo™ drainage system or non-penetrating deep sclerectomy after previously performed surgical interventions for POAG (NPDS and/or implantation of various drainage models). The patients were divided into 2 groups — the Preserflo group (group I, 28 patients) and the NPDS group (group II, 36 patients). The follow-up period was 1.0 ± 0.1 years. Results. In the study groups, complications such as hyphema (n = 2 in group I and n = 3 in group II) and ciliochoroidal detachment (n = 1 in group I and n = 2 in group II) were identified in the early postoperative period. In group I, severe hypotension was noted on day 1 after surgery (7.4 ± 1.8 mmHg compared with 31.0 ± 4.7 before surgery). Subsequently, an increase in IOP was noted to 18.3 ± 6.1 during the follow-up period of 1 year. In 17 out of 28 patients (60.7 %), an IOP of less than 18 mmHg was determined, of which 2 were without drug therapy. It was regarded as a “relative” and “absolute” success, respectively. In group II, in the early postoperative period, the dynamics of the decrease in IOP was less pronounced (17.5 ± 3.8 mmHg on the first day after surgery, with a further increase to 26.6 mmHg after a year of follow-up) even against the background of the maximum medication regimen. In the maximum follow-up period, the average number of drugs was used for reducing the IOP in group I was 0.94 ± 0.16, and in group II — 2.28 ± 0.87 (differences are statically significant, p < 0.05). The frequency of “relative” success in group I after 6 months and 1 year of follow-up was significantly higher than in group II (43.4 % versus 25 % and 53.6 % versus 30.6 %, respectively, p < 0.05). Conclusion. The paper presents the first data in the literature on the comparative analysis of the effectiveness of Preserflo drainage implantation and non-penetrating deep sclerectomy in patients with refractory and repeatedly operated primary open-angle glaucoma. The advantage of the implantation of the Preserflo drainage in relation to the antihypertensive effect and reduction of the number of instillations of antihypertensive drugs have been shown.
Structural Changes in the Macular Region after Transplantation of the Autologous Retinal Pigment Epithelium in Neovascular Age-related Macular Degeneration with Subretinal Hemorrhage
Purpose: to investigate the structural changes in the macular region after transplantation of autologous retinal pigment epithelium (RPE) in patients with neovascular age-related macular degeneration (nAMD) complicated by subretinal hemorrhage. Patients and methods. The prospective study included 14 patients with widespread nAMD complicated by extensive SRH of 46.5 (38.3; 83.0) days duration, for which autologous RPE transplantation was performed. During OCT before and 6 months after surgery, changes in the thickness of the neuroretina, the thickness of the RPE and choroidea, the presence of hyperreflective foci, the type of edema, the preservation of the ellipsoid zone, the structure of the subretinal material before surgery and the structure of the RPE patch after treatment were studied, and the relationship with BCVA was analyzed. Results. In all cases, significant retinal structural abnormalities were observed before the RPE transplantation. After the surgery, there was a significant increase in the maximum thickness of RPE in the macula from 22.5 (19.0; 27.0) to 29.5 (26.3; 35.8) microns (p = 0.03). The thickness of the RPE in the fovea also increased from 1 (0; 3.8) to 15.5 (12.0; 23.3) microns (p = 0.014). Additionally, there was partial recovery of the ellipsoid zones in the fovea and parafovea. After 6 months, the value of BCVA correlated with the presence of preserved ellipsoid zone before treatment in the parafovea (r = 0.62, p = 0.018) and after RPE transplantation in the fovea (r = 0.64, p = 0.016). Conclusion. Transplantation of autologous RPE in patients with nAMD complicated SRH can significantly improve the functional state of the macula due to the restoration of its structure. An important OCT-marker affecting the functional outcomes of surgical treatment is the preservation of the ellipsoid zone in the fovea and parafovea.
