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.

This article reviews the pathogenic mechanisms underlying proliferative diabetic retinopathy (DR), focusing on the development of angio-fibrotic switch, neurodegeneration, pro-inflammatory and pro-angiogenic biomarkers, emphasizes the modern perspectives on the role of the vitreous body and mechanical traction in DR progression. Understanding of these pathogenic mechanisms will provide new opportunities for improvement and development of treatments for DR at earlier stages, before significant and persistent functional impairment occurs.

The earliest damage in glaucoma starts in the posterior pole of the eye, where the axons of retinal ganglion cells, that form the optic nerve fibers, and retinal vessels pass through the connective tissue network called the lamina cribrosa (LC). Modern diagnostic techniques, such as optical coherence tomography (OCT), enable the visualization of the LC and the assessment of blood flow within it, providing new opportunities for the diagnosis of glaucoma. This review highlights the anatomy and vascularization of the LC, along with the latest research findings obtained via OCT. The article details age-related changes in the LC and the impact of intraocular pressure (IOP) changes on its properties. A novel parameter, the lamina cribrosa curvature index (LCCI), reflecting LC deformation, has been shown to be the most important biomarker of glaucomatous damage.

The 21st century is characterized by the study of the features of malignant tumor infiltration by cellular components of the immune system. While some findings suggest a favorable role of lymphoid infiltration in tumors and its positive impact on survival due to immune defense, the opposite is observed in uveal melanoma (UM): lymphoid infiltration significantly worsens the patient's prognosis. Research on this topic is limited, with some studies confined to experimental models.

Purpose: This study investigated the correlation between microRNA-155 expression in the plasma of UM patients after primary enucleation and with pathomorphological inflammatory changes.

Material and methods: Eighty-three patients with UM were examined, in 21 cases lymphoid infiltration of the primary tumor was detected, in 6 cases accompanied by a microenvironment. The degree of tumor infiltration with lymphocytes was estimated as a percentage of the total number of cells in the analyzed field, ranging from 1% to 25%. Real-time polymerase chain reaction was used to determine microRNA-155 expression in the plasma of all patients before and after enucleation, and its correlation with the level of lymphoid infiltration was analyzed. Postoperative follow-up lasted 6 to 53 months (mean 21.5±14.9 months). In two cases, in the presence of a tumor microenvironment, metastases to the liver were detected 6 and 10 months after enucleation. MicroRNA-155 levels in a volunteer group were used as the control baseline, set at 100% for clarity and convenience.

Results: MicroRNA-155 expression levels were higher in patients with lymphoid infiltration (p<0.05) and tended to increase with the degree of primary tumor infiltration (p<0.001), which in itself, with the appearance of a perifocal lymphoid environment, indicated a poor prognosis.

Conclusion: Monitoring microRNA-155 expression levels in the plasma of UM patients may help predict occult metastasis prior to enucleation. This is not only crucial for clinical follow-up but may also play a significant role in the development of targeted therapies.

Glaucoma is a chronic multifactorial neurodegenerative disease; the most studied local risk factors for glaucoma progression are elevated intraocular pressure (IOP) and its diurnal fluctuations. However, normalization of IOP does not always guarantee stabilization of the glaucomatous process. This article reviews data from international and Russian studies on the pathophysiological mechanisms underlying the development and progression of glaucomatous optic neuropathy, and discusses current approaches to its therapeutic management.

Refractive anomalies are among the leading ocular conditions affecting the working-age population. One of them - high myopia - can cause severe and irreversible ocular changes, resulting in significant visual impairment or loss.

Purpose: This study evaluated changes in vault height of phakic intraocular lenses (PIOL) and intraocular pressure (IOP) following the implantation of the ICL V5 (VICM5) lens in patients with high myopia.

Material and method: The study included 60 patients. They were monitored for at least 24 months. Observation included measurement of clinical refraction, uncorrected visual acuity (UCVA), IOP, and the distance between the posterior surface of the optical part of the lens and the anterior surface of the crystalline lens (vault).

Results: All surgeries were completed without complications. The safety and efficacy indices were 1.43 and 1.34, respectively. In 97 eyes (86%) with high myopia UCVA was equal to or better than preoperative values. The mean preoperative spherical equivalent was -10.59±3.4 D, which improved postoperatively to -0.5±0.75 D. Subsequently, the spherical equivalent remained within ±0.5 D in 89% of patients. The mean postoperative IOP was 15.86±3.30 mm Hg over the course of the 24-month follow-up. One month post-implantation, the vault height of the spherical lens ICL was 469.3±134.4 µm and 432.6±124.5 µm after 24 months (p<0.001).

