Vestnik oftalmologii最新文献

Ophthalmic herpes zoster is the second most common form of herpes zoster and can lead to complete vision loss. Since necrotizing herpetic retinopathies are relatively rare and often reported as isolated clinical cases, establishing a unified approach to managing such patients is challenging. The aim of this study was to summarize current knowledge on the etiopathogenesis, diagnostic features, and treatment of progressive outer retinal necrosis. A total of 30 articles published in peer-reviewed journals between 2011 and 2019 and accessible through the EBSCO database were analyzed. The search employed relevant keywords and abbreviations: varicella zoster virus (VZV), herpes zoster ophthalmicus (HZO), necrotizing herpetic retinopathies (NHRs), and progressive outer retinal necrosis (PORN). The results of this analysis present the current understanding of the prevalence, clinical features, and management strategies for progressive outer retinal necrosis caused by VZV.

Age-related macular degeneration (AMD) is a progressive degenerative retinal disease and a leading cause of blindness in older adults worldwide. According to numerous studies, the number of affected individuals reached 196 million in 2020, with projections estimating an increase to 288 million by 2040, including 18.6 million cases of advanced AMD. The advent of optical coherence tomography (OCT) has enabled researchers and clinicians to characterize microstructural changes in different retinal layers at earlier disease stages and improve monitoring strategies. Important steps have been taken to develop algorithms capable of recognizing early signs of AMD, assessing its severity, and predicting progression. These algorithms have formed the basis for artificial intelligence (AI)-driven systems applicable to any hardware or software exhibiting intelligent behavior. OCT imaging allows for the identification of biomarkers whose presence or interaction with other factors predict transition from intermediate to advanced AMD. The obtained data can provide deeper insights into the pathogenesis of intermediate AMD, enhance early diagnosis for timely intervention, and facilitate the search for new treatment options. Artificial intelligence could make this process easier, simpler, less time-consuming, and more accurate by integrating structural OCT data with genetic risk indicators and lifestyle characteristics. However, the results are still inconsistent due to factors leading to limited result reliability, such as database quality, sample sizes, and data acquisition methods.

Treatment of proliferative diabetic retinopathy (PDR) complications, such as vitreous haemorrhage and tractional retinal detachment, as well as macular involvement, remains a complex multifactorial challenge. The use of angiogenesis inhibitors (AIs) at different stages of patient management is being investigated. In particular, intraoperative use of AIs appears to be pathogenetically justified.

Purpose: This study evaluates the effect of intraoperative administration of AIs on the outcomes and complication rates in the surgical treatment of PDR.

Material and methods: A comparative analysis of anatomical and functional outcomes, as well as postoperative complication rates, was performed in two comparable groups of patients who underwent surgery for PDR complications: one with intraoperative AI use (60 cases, 60 eyes), and one without it (109 cases, 109 eyes). The evaluation was conducted at the early (1 month) and long-term (6 months) postoperative follow-ups.

Results: The use of AIs was significantly correlated with higher postoperative visual acuity at all follow-up periods and with lower central retinal thickness (CRT) at 1 month after surgery. The complication rate was numerically higher in the group without AIs use, with borderline statistical significance noted for vitreous hemorrhage and anterior segment neovascularization (p=0.079 and p=0.096, respectively). No statistically significant differences were observed between the groups in the incidence of diabetic macular edema (DME) or cases of vitreous hemorrhage requiring revision surgery.

Conclusion: Given the high variability in clinical presentation of PDR, the use of AIs at different stages of treatment is justified. The study provides promising insights into the effects of intraoperative AIs administration on anatomical and functional outcomes, as well as complication rates. Further research into AIs effects taking into account the cytokine profile may be relevant for the personalized selection of treatment strategies.

A healthy ocular surface is characterized by relatively stable and comparatively low microbial diversity. However, pathological conditions can provoke shifts in the composition of bacterial taxa, which may be associated, among other factors, with the progression of myopia.

Purpose: This study compared the taxonomic diversity of the conjunctival microbiota in children with varying degrees of myopia and those without clinically confirmed myopia.