Treatment of Painful Bullous Keratopathy with Accelerated Transepithelial Crosslinking
Purpose: tо evaluate the effectiveness and safety of a modified accelerated transepithelial corneal crosslinking (CXL) technique with intrastromal riboflavin injection for pain relief and reduction of corneal edema in patients with painful bullous keratopathy (BK) who are not candidates for keratoplasty. Patients and methods. This single-center retrospective study analyzed outcomes in 15 patients (15 eyes) with painful BK (mean age 71.7 ± 8.4 years). The procedure consisted of two paralimbal intrastromal injections of 0.1% riboflavin (at 3 and 9 o’clock), followed by UV irradiation (5.4 J/cm2, 15 minutes) without epithelial removal. Postoperative followup lasted 9 months. Evaluations included symptom severity (0–4 scale), central corneal thickness (CCT), and intraocular pressure (IOP). Results. Pain reduction was observed in all patients within the first days after surgery. In 60 % (9 patients), pain did not recur throughout the follow-up period (p < 0.032). CCT decreased from 885.5 ± 95.8 µm to 680.2 ± 99.5 µm at 9 months (p < 0.02), amounting to a mean reduction of 259.1 ± 122.0 µm. IOP remained stable (p > 0.05). No complications were recorded. Conclusion. The proposed technique demonstrated a long-lasting analgesic effect, sustained reduction of corneal edema, and minimized complication risk due to the absence of epithelium removal. This method appears promising for the palliative treatment of painful BK in patients with contraindications to corneal transplantation.
Dynamics of Electrical Sensitivity of the Retina and Electrical Lability of the Optic Nerve in the 12-month International Experiment SIRIUS-23
The aim of the 12-month international experiment SIRIUS 23/24 was to evaluate the effects of long-term isolation conditions and exposure to stress factors on electrical sensitivity (ES) of the retina and electrical lability (EL) of the optic nerve (ON) in the ES&EL test in participants. On board the artificial station, monthly testing of the retinal ES and EL of the ON was carried out. The results obtained in this 12-month experiment confirm the patterns of changes in the retinal ES and the ON EL established earlier in the 8-month SIRIUS-21 experiment. It was shown that with short-term or moderate physical and psycho-emotional stress, the retinal ES can increase. A decrease in the threshold of the ES may also indicate individual physical and mental endurance of the crew members. It has been confirmed that the EL of the ON is more resistant to physical and psycho-emotional stress than the thresholds of the ES of the retina. Considering the relative stability of EL indices and the dynamics of EC thresholds, the EC&L test may be a useful method for assessing the individual endurance of crew members, the functional state of the papillomacular bundle of fibers of the ON in astronauts on orbital space stations, and identifying the risk of developing SANS during long-term interplanetary flights.
Dynamics of Clinical Signs of Dry Eye Syndrome of Various Etiologies Against the Background of Drug Therapy Using a Biologically Active Supplement with Antioxidant Action in Various Dosages
The purpose: to study the effectiveness of using different dosages of the anthocyanin-based biologically active supplement “Delfanto”, which has an antioxidant effect, in the complex therapy of patients with dry eye syndrome. The study material consisted of 178 patients (353 eyes) with dry eye syndrome of varying severity, developed on the basis of meibomian blepharitis (109 patients, 215 eyes) and climacteric syndrome (69 patients, 138 eyes), examined in various medical institutions of St. Petersburg, Moscow, Krasnodar, Omsk and Samara. All patients were surveyed using the OSDI questionnaire, the stability of the tear film according to Norn, as well as the amount of total and main tear production according to Schirmer-I and II before the start of the study, as well as on the 3rd, 20th and 30th days of complex therapy. The latter included instillations of artificial tears in combination with oral administration of Delphanto in various dosages: 60 mg for mild to moderate ocular surface xerosis and 120 mg for severe xerosis (stage 1 of the study) and 240 mg for xerosis of all severity (stage 2). Results. Against the background of complex therapy using Delphanto in various dosages, a progressive decrease in OSDI, an increase in tear film stability, as well as the values of basic and total tear production were noted. In most cases, the values of these parameters were statistically significantly different from their initial values, starting from the 20th day of therapy and reaching a maximum by the 30th day. A dose-dependent effect of Delphanto has been established: in comparison with the results of using Delphanto in a daily dose of 60 mg for mild and moderate forms of xerosis and 120 mg for its severe form, a daily dose of Delphanto in 240 mg was more effective, moreover, in patients with dry eye syndrome due to meibomian blepharitis — to a greater extent for its moderate and severe degree, and in patients with dry eye syndrome due to climacteric syndrome — for its mild clinical form. Conclusion. The data obtained allow us to recommend the biologically active supplement Delphanto in a dosage of 240 mg in the complex therapy of patients with dry eye syndrome.