Conclusion: Implantation of the Visian ICL V5 lens is a safe and effective alternative refractive surgery method for the correction of high myopia.

The rising prevalence of diabetes mellitus increases the need for treatment of diabetic maculopathy (DM). Evaluation of surgical outcomes in DM, including postoperative microstructural changes in the retina and its vascular plexuses, remains a relevant challenge.

Purpose: This article assesses changes in angiographic parameters of the retinal capillary plexuses after surgical treatment of DM using various methods of internal limiting membrane (ILM) peeling.

Material and methods: Vitreoretinal surgery, including vitrectomy with membrane peeling, was performed in comparable groups of patients with proliferative diabetic retinopathy and DM. The surgical methods differed in the approach to retinal ILM peeling: in group 1 the ILM was completely removed; group 2 underwent dosed fovea-sparing peeling (DFSP) of the ILM; in group 3 the ILM was left intact. Postoperative outcomes were compared between groups using optical coherence tomography angiography (OCT-A).

Results: Intergroup comparisons across all time points and parameters did not reveal statistically significant differences. The analysis showed no significant changes in angiographic parameters in groups 1 and 3. In group 2 significant changes were observed in the parameters of deep capillary plexus: increased vessel density, vessel skeleton density and vessel perimeter index, as well as reduced foveal avascular zone (FAZ) area. Correlation analysis revealed that high FAZ area values in the deep capillary plexus were predictors of the development of retinal atrophy in the long-term.

Conclusion: The obtained results demonstrate the dynamics of changes following DFSP of the ILM in both the neuronal structures of the retina and its capillary plexuses, with these changes tending toward normalization of retinal structure.

Purpose: This study investigates the clinical features and outcome dimensions of neovascular age-related macular degeneration (nAMD).

Material and methods: This retrospective study analyzed 80 subjects diagnosed with nAMD. The patients received successful treatment through intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents. The subjects were classified into three groups based on the final integrity of their inner segment/outer segment (IS/OS) layer of the retina, assessed using spectral-domain optical coherence tomography (SD-OCT). This classification helped to understand the extent of retinal damage and the progression of nAMD. The primary evaluation was to examine the association between final IS/OS integrity and final visual acuity in the groups. The study also evaluated foveal microstructures (choroidal neovascularization size, external limiting membrane, outer nuclear layer thickness, and central macular thickness) at the initial and final visits, and their relationships with final IS/OS integrity.

Results: The study found a significant association (P<0.001) between final visual acuity and IS/OS integrity. The V group had the best visual acuity (0.12±0.09) compared to the P group (0.39±0.45) and I group (0.92±0.42). Improved visual acuity was strongly correlated with less disrupted IS/OS and ELM. Intact photoreceptor integrity was linked to preserved IS/OS and ELM, thinner CMT, and shorter CNV height before treatment. However, photoreceptor integrity was not significantly correlated with CMT, RPE regularity, or ONL thickness at the final examination, suggesting it may be independently affected by nAMD.

Conclusion: Final visual acuity in nAMD patients post-treatment was strongly linked to foveal photoreceptor integrity. Photoreceptor integrity correlated with initial visual acuity, CMT, ELM integrity, CNV height, and IS/OS layer integrity. These factors can predict visual outcomes after resolution of exudaiton.

This article analyzes two clinical cases of axial displacement of an intraocular lens (IOL) in the postoperative period in hyperopic patients following cataract surgery with implantation of a monoblock hydrophobic acrylic IOL with S-shaped haptics. In both cases, cataract phacoemulsification was performed using the standard phaco chop technique, with intracapsular IOL implantation targeting emmetropia. It was determined that the refractive shift towards myopia with underlying baseline hyperopia in these cases was not due to errors in calculating the IOL optical power. The cause of ineffective IOL positioning and myopization was the formation of blocks: in the first case - a vitreo-pseudophakic block due to anterior displacement of the pseudophakic diaphragm, and in the second case - a capsular block. It was concluded that when a myopic shift is detected in the postoperative period in patients with cataract surgery targeting emmetropic refraction, it is necessary to thoroughly analyze the obtained results, identify the precise causes of refractive failures, and provide appropriate pathogenetically oriented treatment to achieve the initially planned outcomes.

Proteins and lipids in the meibum help maintain the balanced chemical composition of the tear film. However, the secretion of the meibomian glands contains various protein fractions, the function and effects of which on the lipid profile remain incompletely understood. This literature review provides a description of the main proteins of the meibum and their roles in the pathogenesis of meibomian gland dysfunction associated with age-related changes and metabolic disorders that lead to impaired tear film functionality. The article also analyzes modern methods for studying meibomian gland secretion.