REVIEWS
The review provides information on methods for crosslinking corneal collagen (КРК), from the time of experimental studies and the first clinical observations to the present. Data are presented on the methods and results of CXL various modifications, as well as on possible promising directions for finding ways to improve the technique to improve functional results and reduce possible complications. Research is currently ongoing not only to improve already proven approaches for CXL, but also to search for new combinations and devices.
Lens transparency is determined by both cellular and subcellular levels of its organization. Abnormalities of its size, uniformity of shape and correct arrangement of the fibers lead to the scattering of light falling on the lens. At the same time, its normal transparent proteins turn into a cloudy, coagulated, insoluble form, and undergo denaturation. Therefore, the preservation of lens transparency is possible only with a certain chemical composition, achieved by a strict balance of all metabolism links. There are many different hypotheses about the disease etiology. It is known that intraocular fluid has a low content of proteins and an increased concentration of chloride-, lactate-, ascorbatanions in its composition, in contrast to blood plasma. It cannot be ruled out that this is due to the selective permeability of the blood–ocular barrier, which consists of non-pigmented epithelial cells of the ciliary body. In addition, the modification of molecular composition and constitutional imbalance in the intraocular fluid often causes of pathological processes development in the anterior segment of the eye. The blood-ocular barrier makes the eye an immune-privileged organ. However, many diseases, surgical interventions and eye injuries can lead to blood-ocular barrier damage. This causes to inflammatory effector cells and molecules inducing a cascade of reactions, which in turn results in irreversible fibrotic changes in the lens substance. In this regard, it becomes necessary to search for new reliable methods of determining the level of certain biochemical agents in intraocular structures, as well as establishing reference values for strategically important biomarkers of cataract development. This review presents modern views on biochemical markers imbalance in the anterior chamber aqueous humor and the lens, which contributes to its substance opacity.
The prevalence of late AMD, including neovascular AMD or geographic atrophy, and cataract in the same eye after age 80 years is estimated to be 12 and 68 %, respectively. There is currently no consensus on whether cataract surgery is beneficial or harmful for people with dry AMD. Although cataract surgery has been reported to provide better visual outcomes in eyes with AMD 6 months after surgery compared with previously followed eyes, it is unclear whether the timing of surgery relative to the start of AMD treatment influences long-term outcomes. The question of risk factors predisposing to the occurrence of exudation after cataract surgery in people with nAMD remains controversial.
This publication continues a review published in December 2023 about the genetic epidemiology and genotype-phenotype correlations in primary congenital glaucoma (PCG) worldwide, and presents data from East and South Asia, Western Europe and Russia. Analysis of the incidence of PCG data in these regions shows that the rates for Western Europe, the European part of Russia and East Asia are comparable and average 1:10,000–18,000 newborns and higher in ethnically mixed groups. On the territory of South Asia, the minimum number of children with PCG was recorded in Nepal, and the maximum in India. The majority of researchers talk about the predominance of bilateral process in 62 to 99 % cases. As a rule, there is a slight predominance of boys among patients with PCG; authors from India and France report approximately the same number of boys and girls, and German scientists have found a higher prevalence of PCG among girls. If we talk about the phenotype of the disease, almost all researchers note a more severe course in subgroups with the presence of CYP1B1 mutations than in patients who do not have a mutation in this gene. As for the genetic causes of PCG, the most common are mutations in the CYP1B1 gene, accounting for up to a third of cases in India, Pakistan, Western Europe and the European part of Russia. In East Asian patients, mutations in the CYP1B1 gene are most likely not the main ones in the pathogenesis of PCG, because are found much less frequently and often only in one allele. Chinese scientists say that it is necessary to pay attention to mutations TEK and ZC2HC1C, VPS13D, PGF.