Optical Coherence Tomography-angiography in the Diagnostics of Fundus Microcirculation in Patients in the Post-COVID Period
Purpose: tо study the retinal vessel density of the parafoveal and peripapillary zones and the optic disc area in patients in the postCOVID period using OCT-A. Patients and methods: A total of 30 people (60 eyes) aged 18 to 82 (average 61.7 ± 14.2) years were examined at the Federal State Budgetary Institution “United Hospital and Polyclinic” of the Presidential Executive Office of the Russian Federation. All subjects had a history of a new coronavirus infection COVID-19 of varying severity, confirmed by a positive result for SARS-CoV-2 RNA by PCR. OCT-A was performed on an Optopol SOCT Copernicus REVO NX device (Poland). Results. The vessel density of the superficial and deep retinal capillary plexus of the parafoveal zone in all quadrants (nasal, inferior, temporal and superior) was significantly lower compared to the normal values of the corresponding zones (p < 0.001). A significant decrease in the microcirculation parameters of all studied optic disc parameters was proven compared to normal values (p < 0.001). At the same time, the vascular bed density inside the optic disc was the lowest, amounting to 29.6 ± 5.6 % for the right eye and 27.9 ± 6.4 % for the left, which was significantly lower than the normal values of 52.9 ± 3.6 %, p < 0.001. Conclusion. The studies conducted using OCT-A proved microcirculatory fundus’ changes in patients after a new coronavirus infection. Thus, a significant decrease in the vascular density was revealed both in the retina’s parafoveal and peripapillary zones, as well as in the optic nerve head area, which may indicate the development of preclinical maculopathy and optic neuropathy. The obtained data made it possible to continue the studies initiated in order to develop and apply rehabilitation measures at the initial stages of the disease.
Comparison of Biometric Parameters in Standard and Segmental Optical Biometry
Optical biometry is widely used in ophthalmology for different purposes. The Argos (Alcon, USA) device, which recently entered the Russian market, uses different refractive indices for different eye structures. This feature fundamentally distinguishes it from other models. The issue of its comparability with other biometers in the Russian population has not been researched sufficiently. Purpose. To compare keratometry in the flat (K1) and steep (K2) meridians, mean keratometry (Km), axial length (AL), anterior chamber depth (ACD), lens thickness (LT), white-to-white (WTW) and the frequency of relevant AL measurement between the Argos and IOLMaster 700 devices. Patients and methods. Two hundred fifty-one patients (368 eyes) were included in the study regardless of the presence of cataract: 244 females (66.3 %) and 124 males (33.7 %). The mean age was 68.18 ± 13.36 years (24–92 years). The exclusion criteria were: unstable visual fixation, pseudophakia, aphakia, history of vitrectomy, the difference between the dates of biometry on the Argos and IOLMaster 700 more than 1 month. Clinical significance of the differences was assessed using Bland-Altman plots and 95 % limits of agreement (95 % LoA). Results. The frequency of relevant AL measurements was 100 % on the Argos, and 99.2 % on the IOLMaster 700 (p = 0.25). The K1, K2, Km, ACD, LT and WTW measurements were significantly higher on the Argos compared to the IOLMaster 700. AL did not differ significantly only in the range of 22.0–23.0 mm. At AL < 22.0 mm this parameter was significantly higher on the Argos, at AL > 23.0 mm — on the IOLMaster 700. The more was the AL deviation from the range of 22.0–23.0 mm, the greater was the difference in AL between the two biometers. The difference in ACD was inversely proportional to the magnitude of ACD. Strong correlations were found for all studied parameters on the two biometers, however, 95 % LoA were wide. Conclusion. The differences in keratometry, AL, ACD, LT and WTW between the Argos and IOLMaster 700 are clinically significant and therefore this biometers cannot be considered interchangeable in all clinical situations.