Material and methods: Ocular surface samples were obtained from 29 children aged 6-17 years with myopia (58 eyes) and from 12 children of the control group aged 9-17 years (24 eyes). The taxonomic composition of the conjunctival microbiota was analyzed using 16S ribosomal RNA gene (rRNA) sequencing, followed by microbiome profiling through bioinformatics and statistical tools.

Results: The ocular surface microbiota in children with myopia demonstrated higher alpha diversity compared to the control group. This was confirmed by values of the Chao (reflecting low-abundance taxa) and Shannon (reflecting overall bacterial diversity - higher diversity means higher index; optimal value; 3.1-4.2) indices. The results revealed a clear trend toward differentiation in bacterial composition between myopic and control groups. These differences were associated with changes in the relative abundance of opportunistic bacteria depending on the degree of myopia.

Conclusion: The taxonomic diversity of the ocular microbiota at the genus level in patients with varying degrees of myopia was characterized by a higher number of taxonomic units compared to the control group. The general trend is an increase in the biodiversity of the bacterial composition due to an increase in the relative representation of opportunistic microorganisms. Further research on the influence of the ocular microbiota on the progression of myopia is needed.

Rosacea is a chronic inflammatory dermatosis, one manifestation of which involves pathological processes in various ocular structures. The most severe form is rosacea-associated keratitis. Given the multifactorial etiology and pathogenesis, this condition remains unpredictable and resistant to treatment. This study presents a clinical case of using ozone therapy in the management of complications following penetrating keratoplasty in the setting of rosacea-associated keratitis and demonstrates the therapeutic effectiveness of ozone therapy as part of a comprehensive approach to managing post-keratoplasty complications in patients with rosacea-associated keratitis. The inclusion of ozone therapy led to clinical and functional improvement by day 10. By day 60, corneal syndrome manifestations were minimal, the graft remained transparent, and significant regression of neovascularization was observed. Due to the pronounced anti-inflammatory and reparative effects of therapeutic ozone concentrations, its use in this context is pathogenetically justified.

Diffuse lamellar keratitis (DLK) is a known complication of lamellar corneal surgery. The underlying mechanism of the cellular response in DLK is well described. There are two clinical forms - sporadic and cluster - each largely influenced by surgical triggers.

Objective: This study analyzes the incidence of different variants of DLK, identifies surgical causes, and outlines distinguishing features and preventive strategies.

Material and methods: The study included data from 19783 patients aged 18-45 years, among them 97% had myopia, and 3% had hyperopia. Patients in all examined cases underwent Laser-Assisted in Situ Keratomileusis (LASIK).

Results: The incidence of the sporadic form of DLK was 1:110, and the cluster form - 1:20. The main causes of cluster-form DLK were related to toxic surgical agents used in eyelid sanitation, keratomes, and medical gloves. Elimination of these factors stopped the progression of the cluster form. Sporadic DLK was associated with transient triggers disrupting the state of the interface. No DLK cases were recorded in patients undergoing hyperopia correction.

Conclusion: The primary surgical trigger for diffuse lamellar keratitis during LASIK is instability of the stromal interface resulting from improper flap repositioning, specific features of planar ablation, and exposure to toxic agents during surgery.

Despite the positive outcomes of anti-VEGF therapy, neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME) remain major medical and social challenges, and optimization of their treatment is an urgent need.

Purpose: This study evaluated the effectiveness of Vabysmo (faricimab) in the treatment of patients with nAMD and DME in real-world clinical practice in Russia.

Material and methods: A multicenter retrospective analysis was conducted based on the medical records of 328 patients (370 eyes) with nAMD and 87 patients (112 eyes) with DME (both treatment-naïve and previously treated with anti-VEGF agents) who received faricimab from July 2023 to February 2025. The following primary effectiveness indicators were assessed: changes in visual acuity (VA) and central retinal thickness (CRT) after the first four faricimab injections. Secondary outcome indicators included changes in VA, CRT, and selected disease biomarkers at 6, 12, and 18 months of treatment, as well as injection intervals during the maintenance phase.