The retinal pigment epithelium performs a number of highly specialized functions. The relevance of studying morphological changes in the pigment epithelium is associated with an increase in the number of patients with age-related macular degeneration (AMD), polypoid choroidal vasculopathy (PCV), central serous retinopathy and retinitis pigmentosa. The increase in the number of patients with these pathologies is associated both with the general trend of aging of the world’s population and with modern opportunities for mass diagnostics. The pigment epithelium performs a number of functions that ensure the normal functioning of the retina. The main structural unit is a hexagonal epithelial cell with a large number of melanosomes containing the pigment melanin. Pathomorphological changes in the pigment leaf are an important indicator of the development of AMD. In most cases, an elevation or detachment is formed, in which three types are distinguished: druzenoid, fibrovascular (hemorrhagic) and serous. According to a prospective multicenter study, in 19 % of cases, the druzenoid form progresses into atrophy of the pigment epithelium. There are a number of studies that present harbingers of integrity damages. Fibrovascular detachment is the pathomorphological basis for the formation of submacular hemorrhage. The pathogenesis of serous exfoliation in AMD is associated with a range of different mechanisms, ranging from degenerative changes in the Bruch membrane to the formation of choroidal neovascularization. In the scientific publications of a number of authors, information is presented about the complication of detachment in the form of the development of a rupture of the retinal pigment epithelium. The key criterion for a threatening rupture is the height of the pigment leaf detachment. Damage of the integrity of the pigment leaf in the long term is a factor in reducing or complete loss of vision. This is especially characteristic when a gap is formed in the central area of the retina. Also, visual impairment is observed in cases of submacular hemorrhage and the formation of a fibrous scar. An important point, at present, is the development of protocols for the management of patients with ruptures on the background of the underlying disease.
The cornea is the most powerful refractive element of the eye and plays a fundamental role in the quality of vision. Imperfection of corneas shape leads to the focusing errors formation, known as optical aberrations, which are responsible for visual performance deterioration. Understanding and assessing wavefront errors in IOL selection and calculation is great importance to achieve maximum optical outcome in the postoperative period. The article presents literature data of the effect of higher-order aberrations on the vision quality in unoperated eyes, changes of the wavefront in the eyes after cornea surgical interventions, the effect of various types of IOLs (spherical, aspherical, multifocal and EDOF) on the total error of the eye wavefront, recommendations at their choice with different severity levels of optical aberrations, as well as promising areas of research on this issue.
Perfluoroorganic compounds are surgically invasive medical devices, which are represent liquid fluorine-containing substances, chemically and biologically inert and thermodynamically stable due to the strength of chemical bonds between carbon and fluorine atoms. Due to their density, these compounds are able to exert pressure on the detached retina and expel the subretinal fluid. Currently, the use of perfluoroorganic compounds is limited to intraoperative use due to multiplesevere complications of prolonged tamponade. In the analyzed studies, the use of perfluoroorganic compounds as a tamponade was divided into short-term and medium-term tamponade of the vitreal cavity. The authors preferred such tactic for restoring the anatomical fit and a higher rate of aging of retinal laser coagulates, despite proven postoperative complications. Based on the analysis of the results of the presented studies, it can be concluded that it is possible to safely use perfluoroorganic compounds for short-term tamponade of the vitreal cavity. However, among the analyzed domestic and foreign studies, no large-scale statistically significant studies were found to justify the choice of tamponade for retinal breaks different localization, terms of retinal detachment and stage of proliferative vitreoretinopathy. All of that determines the relevance of a more detailed study of the use of perfluoroorganic compounds for short-term tamponade of the vitreal cavity.
OPHTHALMOSURGERY
Purpose: to evaluate the features and outcomes of penetrating keratoplasty in combined opto-reconstructive surgery for combat eye injury and its complications.
Patients and methods. The study enrolled 17 eyes (16 men) aged 34.00 ± 12.51 years, divided into 2 groups: I — with inflammatory diseases of the anterior segment, complicated combat eye injury (4 eyes), II — with open eye injury (OGI, 13 eyes). Patients underwent examination to reveal and localize damaged intraocular structures and intraocular foreign bodies (IOFB), determine the prognosis of visual functions, as well as impression cytology. In all cases penetrating keratoplasty was performed, as well as complex of vitreoretinal surgery if it was needed. In the postoperative period, visual acuity, the timing of epithelialization, and graft transparency were assessed. Period of observation was 4,5 ± 2,1 months.
Results. Group I had severe keratouveitis, when intraocular structures were intact also as electrophysiological parameters. The presence of mucosal cells was determined in 50 % of cases. The number of surgery was 2.00 ± 0.82. Graft epithelialization was completed in 38.99 ± 35.43 days. Postoperatively all grafts had transparent retention and complete epithelialization, also as had high visual acuity (0.25 ± 0.10) was noted. Group II had damaged several intraocular structures and varying electrophysiological parameters. The epithelial phenotype was corneal all over. The average number of surgical treatments was 3.00 ± 1.48. The time of graft epithelialization was significantly less — 17.66 ± 8.69 days (p = 0.014). Corrected visual acuity ranged from zero (30.77 %) to 0.3 (0.08 ± 0.11) and was significantly less than in group I (p = 0.018). The parameters that correlated low visual acuity were aphakia, the level of electrical sensitivity, the number of surgical interventions, and the age of patients.