Prediction of Diabetic Retinopathy Progression Based on Logistic Regression Model
Diabetic retinopathy (DR) remains a leading cause of blindness in the working-age diabetic population. DR progression often occurs asymptomatically, and current screening methods do not always detect the onset of retinal deterioration in a timely manner. This creates a strong need for risk prediction models that can identify high-risk patients in advance and enable prompt preventive treatment. Moreover, the pathogenic mechanisms of DR may differ between type 1 and type 2 diabetes (neurodegeneration and inflammation vs. microangiopathy), which justifies developing separate progression models for each diabetes type. Purpose: tо develop and validate multivariable logistic regression models predicting 1-year progression of diabetic retinopathy (DR) in type 1 diabetes (T1D), type 2 diabetes (T2D), and a combined cohort, and to compare their accuracy and key predictors. Patients and methods. In this prospective study, 731 patients (731 eyes) without proliferative DR underwent optical coherence tomography (OCT), OCT angiography (OCTA), and systemic evaluation. A total of 102 candidate predictors were considered. Separate multivariable logistic models were built for T1D, T2D, and the combined cohort (75 % training / 25 % validation; class balancing). Performance was assessed by macro F-measure, sensitivity, specificity, and negative predictive value (NPV). Results. The T1D model achieved a macro F-score of 0.96 with 100 % sensitivity and 97.3 % specificity (NPV 100 %). The T2D model yielded a macro F-score of 0.85 with 90.5 % sensitivity and 87.8 % specificity (NPV 97 %). The combined model showed a macro F-score of 0.91 with 91.2 % sensitivity and 94.6 % specificity (NPV 97.9 %). Key predictors were: for T1D— hyperreflective foci (HRF), relative ganglion cell complex thickness (GCC %), and central retinal thickness; for T2D—fractal dimension in the superficial capillary plexus (FD-SCP), GCC and GCL+ thicknesses, and estimated glomerular filtration rate (eGFR); for the combined model—HRF, GCC, GCL+, and eGFR. Conclusions. Logistic regression models were developed for T1D, T2D, and a combined cohort; validation confirmed high predictive accuracy and delineated distinct key predictors—predominantly neurodegenerative and neuroinflammatory biomarkers in T1D, and neurodegenerative, vascular, and systemic indicators in T2D.
Evaluation of the InP/ZnSe/ZnS 650 Quantum Dots Toxic Effect on the Eye Anterior Segment Structures upon Intracameral Administration in vivo Experiment
Objective: to evaluate the toxic effect of InP/ZnSe/ZnS 650 nanoparticles (quantum dots) on the structures of the anterior segment of the eye during their intracameral administration in vivo. Materials and methods. An experimental study was conducted on 20 eyes of New Zealand rabbits. Animals were divided into 4 groups: three groups were injected into the anterior chamber of the eye with a solution of quantum dots at concentrations of 1%, 0.1% and 0.01%, respectively, the fourth group (control) received a balanced saline solution. Corneal, iris, anterior chamber moisture, and corneal endothelium were evaluated by slit lamp, optical coherence tomography, and endothelial microscopy on Days 1 and 7 after injection. Results. Clinically, there were no signs of inflammation or toxic damage (corneal edema, hypopyon, precipitates) in all groups. Endothelial microscopy data showed no statistically significant differences (p > 0.05) between groups and follow-up periods in key morphometric parameters: endothelial cell density (ECD), coefficient of variation (CV), and percentage of hexagonal cells (6A). The parameters remained within the physiological norm for this animal species. Conclusion. Intracameral administration of InP/ZnSe/ZnS 650 quantum dots at the studied concentrations (up to 1%) does not have a toxic effect on the structures of the anterior segment of the eye under experimental conditions in vivo during the observation period of 7 days. The data obtained demonstrate the high biocompatibility of nanoparticles and justify the prospects for their further study as a platform for targeted drug delivery in the treatment of severe infectious eye diseases.
Patterns of Changes in Morphometric and of the Cornea Biomechanical Properties during the Formation of Peripheral Vitreochorioretinal Dystrophies in Children with Myopic Refraction
Purpose: elucidation of the patterns of biomechanical and morphometric properties of the cornea in children with presence of peripheral vitreochorioretinal dystrophies (PVCRD) against the background of myopic refraction. Patients and methods. The clinical material consisted of 20 children with prognostically dangerous types of PVCRD against the background of acquired myopia from 9 to 17 years old (28 eyes), mainly lattice PVCRD. The anterior-posterior axis (APA) of the eyes varied from 25.02 to 26.58 mm (main group). The comparison group (20 children) included 2 subgroups: A — 12 children (24 eyes) with myopia; B — 8 children (16 eyes) with emmetropic and slightly hypermetropic refractions. Keratotopography parameters and biomechanical properties of the cornea were assessed. Results. A statistically significant difference in APA length of the eyes was found between the main group and subgroup B of the comparison group (25.8 ± 0.78 mm versus 23.6 ± 0.5 mm), p ≤ 0.01. There was no statistically significant difference in the pachymetric values of the corneal optic zone between the main group and the comparison group, as well as between both subgroups of the comparison group. The average corneal elasticity index in the main group was statistically significantly lower than that in subgroups A and B of the comparison group. A statistically significant difference in the peak corneal distance indices was also found between the main group and subgroups A and B of the comparison group. The revealed patterns indicate the presence of a “softer” cornea in the main group (the greatest degree of its deflection), in comparison with a “rigid” cornea in both comparison subgroups. Conclusion. The cornea in children with PVCRD against the background of myopic refraction is characterized by reduced biomechanical properties, compared to children with myopia without PVCRD.