Results: After the first four consecutive faricimab injections, VA improved by 8.1 ETDRS letters (p<0.05) in the nAMD group and by 12.8 ETDRS letters (p<0.05) in the DME group. CRT decreased by 103.3 μm (p<0.05) and 177.4 μm (p<0.05), respectively. These improvements remained stable during further follow-up (8.78±4.51 months in the nAMD group and 10.48±5.24 months in the DME group, up to a maximum of 19 months in both groups). The proportion of patients who achieved injection intervals of ≥12 weeks was 27.9% in the nAMD group and 38.5% in the DME group.

Conclusion: Faricimab demonstrated high clinical effectiveness in real-world settings in patients with nAMD and DME, with the potential to reduce the treatment burden for patients and the healthcare system.

An increase in the content of pro-inflammatory cytokines in blood plasma in sarcopenic obesity (SO) is a predictor of progressive loss of muscle strength and is associated with an increased risk of disability and mortality in old age. To date, practically no studies has been conducted to address the characteristics of cytokine status in this category of patients with age-associated ophthalmic pathology.

Purpose: This study analyzed and evaluated the ratio of pro- and anti-inflammatory interleukin (IL) levels in blood plasma of elderly patients with sarcopenia/SO and cataract.

Material and methods: The study included 48 patients aged 60-74 years with SO and cataract (group 1) and 54 patients aged 60-74 years with sarcopenia and cataract (group 2) who underwent inpatient examination and treatment at the Tambov branch of the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" in 2023-2024. Plasma levels of IL-1α, -1β, -4, -5, -6, -7, -8, -9, -10, -12, -17, and IL-18 were measured using flow cytometry. The control group included 32 patients aged 60-74 years without sarcopenia/SO and ophthalmic pathology.

Results: The study revealed that in elderly patients with cataract, a pronounced increase in pro-inflammatory and a decrease in anti-inflammatory IL plasma levels contributes to the transition from sarcopenia to SO. Plasma IL-6 levels in group 1 patients reached 22.3±2.0 pg/mL compared with 4.9±0.6 pg/mL in the control group (p<0.001). Development of SO in elderly patients with age-associated ocular pathology was also associated with an increase in IL-8 concentrations to 36.4±3.3 pg/mL and IL-17 to 20.5±1.6 pg/mL (p<0.001 for both). Plasma levels of anti-inflammatory ILs were significantly lower (p<0.01) in patients with SO and cataract: for IL-4 it was 2.1±0.2 pg/mL, for IL-10 - 9.4±0.4 pg/mL.

Conclusion: The identified features of comorbidity of age-associated ophthalmic pathology (cataract) and sarcopenic disorders may have certain clinical significance. In particular, the observed associations may provide a basis for developing recommendations by nutritionists/dietitians and ophthalmologists for these patients regarding dietary and lifestyle modifications.

Tolosa-Hunt syndrome (THS) is a rare neuro-ophthalmological pathology caused by nonspecific granulomatous inflammation in the area of the cavernous sinus, which leads to painful ocular motility restrictions and ophthalmoplegia. The disease is characterized by lesions of the III, IV, and VI cranial nerves, with possible extension to branches of the V nerve and oculosympathetic fibers. This review analyses current data on this disease, with emphasis on its clinical presentation, diagnostic criteria and treatment methods. Taking into account the complexity of identifying THS, emphasis is made on the need for careful differential diagnosis with other clinically similar conditions, such as brain tumors, vascular aneurysms, inflammatory processes, etc. Timely detection of the syndrome and initiation of appropriate treatment, including the use of glucocorticoid hormones, can help prevent serious complications in the form of vision loss or permanent impairment of ocular motor function.

This review addresses the current state of quantitative assessment of metamorphopsia. The article briefly describes the main symptoms of macular pathology as well as diseases associated with the development of metamorphopsia, defines the concept of metamorphopsia, and outlines different approaches to its classification. A substantial part of the review focuses on diagnostic methods for metamorphopsia, particularly the most widely used techniques for its quantitative evaluation. In addition, the work analyzes the main advantages and limitations inherent to these methods. It is substantiated that no optimal method for the quantitative assessment of metamorphopsia currently exists.