Conclusions. Penetrating keratoplasty functional results prognosis is better in group with infectious complications of combat eye injury with reduced cornea transparency than in patient with open globe injury. Besides light perception and conducting structures (retina, optical nerve) lesion, optico-reconstructive surgery in open globe injury often leads to single-chamber formation in silicone filled eye, which significantly worsens the functional prognosis of treatment.
Purpose: to study the clinical features of patients with penetrating eye injury and foreign body, complicated by endophthalmitis.
Methods. 68 patients (68 eyes) with penetrating injury and ocular foreign body were included in the retrospective study, including 91.2 % males and 8.8 % females. The mean age was 50.00 [32.00; 60.00] years. The patients were divided into 2 groups: with endophthalmitis — 24 patients, without inflammation — 44 patients. All patients underwent standard ophthalmologic methods of examination.
Results. The age of patients with endophthalmitis was significantly greater compared to patients without inflammation — 51.50 [46.25; 63.25] years and 36.50 [31.25; 58.50] years, respectively (p = 0.0446). In the first day after injury, only 25 % of patients asked for medical care (p = 0.0071). In patients with endophthalmitis according to biomicroscopy data on admission the following were significantly more frequent: eyelid edema (p < 0.0001), purulent discharge (p < 0.0001), total hyphema (p = 0.029), hypopyon (p < 0.0001), iris edema (p < 0.0001), fibrin in vitreous body (p = 0.0014), as well as its destruction (p = 0.0005). 87.5 % of patients with endophthalmitis showed absence of fundus reflex (p = 0.0105), and 25 % of patients with inflammation showed increased intraocular pressure (p = 0.0019). In patients with endophthalmitis, surgical treatment was performed: cataract phacoemulsification in 91.7 % of patients (p < 0.0001), vitreoectomy in 87.5 % (p = 0.0098), enucleation of the eye in 12.5 % (p = 0.0165) and evisceration in 12.5 % (p = 0.0165). Bacterial culture in patients with endophthalmitis revealed Gram-positive microflora in 100 % of cases. There were also significant differences between the groups in the intravitreal, systemic and subconjunctival antibiotic therapy used.
Conclusion. Patients with penetrating eye injury and foreign body, complicated by endophthalmitis, are characterized by more signs of inflammation, pronounced damage to the eye and its structures.
Purpose. Development and evaluation of the clinical effectiveness and safety of a vitrectomy (VE) technique for patients with advanced stage proliferative diabetic retinopathy (ASPDR).
Materials and methods. We observed 132 patients (mean age 62.8 ± 2.4 years) with the following criteria for inclusion in the study, corresponding to the classification criteria of ASPDR: it is impossible to estimate the area of neovascularization; the fundus of the eye is partially ophthalmoscoped or not ophthalmoscoped in the posterior pole; preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs; retinoschisis in the macular zone. All patients were divided into the following two groups, equal in age, gender and visual status of the “healthy” eye: the main group (MG, 69 patients, 69 eyes), who underwent VE was performed according to the developed method and a control group (CG, 63 patients, 63 eyes), in which VE was performed according to the traditional method.
Results. The incidence of intraoperative complications in patients in the MG (5.8 %) was 8.1 % (p < 0.05) lower than in the CG (13.9 %). The incidence of postoperative complications in patients from the MG (5.5 ± 0.5 %) was 4.2 % (p < 0.01) lower than in the CG (9.7 ± 1.0 %). The increase in best-corrected visual acuity after surgery in patients from the MG was significantly (by 0.13 rel. units, p < 0.001) higher than in the CG. The value of the average decrease in the developed qualitative criteria for the condition of the fundus in patients in the MG (1.6 ± 0.1) was 23.1 % (p < 0.05), higher than in the CG (1.3 ± 0.1).
Conclusion. Surgical treatment of patients with ASPDR using the developed technique provides (compared to the traditional approach) a higher level of safety and clinical effectiveness. The main advantage of the developed technique is an integrated approach to surgical intervention, including the improvement of ophthalmological “techniques” (use of one-stage combined surgery, endolaser coagulation technology, etc.) and drug support (administration of ranibizumab at a dose of 0.05 mg 3–5 days before surgery) and the choice of intravenous sedation as the optimal anesthetic aid.