The place of Pneumoretinopexy in the Treatment of Primary Detachment of the Retina in a Multidisciplinary Hospital
Objective. To analyze our own long-term results of pneumatic retinopexy in the treatment of rhegmatogenous retinal detachment. Patients and methods. The treatment outcomes of 244 patients were analyzed. Pneumoretinopexy followed by delimiting retinal laser coagulation was used in 187 patients: in 57 cases, stage C1-D3 PVR events were detected, which required other types of intervention. All patients underwent a complete baseline examination. Hexafluoroethane C2 F6 “Arceole” gas from ARCADOPHTA (France) was usually used as an air-gas tamponade. Delimiting retinal laser coagulation was performed on a Nidek MC-500 Multicolor Laser photocoagulator. Results. The retina adhered in 183 eyes (97.86 %). In 4 cases, surgery was performed for inferior retinal breaks, including those with a large tear area and extensive detachments: complete retinal reattachment was achieved in 3 cases. Recurrent retinal detachment occurred in 5 patients (2.67 %); repeat pneumatic retinopexy was performed with a positive effect in 1 case; vitrectomy was required in 4 cases due to PVR progression. Conclusion. The obtained results demonstrate the high efficacy and safety of pneumatic retinopexy followed by delimiting retinal laser photocoagulation in the treatment of patients with rhegmatogenous retinal detachment. The use of this technique, with its high anatomical and functional effect, makes pneumatic retinopexy the procedure of choice in the absence of advanced PVR.
Proteomic Analysis of Normal Lacrimal Fluid: Identification of Major and Unique Proteins (Clinical and Experimental Study)
The protein composition of lacrimal fluid changes in various pathological conditions, making it a promising biomarker for the diagnosis of ophthalmic and systemic diseases. Modern methods of lacrimal fluid analysis include chromatography and mass spectrometry, which ensure highly accurate identification and quantification of proteins, serving as indispensable tools for proteome studies. The aim of this study was to investigate the protein composition of lacrimal fluid using mass spectrometry in 5 healthy volunteers, identify the main components and unique proteins, and analyze their significance for the diagnosis and treatment of ophthalmic diseases.
Features of Optical Coherence Tomography of the Optic Nerve Head in Patients with High Myopia
Purpose: to evaluate the differences in the structural parameters of the optic nerve head (ONH) and peripapillary region in patients with high myopia in comparison with patients without refractive errors. Patients and methods. The first group included patients with an equivalent refractive error ≥ -6.00 diopters and an eye length ≥ 26.00 mm (74 eyes). The second group consisted of patients with a refraction of -0.5 diopters — +1,25 diopters and an eye length of 22,50–24,20 mm (32 eyes). Axial length measurements were carried out using an IOLMaster 700 (Zeiss, Germany). Optical coherence tomography (OCT) of the ONH was performed with SOLIX (Optovue, USA) using the AngioAnalytics software. For statistical analysis of the results, the nonparametric Mann-Whitney’s test and Spearman’s rank correlation coefficient were used. Results. In the first group, the cup-to-disc vertical ratio (VCDR) values were lower (0.38 (0.14–0.51), p < 0.05), and there was a decrease in the average thickness of the retinal nerve fiber layer (RNFL) (86.00 (80.00–94.00), p < 0.01), as well as RNFL thickness measured in individual sectors (p < 0.01), compared with the second group. The thickness of the RNFL in the temporal quadrant, in the inferior sector of the temporal quadrant (TI), on the contrary, was greater (71.00 (58.05–87.25), p < 0.01). All radial peripapillary capillary vessel density (RPC VD) values were not significantly different between groups (p > 0.05). The highest RPC VD is in the upper sector of the temporal quadrant (TS) (56.65 (51.72–59.47)). The density of all vessels (VD) was significantly lower in patients with high myopia, except for the zones corresponding to the temporal quadrant and the inside disc zone (ID) (p > 0.05). Conclusion. Significant differences were revealed between the groups in VCDR, RNFL thickness and VD in all areas, except the temporal quadrant. A decrease in the thickness of the RNFL in the temporal quadrant, TI, as well as a decrease in the thickness of the RPC VD in the ID zone and the temporal quadrant, TS, can be the most indicative parameters for diagnosing optic nerve pathology in patients with high myopia, not associated with axial elongation of the eyeball.