Purpose: to evaluate the long-term results of using polytetrafluoroethylene orbital implants in patients with anophthalmos.
Patients and methods. The clinical group consisted of 1560 patients with blind and unpromising eyes or anophthalmos, who were divided into 3 groups (I, II, and III) depending on the method of surgical treatment used — evisceration of the eye with posterior pole resection and neurectomy, enucleation of the eye, and plastic orbital socket surgery, respectively.
Results. All patients in the study groups showed a positive result according to the criteria: stump mobility averaged (130,1°), prosthesis mobility averaged (106,6°), prosthesis entrapment after evisceration was less common than in patients after eye enucleation by 14.5 %. And the average value of the prosthesis sinking (mm) was lower by 78.0 %. Occlusion of the upper eyelid was also 16.7 % less common, and the average occlusion of the upper eyelid (mm) was 37.3 % lower. PTFE orbital implants have proven to be affordable, biocompatible and easy to use implants. The effect of the operation remained stable with long-term follow-up up to 15 years. There were no complications directly related to the use of PTFE orbital implants.
CLINICAL STUDIES
Justification and purpose of the study. Changes in the vessels of the ocular surface are often associated with the presence of various systemic or ocular diseases. Segmentation of the vessels of the ocular surface using artificial intelligence (AI) tools is highly relevant in terms of improving the quality of early diagnosis of pathology. Purpose: to develop a model of segmentation of the capillaries of the ocular surface based on images from an ophthalmic slit lamp using AI tools using Python.
Materials and methods. The study used a dataset (700 eyes), which is publicly available on the Internet and includes photos from an ophthalmological slit lamp, marked up manually. With the help of the augmentation method, this set for research has been increased several times. The system of segmentation of the capillaries of the eye in the images from the ophthalmological slit lamp is based on the trained neural network Unet.
Results. The main result of the study is the development of an algorithm for automatic segmentation of eye capillaries in images from an ophthalmic slit lamp. The metric reached 85% during the training of the neural network model.
Conclusion. The high efficiency and potential of all methods in the construction of an automatic segmentation system of the capillaries of the ocular surface in the images within the framework of the developed in the Helmholtz National Medical Research Center of Eye Diseases automated system of medical decision-making. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of treatment of eye diseases in conditions of reduced availability of primary ophthalmological care in part of the territories of the Russian Federation, including at the pre-medical stage.
Actuality. One of the significant ophthalmic diseases is a dry form age-related macular degeneration (dAMD). The issues of etiology and pathogenesis are not completely cleared nowadays and they signify the subject of discussion. There are risk factors of dAMD (age, heredity, lifestyle etc.) which can cause metabolic disorders, changes hemorheological parameters which promote activation of druseogenesis and as a result an angiogenesis. Mostly an outcome of dAMD is geographical atrophy and decrease of central visual acuity. At the same time, it is known that similar metabolic and rheological disorders detected in other diseases are effectively corrected by extracorporeal rheoaferesis, in particular, using double filtration plasmapheresis. Thus, using of extracorporeal rheoaferesis with dAMD patients is pathogenetically well-reasoned, but in the available literature, a correct analysis of the effectiveness and safety of double filtration plasmapheresis in patients with intermediate stage of dAMD is presented poorly.
Objective. To study along with data of OCT, OCT angiography, visometry, microperimetry and electroretinography structural and functional changes in the macular zone in patients with a dry form of age-related macular degeneration after the using of double filtration plasmapheresis.
Patients and methods. The study included 63 patients (94 eyes) with an intermediate stage of dAMD. The patients were separated into two groups randomly. The first (main) group included 34 patients (52 eyes) who were performed double filtration plasmapheresis (DFPP) on an OctoNova device using a Plasmaflo plasma filter and a Cascadeflo EC40 fractionator in the amount of 4 procedures with a frequency of 1 time per week for 1 month. The second group (control) included 29 patients (42 eyes) who did not receive any specific treatment. In the main group of patients, OCT, OCT angiography, microperimetry and electroretinography were additionally performed in addition to standard ophthalmological examination before the DFPP course, after the DFPP course (1 month after the start of follow-up), 6 and 12 months later. Patients in the control group also underwent a similar examination at the specified time — 1, 6, 12 months after the start of follow-up.
Results. In this study we found according to optical coherence tomography, optical coherence tomography-angiography, visometry, microperimetry and electroretinography, positive dynamics of structural and functional parameters of the macular retina is observed in patients with a dry form of age-related macular degeneration with using double filtration plasmapheresis. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, which points to stabilization of the pathological process during the specified period.
Conclusions. This study showed that after applying the double filtration plasmapheresis in patients with dry form of age-related macular degeneration, there is an improvement in structural and functional parameters of the macular zone, consisting in a decrease volume DOPES and stabilization of retinal light sensitivity.
Purpose: to assess hypertension as a risk factor for a poor response to antiangiogenic therapy.
Patients and methods. Systemic blood pressure was studied in 84 patients (92 eyes) with age-related macular degeneration who were treated with intravitreal injections of Eilea in a fixed mode.
Results. It was found that significantly more often a poor response to treatment in the form of partial non-resposing or progression of the disease, despite treatment, is associated with elevated diastolic blood pressure (DBP, p = 0.01). An increase in systolic (SBP) blood pressure in patients with arterial hypertension and AMD is accompanied by an increase in eye perfusion pressure (p < 0.01), which apparently worsens the absorption of angiostatics and causes a poor response to treatment. According to the results of the study, the most favorable corridor of SBP values associated with ideal response is in the range of values of 104–140 mm Hg, and DBP is in the range of 68–80 mm Hg st., which should be taken as the recommended parameters of blood pressure in patients with nVMD receiving a course of treatment for Eylea. Intraocular pressure (IOP) has demonstrated itself as a second modifiable independent and independent risk factor for poor response to treatment with nVMD with line 1 anti-VEGF therapy drugs. Intraocular pressure (IOP) has demonstrated itself as a second modifiable independent and independent risk factor for poor response to nVMD treatment with line 1 anti-VEGF therapy drugs. The biomarker associated with the ideal response was — 12.6 mm Hg, and the corridor of recommended values — 11–21 mm Hg. An increase in ophthalmotonus with the output of personalized values beyond this corridor seems to worsen the outcome of treatment.
Conclusion. The identification of modifiable risk factors is extremely important in practical ophthalmology, as it opens up the possibility of increasing the patient’s chances of a better treatment outcome. Modifiable risk factors are valuable and powerful tools that replenish our arsenal. Information about them is important not only in the treatment of AMD, but can also be the patient’s motivation for switching to a healthy lifestyle and reducing the risk of developing the disease.
Purpose: evaluation of obesity as a risk factor for poor outcome (ineffectiveness) of antiangiogenic treatment of patients with neovascular AMD.
Patients and methods. Body mass index (BMI) was studied in 84 patients (92 eyes) with neovascular AMD who were treated with intravitreal injections of Eilea in a fixed mode.
Results. It was found that a poor treatment outcome in the subgroup with disease progression was associated with obesity of 1–2 degrees; the average BMI in this subgroup (with a deterioration in the morphostructural parameters of the retina) significantly exceeds the indicators of ideal respondents, for comparison: 31.5 ± 0.8 versus 28.6 ± 1.1 (p = 0.04); and the incidence of obese individuals is dominant: 72 %. At the same time, a moderate inverse reliable relationship of BMI with another risk factor — systolic blood pressure (SBP) was found. In this regard, we suggested that obesity indirectly affects the outcome of treatment, since it is “tied” to systolic blood pressure (p = 0.01). An argument in favor of this assumption is a higher correlation coefficient of SAD with the outcome of treatment. The authors hypothesized that obesity contributes to the development of hypertension by increasing the risk of poor outcome of nAMD treatment. The hypothesis explained the association of obesity with the progression of morphostructural changes in the retina in the group of non-responsents with nAMD.
Conclusion. Studies have demonstrated a causal relationship between obesity and the outcome of antiangiogenic treatment of patients with nAMD. The data obtained allow us to attribute OBESITY to moderate risk factors for a poor outcome of antiangiogenic treatment of patients with nAMD. Taking into account the fact that OBESITY is a modifiable factor that can be eliminated with certain efforts, opportunities are revealed to reduce the risk of an unfavorable outcome of treatment of patients with nAMD.
Visiometry is one of the fundamental diagnostic methods for assessing visual acuity, including the evaluation of the effectiveness of eye pathology treatment. Therefore, a precise determination of visual acuity is crucial. For a long time, visual acuity has been determined by reading optotypes on optometric charts (in Russia and the CIS countries, the Sivtsev — Golovin chart is the most widely used). With the advancement of “Eye tracking” technologies and the development of high-frequency and detailed monitors, it has become possible to determine visual acuity using induction of normal physiological nystagmus, followed by an analysis and conclusion about the presence of nystagmus on specific presented optotypes. One of the key factors in the accuracy of visual acuity determination is the correct calculation of the size and movement of optotypes, which is analyzed in this review.