Phacoemulsification of Cataract with IOL Implantation after Multiple Keratorefractive Surgeries. Clinical observation
Phacoemulsification after keratorefractive surgery always requires an individual approach. In addition to choose the optimal surgical access site, it is important to calculate the optical power of the IOL in conditions of changing corneal topography. To date, certain formulas have been proposed for calculating IOLs in this category. However, none of them can guarantee an accurate result. The presented clinical case demonstrates the successful use of the Barrett True-K formula, which allowed us to obtain satisfactory refraction data and subjectively high visual acuity at a distance and up close without correction. The use of magnetic laser therapy in the early postoperative period helped to level out the signs of developing bullous keratopathy.
The article provides a detailed description of a unique clinical case in which a patient with cutaneous malignant melanoma of the lower extremity developed a rare and serious neurological complication — paraneoplastic syndrome (PNS), which affected the optic nerve. The key manifestation of this syndrome was optic neuropathy — damage to the optic nerve, which clinically presented as optic disc edema, identified during ophthalmoscopic examination. This case demonstrates how cancer can manifest with or be accompanied by severe complications in organs distant from the primary tumor, necessitating increased vigilance from physicians.
The Importance of Nutraceutical Support According to the AREDS2 Protocol in Age-related Macular Degeneration. Clinical observation
Carotenoids, which are part of macular pigment, play a key role in maintaining visual functions. Age-related changes in the visual organ necessitate increased intake of vitamins and minerals to slow down degenerative processes in the retina. Vitamin and mineral complexes (VMC) containing lutein, zeaxanthin, and antioxidants have been proven to be effective in slowing down the progression of advanced AMD, as evidenced by international studies. Multifocal electroretinogram (mFERG) is of interest as a method of objective assessment of retinal function and is one of the sensitive biomarkers of severity and progression of the disease. The article presents clinical examples of the use of the objective mFERG technique in assessing the effect of VMC on retinal cells.
Clinical Efficacy of Home Accommodation Training Based on Monocular Exposure with Negative Lenses with Exponentially Increasing Power
Purpose. To study the clinical efficacy of home accommodation training based on monocular exposure to negative lenses with exponentially increasing power. Materials and methods. We observed 64 patients aged 20 to 30 years with visually demanding work (VDV). They were divided into two groups of equal age and uncorrected distance visual acuity (UDVA). These groups met the diagnostic criteria for habitual excessive accommodation strain (HEAS, 33 patients) and asthenic form of accommodative asthenopia (AFAA, 31 patients). The home training method was carried out using the mini-trainer “Okos” developed by the author, based on the monocular effect of 7 negative lenses with an exponentially increasing power (sph: -1.0; -1.5; -2.5; -4.25; -7.0; -9.0; -12.0 D). Examination of the patients’ vision was performed before and after the end of the home training course based on the values of the UCVA, the absolute accommodation volume (AAV), the relative accommodation reserve (RAR), as well as the patient’s assessment of the “feeling of eye fatigue” (on a 10-point scale). Results and discussion. Conducting home training is a fairly effective method, which is confirmed by the restorative correction of the leading functional disorders in patients with accommodative asthenopia (with AFAA — an increase in the AAV by an average of 3.5 D (p < 0.001), with HEAS — an increase in the RAR by an average of 2.6 D (p < 0.001), while in both cases, the specified indicators after the training course corresponded to the normative age values. The described positive dynamics is confirmed by an increase in the uncorrected visual acuity (by 0.17–0.18 relative units, p < 0.05) and a significant decrease in subjective “eye fatigue” (by 4.0–4.6 points, p < 0.001). The main advantages of the proposed home training method are the exposure mode, which corresponds to the physiology of the ciliary muscle with the highest possible speed close to the exponential law and short exposure, which is an effective prevention of severe muscle fatigue. Conclusion. The described clinical efficacy, low cost, and small weight and dimensions allow for the widespread use of the proposed “Okos” mini-trainer in patients VDV as maintenance therapy following an outpatient course of hardware-based rehabilitation.