Purpose: to identify the most significant factors associated with myopic refraction in medical university students, which can be used for early prediction and prevention of myopia.
Materials and methods. The survey data of students of 1–6 courses of Kazan State Medical University and the data on refraction of patients’ eyes obtained from the “Medical record of a patient receiving medical care on an outpatient basis” (registration form No. 025/y) were used. The refraction of the eye in each of the participants was calculated as the average value of the spherical equivalent of the right and left eyes.
Results. According to the ophthalmologist’s examination, myopia was detected in 219 (69 %) of the surveyed students. 134 (42 %) students had mild myopia, 66 (21 %) had moderate myopia, 19 (6 %) were highly myopic. Among myopes, 73 % of students wear glasses (160/219), contact lenses — 41 % of respondents (90/219). The median age of onset of spectacle wear was 13 years (Q1–Q3 = 10–26). The median refraction of the right eye (D) was -2.50 D (Q1–Q3 = -1.5…-4.0), the left eye -2.75 D (Q1–Q3 = -1.6…-4.0). The early age of onset of spectacle wear is the factor most significantly associated with myopic refraction (+0.23 D/year, p = 1.30×10-11), and an important prognostic sign of the development of high myopia. Factors associated with stronger myopic refraction are high height and low weight, as well as less physical activity.
Conclusion. It is necessary to take into account the anthropometric and behavioral features of the patient when developing an individual plan for the prevention and treatment of myopia, in order to avoid the development of complications leading to vision loss.
Background. Congenital partial atrophy of the optic nerve is one of the main causes of blindness and low vision in patients with fundus pathology, and the study of color vision is important in diagnosis and monitoring visual functions in patients with this disease.
Purpose: to study the possibilities of using the own developed method of quantitative and qualitative assessment of color vision in patients with partial optic nerve atrophy.
Materials and methods. 55 patients aged from 8 to 20 years with congenital partial atrophy of the optic nerve (PAON) with a typical fundus pattern and EFI indicators for this disease were observed. The control group included 116 people of the same age without fundus pathology and with normal visual acuity. To study color vision in both groups, the classic FarnsworthMunsell Dichotomous D15 Test and the own developed method for quantitative and qualitative assessment of color vision were used.
Results. The method developed by us made it possible to identify color perception disorders of varying severity in the majority (about 90 %) of patients with PAON. In the control group, no color perception disorders were detected in more than 70 % of the subjects. Quantitative assessment of color vision conducted using the method developed by us demonstrates significantly higher indicators of the total error of perception of color tones in patients with PAON (35.6 ± 3.2 degrees for a better-seeing eye and 39.9 ± 3.3 degrees for a worse-seeing eye) in comparison with the subjects of the control group (6.2 ± 1.1 degrees for a better-seeing eye and 7.5 ± 1.3 degrees for a worse-seeing eye). The severity of color perception disorders in patients with PAON does not depend on age, but has a significant inverse relationship with visual acuity. In the group of patients with PAON, when examining both better-seeing eye and worse-seeing eye, perception disorders of all color tones are detected with a slight predominance of disorders of perception of red, green and blue. The method developed by us has sufficiently higher sensitivity and specificity in comparison with the classic Farnsworth-Mansell D-15 test.
Conclusion. The method developed by us makes it possible to effectively carry out a quantitative and qualitative assessment of the state of color perception in patients with PAON.
CASE REPORT
The article describes a clinical case of the Vogt — Koyanagi — Harada syndrome with an ophthalmic manifestations: bilateral granulomatous panuveitis with funnel-shaped serous retinal detachment complicated by cataracts, clinical manifestations in the form of alopecia and poliosis, as well as the results of phacoemulsification with IOL implantation.
Purpose: analysis of clinical cases illustrating the classification features of severe stages of proliferative diabetic retinopathy (PDR).
Patient and methods. Three clinical cases of PDR are presented, in which ophthalmoscopic signs (according to the classification of the Early Treatment Diabetic Retinopathy Study, 1991) corresponded to severe PDR (high risk 1, high risk 2) and advanced PDR. The ophthalmological status was assessed using standard methods based on measuring the best corrected distance visual acuity, performing ultrasound (Opticon 2000, Italy), photographic recording of the condition of the fundus (Carl Zeiss Visucam 500, Germany) and optical coherence tomography of the macular region (on an RTVue-100 tomograph, OptoVue, USA).
Results and conclusion. The presented clinical examples will provide the ophthalmologist with a more complete understanding of the clinical picture of pathological changes in the retina in diabetes mellitus, which will ultimately increase the level of diagnosis and tactics of surgical intervention both during the initial (preoperative) examination and after vitrectomy.
Objective. To present the results of successful treatment of a patient with corneal lesions caused by Acanthamoeba spp. receiving long-term conservative treatment.
Methods. A child with corneal ulcer of mixed etiology with a history of wearing orthokeratology lenses and long-term ineffective treatment in Moscow hospitals was referred to Moscow in S.N. Fyodorov Eye Microsurgery Federal State Institution. The patient underwent a complete ophthalmological examination, including confocal microscopy.
Results. The condition of the child’s eye was extremely severe, live and dead cysts of Acantamoeba spp were found in the central zone of the cornea at the depth of 113–149 μm, Along with intensive conservative treatment with catheterisation of the retrobulbar space and introduction of drugs into the irrigation system, UV corneal crosslinking was performed twice.
Conclusion. Treatment according to the proposed method allowed to achieve excellent results: there was no corneal syndrome, complete epithelialisation of the corneal defect, disappearance of corneal edema and remission of uveitis manifestations. According to the data of confocal microscopy there is no growth of microflora and acanthamoeba cysts.
Introduction: Giant cell (temporal) arteritis (GCA) is a cell-mediated vasculitis that damages the major blood vessels such as an aorta with its major branches and mainly extracranial branches of the carotid artery. Vision loss that can be caused by the anterior ischemic optic neuropathy (AION) or by the central retinal artery occlusion (CRAO) is considered to be one of the most terrible complications of the GCA. In the represented clinical case the complete vision loss was the cause of hospitalization of the patient and the basis for a diagnosis of GCA at the same time. The episodes of the reversible visual impairment that were observed 9 days before the hospitalization attract attention to themselves.
Purpose. to pay attention to the main ophthalmological and general symptoms that let the doctor to suspect this disease during the primary reception and to carry out diagnostics promptly to start timely treatment.
Conclusion. The main criteria for diagnosis of GCA in the practice of ophthalmologists are female gender, age over 50 years, intense headache with paresthesia, pain in the lower jaw during chewing and short-term episodes of vision loss. Clinical blood test including erythrocyte sedimentation rate, C-reactive protein level and platelet count are the necessary laboratory diagnostic methods.
TIPS FOR ОPHTHALMOLOGIST
The priority directions of the state policy of the Russian Federation are medical and preventive measures related to the physical and social improvement of the country’s population. These measures are aimed at improving the quality and effectiveness of medical rehabilitation activities and at reducing the morbidity and disability of various groups of patients. Clouding of the lens (cataract) is very different in terms of time of occurrence, localization, flow and is always accompanied by weakening of vision. Existing theories explain the pathogenesis of cataracts by the general state of the body (dysfunction of the glands of internal secretion, hidden tetany, violation of the functions of the autonomic nervous system, main exchange, etc.), unfavorable heredity, negative external influences, etc.The results of various studies strongly show that Quinax (azapentacen 5,12-dihydroazapentacene sodium disulfonate), 0.015 %, is an anticataract agent on all layers of the lens. In 2023, PROFIT-PHARM (PROFIT-PHARM LLC) developed domestic Quinax eye drops. It is necessary to conduct a study of their clinical effectiveness in patients with various types of cataracts, as well as to prevent its occurrence.
ЕXPERIMENTAL STUDIES
justification. Degenerative retinal diseases associated with retinal pigment epithelium damage are untreated and lead to irreversible vision loss. The most promising approach nowadays is considered to be the transplantation of retinal pigment epithelium differentiated from pluripotent stem cells (PSC-RPE). When testing biomedical cellular products, special requirements are placed on the animal model, which should simulate pathological changes, such as in humans, and have sufficient immunological tolerance to xenogenic human cells, enabling them to function fully. For this purpose, lines of immuno-modified or immunodeficiency animals are used, usually small rodents (rats and mice), but the small size and structure of their eyes do not allow manipulation in vitreoretinal interventions in humans. An alternative method of preventing xenotransplantation rejection in large models is pharmacological immunosuppression, under which transplanted PSC-RPE may have biological effects. However, targeted studies of the effectiveness of PSC-RPE transplantation with use of immunosuppressive therapy have not been conducted in our country, and the data of a few foreign works devoted to this problem are contraversial.