Evaluation of the Therapeutic Efficacy of Local Anesthetics Used in the Removal of Corneal Foreign Bodies
Corneal injuries, including foreign body (FB) penetration, represent a significant portion of ophthalmic pathology, particularly among the working-age population. Successful FB removal requires the use of effective and safe topical anesthetics that not only minimize patient discomfort but also reduce the risk of complications such as keratitis, ulceration, or secondary infection. The safety profile of anesthetics is of particular importance, as their toxic effects on the cornea can delay epithelial regeneration and exacerbate postoperative complications. In clinical practice, instillation anesthetics such as proxymetacaine 0.5 % (Dropsthetic) and oxybuprocaine 0.4 % (Inocaine) are widely used. However, their comparative efficacy, effects on corneal status (including central thickness), and impact on tear film stability — particularly in patients with dry eye syndrome — remain insufficiently studied. Key aspects requiring evaluation include the speed of anesthesia onset, duration of action, influence on corneal thickness, and effects on tear film stability, especially in dry eye patients. This study aims to conduct a comparative analysis of these anesthetics in terms of therapeutic efficacy, safety, and patient-reported tolerability. The findings will help to optimize the choice of anesthetic for corneal foreign body removal, which is particularly relevant in emergency ophthalmic care settings. Purpose. A comparative study of the therapeutic efficacy and safety of topical anesthetic instillations — Dropsthetic (proxymetacaine 0.5 %) versus Inocaine (oxybuprocaine 0.4 %) — in patients with corneal foreign bodies. Patients and methods. This open-label prospective randomized study included 60 patients (60 eyes) with superficial corneal foreign bodies (metal — 60 %, concrete — 25 %, wood — 15 %). Patients were divided into two groups: Group 1 (n = 30) received proxymetacaine 0.5 %, Group 2 (n = 30) received oxybuprocaine 0.4 %. Parameters assessed included: оnset of anesthesia, duration of complete and total anesthesia, tear film stability (NIBUT), central corneal thickness (CCT), subjective tolerance (questionnaire). Results. Proxymetacaine 0.5 % demonstrated statistically significant advantages in: faster anesthesia onset (22.0 ± 12.1 sec vs 30.0 ± 15.0 sec; p < 0.001), longer duration of effect (40.0 ± 1.3 min vs 35.0 ± 1.4 min; p < 0.001). Both anesthetics showed no clinically significant changes in tear film stability (NIBUT: p > 0.05), though oxybuprocaine significantly reduced breakup time at 1 hour (p < 0.001). Proxymetacaine caused less burning sensation upon instillation (3.3 % vs 30 %; p < 0.01). Proxymetacaine group showed less corneal edema in the optical zone (p < 0.001). Patients rated proxymetacaine higher for comfort (8.8 vs 7.1 points; p = 0.0001). In addition, DropSthetic was rated by the majority of patients as more comfortable (8.8 vs. 7.1 points; p = 0.0001), possibly due to its selective effect on unmyelinated nerve fibers, which leads to rapid suppression of the generation and conduction of nerve impulses.
Wavefront Aberrations in Children and Young People with Myopia: Comparative Analysis of OPD Scan III and iTrace data
Individual ametropia-correcting products (glasses, contact lenses) selected using standard methods for studying refraction of the eye can provide high visual acuity, however, modern requirements of optical correction users do not always allow achieving the desired quality of vision. The quality of vision is influenced by many factors related to the conditions of the accommodative apparatus, the ocular surface, and the wavefront. The eye wavefront is a characteristic of the eye’s optical system that describes the phase distribution of a light wave after it passes through the cornea, lens, and other optical media of the eye. In an ideal optical system (without aberrations), the wavefront has a flat shape, which ensures that light is focused at a single point on the retina. However, the real optical system of the eye is subject to distortions, which are determined by aberrations — deviations of the wavefront shape from the ideal one. Aberrometry has been widely used in optometry and many areas of ophthalmology in recent decades (for the diagnosis of keratoconus, refractive surgery, and dry eye syndrome). Currently, there is no single standard for measuring eye aberrations, so it is necessary to regularly evaluate the consistency of aberrometer data to ensure the reliability of wavefront data. Purpose: to provide a number of technical and practical parameters that may be useful when choosing an aberrometer for daily clinical practice, as well as to evaluate and compare the general and internal aberrations measured by two aberrometers: the OPD Scan III optical media analyzer (OPD Scan, Nidek) and the ray tracing technology aberrometer (iTrace, Tracey Technology). Patients and methods. This study included 30 patients with 60 eyes. Total and internal aberrations were compared with pupil diameters of 3 mm and 6 mm. These parameters, along with the refraction parameters, were analyzed and supplemented with paired t-criteria. Results. A comparison of the two OPD Scan III and iTrace devices showed that their measurement results of total aberrations at pupil diameters of 3 mm and 6 mm are comparable. Thus, both devices can be used to study wavefront changes in children and young patients with myopia with the same degree of reliability. Differences in data on higher-order internal aberrations obtained from studies of children and young patients with myopia should be taken into account, among other things, when analyzing corneal aberrations (since they are calculated by subtracting the internal aberration index from the total eye aberration index) in these categories of patients.