Purpose. Study of immunological reactivity in transplantation of IPSC-RPE under combined immunosuppressive therapy in rabbit experiment.
Materials and methods. The study was performed on 27 male rabbits of New Zealand albino breed, of which 24 animals underwent subretinal transplantation of induced pluripotent stem cells of retinal pigment epithelium: in the I group (12 eyes) intervention was performed in the healthy eye; in group II (12 eyes) — in the area of pre-modeled atrophy of retinal pigment epithelium. Recipients were given combined immunosuppressive therapy. Control Group — 3 intact rabbits (6 eyes). The observation period was 14, 28 and 60 days. Post-transplant evaluation was carried out using standard and specialized ophthalmological examination methods. The determination of cytokines of the immune response IL-2, IL-6, immunosuppressive factors TGF-β1, TGF-β2, TSP-1 in the serum of the blood and the vitreous body was performed by solid-phase immunosurgical enzyme analysis.
Results. Comprehensive analysis of biomicroscopy, ophthalmoscopy, optical coherent tomography, immunological studies revealed no signs of active inflammation; no local and systemic increase in the concentration of acute phase IL-6, a drop in serum IL-2 levels indicated direct effects of immunosuppressive drug combinations used in this study.
Conclusion. The use of combined immunosuppressive therapy prevented rejection of xenogenic material in rabbits and obtained evidence of safety of subretinal transplantation of IPSC-RPE suspension both in the healthy eye, and pre-induced atrophy of pigmentary epithelium.
Purpose. Wistar rats are often used in ophthalmological studies and in testing substances having therapeutic effects. The condition of the eyes of these animals, as well as other mammals, including humans, in the normal state, pathology, and aging, depends on the work of the lacrimal glands. The aim of this study was to develop convenient approaches for determining age-dependent histopathological changes in the exorbital lacrimal glands (ELGs) of aging rats.
Material and methods. Isolated ELGs obtained from Wistar rats aged of 8 and 11 months served as a material of the study. Changes in the structure of ELGs were evaluated using methods of computer analysis of morphological patterns and quantitative data processing.
Results. The functioning and state of the ELGs are reflected in their dramatic structural changes and progressive inflammation. Our study proposes a simple way to assess the state of ELGs in aging rats using methods of morphology and computer programs. Using the proposed approach, it was shown that in the period from 8 to 11 months of postnatal development, significant age-related changes occur in aging rats. Changes manifest in the progress of parenchymal degeneration and progressive infiltration of the tissue by inflammatory cells.
Conclusions. The proposed method of ELG state’s evaluation can be used in ophthalmological studies, and in particular, when studying the development of “dry eye” syndrome and testing the means of its therapy.
The continuous development of vitreoretinal surgery makes it possible to provide high-tech care to patients with retinal detachment while minimizing intraand postoperative complications. However, their percentage still remains significantly high. This pushes modern ophthalmological science to new research and search for solutions to existing problems. In this task, laboratory animals, on which the latest advances in medicine have been tested for more than 100 years, help like no one else. Unfortunately, the high cost of experiments often repels and/or pushes them back indefinitely. Given the clinical significance of experimental studies of surgical treatment of retinal detachment, as part of the study of the new hydrogel preparation Vitreolon, an analysis was made of methods for removing the vitreous body and their effect on the result of surgical intervention.
Purpose: analysis of differences in vitreous removal techniques in laboratory rabbits.
Material and methods. The experiment involved 6 rabbits (12 eyes) with induced retinal detachment. In 6 eyes, vitrectomy was performed using a vitreotome, in the others, using a syringe (21G). Subsequently, tamponade of the vitreal cavity was performed with the new hydrogel preparation “Vitreolon”. Ophthalmological examinations were performed on the 1st day, 1st and 2nd week, 1st and 3rd months after surgery. After that, the eyes were enucleated to conduct a morphological study of macropreparations and histological sections of the eyes.
Results. According to the results of ophthalmological and laboratory studies, there was no statistically significant difference between the techniques for removing the vitreous body. One rabbit had hypertension and cataracts, which indicates its individual response to surgery. There were no complications that could lead to early termination of the experiment.
ISSN 2500-0845 (Online)