The State of Cancer Care in Russia: Malignant Tumors of the Eye and Adnexa (C69). Prevalence and Year-by-year Mortality. Part 1 (population-based study)
Until 2011, taking into account the rarity of the reported cases of morbidity, malignant tumors of the eye (C69) were not included in the state reports of the Ministry of Health of the Russian Federation. In the state mortality statistics, the C69 isn’t taken into account separately. Currently, it is possible to get a real idea of the prevalence and effectiveness of anti-cancer measures in relation to the C69 heading only using Population-based Cancer Registries (PCR) created in the country. The purpose of our study is to continue studying the features of the dynamics of morbidity, year-by-year mortality and survival of patients with cancer of the eye and adnexa in Russia on the basis of state reporting forms and the database (DB) of the PCR. Methods. Standard methods of oncological statistics were used in accordance with international requirements. Results. In Russia, more than 1 thousand (1184 — 2023) new cases of malignant tumors of the eye (C69) are detected annually. The gross incidence rate increased in Russia from 0.65 (2011) to 0.810/0000 (2023) or by 24.62 %, the standardized, eliminating differences in the age composition of the population increased by only 5.6 %, amounting to 0.56 0/0000 by 2023. From 2019 to 2020 established the negative impact of coronavirus infection, its effect on patients turned out to be almost the same in Russia as for all malignant tumors (-14.3 %). The oneand five-year observed and relative survival rates continued to increase. Conclusion. The conducted study confirmed the previously identified patterns of the dynamics of the prevalence of malignant tumors of the eye and adnexa. The PCR of the Northwestern Federal District of the Russian Federation remains the only territory of Russia that carries out an in-depth analysis of the state of the oncological service using the PCR database at the federal district level.
The Effect of Corneal Collagen Crosslinking on Corneal Tissue Regeneration and Fibrosis. An Experimental Study
The most modern and effective method of treating degenerative corneal diseases is corneal crosslinking (CXL). This technique involves three steps: epithelial removal, stromal saturation with riboflavin, and UV irradiation at a wavelength of 370 nm. This exposure increases corneal rigidity. Consequently, assessing the impact of this technique on the regeneration and fibrosis processes in corneal tissues is of significant interest. Aim: to study the effect of CXL on rat corneas by assessing TGF-β1 and FGF-1 expression in relation to corneal structural characteristics. Materials and Methods. Experiments were conducted in two groups: Control (intact), Group 2 Experimental, in which a corneal crosslinking technique was performed. This technique involved deepithelialization of a 3-mm-diameter area of the cornea, instillation of DEXTRALINK solution (0.1 % riboflavin mononucleotide and 20 % dextran), and UVA irradiation of the cornea using the “UFalink” device (exposure parameters: 3 mW/cm2 for 10 minutes at a wavelength of 370 nm). On days 14 and 30, the eyeballs were enucleated and examined using morphological, immunohistochemical (TGF-β1 and FGF-1), and electron microscopy. For statistical analysis, the Mann-Whitney U-test was used to calculate TGF-β1+ and FGF-1+ keratocytes. Results. Mild pathological changes associated with keratocyte destruction in the stroma were detected in the experimental group on day 14. By day 30, however, no such changes were observed in the corneal stromal lamellae. The ultrastructural organization of the cornea, including the lamellae and cellular composition, appeared normal. The expression of TGF-β1and FGF-1-positive keratocytes decreased 14 days after exposure to UV radiation and Dextralink solution, but returned to normal levels after 30 days, matching those of an intact cornea. Conclusions. Corneal crosslinking with DEXTRALINK solution does not lead to the overproduction of TGF-β1 and FGF-1 in keratocytes. On day 14, preservation of the collagen structure of the cornea and the outer and inner epithelial layers was observed, along with signs of destruction and loss of keratocytes. Subsequently, on day 30, keratocytes with signs of increased functional activity were identified.