Vestnik oftalmologii最新文献

The main controllable factor in glaucoma is intraocular pressure, which is stabilized by medication, laser and surgical treatment methods. Over the past 20 years, advancements in surgical techniques for antihypertensive interventions have led to the emergence of a new class of procedures called microinvasive glaucoma surgery (MIGS). This review focuses on Russian and foreign microinvasive drainage devices that are currently the most widely used. For a large number of glaucoma patients, when traditional treatment methods are not effective and safe enough, MIGS using modern shunts is often the only way to stabilize intraocular pressure.

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 problem of combined surgical treatment for cataract in patients with primary open-angle glaucoma remains highly relevant due to the large number of comorbid patients. Ultrasound phacoemulsification has become the modern standard of cataract phaco surgery, including in combination with other procedures. However, the choice of the antiglaucoma component in simultaneous surgical interventions remains largely unresolved. This review outlines the main current techniques - in particular, pathogenetically oriented - for performing the antiglaucoma component of combined surgery in patients with cataract and primary open-angle glaucoma.

Placement of gold eyelid weights (GWs) is an effective minimally invasive method for protecting the cornea in paralytic lagophthalmos (PL). Potential complications of this surgery include nonspecific inflammatory response (NIR), implant dislocation and eruption, and others. Timely detection, monitoring, and management of these complications require assessment of eyelid tissues, GW capsule and GW position using ultrasonography.

Purpose: Sonographic evaluation of the results of GW placement in patients with PL.

Material and methods: The study included 20 patients (20 eyelids) with chronic facial palsy (CFP) and PL who underwent ultrasound examination (high-resolution gray-scale B-scan, color Doppler mapping (CDM), three-dimensional color Doppler, echodensitometry, ultrasound biomicroscopy (UBM) of the upper eyelid) in the long-term (2 to 13 years) after the placement of a multi-segment gold eyelid weight made of 999-purity gold (99.99% pure metal).

Results: This study characterizes ultrasound diagnostic features that allow determining the GW size and echodensity, GW capsule, anterior lamella, as well as the vascularization of surrounding tissues. The study also describes the imaging features of upper eyelid tissue with proper GW placement in the primary fixation site, and in cases of its dislocation and exposure.

Conclusion: Ultrasound imaging methods provide reliable visualization of the GW and upper eyelid tissues in both uncomplicated and complicated cases involving implant disclocation or tendency to exposure. These methods show promise for identifying risk factors for implantation-related complications and require further investigation.

The etiology of uveitis, choroid inflammation, is diverse, the disease is often recurrent, difficult to treat, and frequently results in disability at a young age. Studies investigating the tear fluid composition in uveitis have revealed promising biomarkers relevant for prognosis and treatment optimization. This review presents literature data on changes in the tear fluid content of proteins involved in local immune responses, intercellular interactions, proteolytic and free radical processes, nitric oxide metabolism, and other metabolic pathways in different forms of uveitis. The paper also demonstrates the significance of assessing these changes for prognosis and for a pathogenetically based, personalized treatment approach, and identifies specific alterations associated with different uveitis etiologies, offering insight into the mechanisms underlying this pathology.

The chronic course of keratoconus (KC) and the associated structural and functional changes in the cornea complicate the interpretation of intraocular pressure (IOP) measurements. A promising approach is to analyze tonometric data with consideration of the variability of corneal biomechanical (viscoelastic) properties and thickness rather than disease stage. This is supported by clinical observations showing a wide variation in IOP values even within the same stage of KC.

Purpose: This study aimed to comparatively evaluate tonometric readings obtained by different devices in KC based on corneal biomechanical characteristics and thickness.

Material and methods: A total of 167 patients (334 eyes) with bilateral KC (mean age 31.0±8.8 years) were examined. Three subgroups were formed according to data from bidirectional pneumotonometry (Ocular Response Analyzer, ORA) and non-contact tonometry (Corvis ST with Scheimpflug imaging), taking into account corneal hysteresis (CH), corneal resistance factor (CRF), and central corneal thickness (CCT). IOP was measured by pneumotonometry, bidirectional pneumotonometry (ORA), rebound tonometry (RT), dynamic contour tonometry (DCT), and Maklakov tonometry.

The analysis assumed that, excluding structural changes in the cornea in young subjects, differences in IOP values between subgroups would be minimal. Thus, the observed deviations were attributed mainly to biomechanical changes in KC, where lower tonometric readings reflected greater dependence of IOP on the degree of corneal deformation.

Results: Statistically significant differences (p<0.05) in tonometry readings between subgroups confirmed the substantial impact of corneal biomechanical parameters and thickness on IOP measurements in KC. The greatest variability (39-50%) was observed with pneumotonometry and bidirectional pneumotonometry (Goldmann-correlated IOP, IOPg, by ORA). In these cases, lower IOP values correlated with poorer biomechanical status of the cornea and lower CCT. For other methods (corneal-compensated IOP (IOPcc) by ORA, RT, DCT, and Maklakov tonometry), the variability was less pronounced and did not exceed 26%.

Conclusion: Regardless of the method used to assess intraocular pressure, alterations in corneal biomechanics in KC result in underestimation of IOP values.

Keratorefractive surgical procedures have become widely used in recent years. However, during femtosecond LASIK, a number of intraoperative cavitation-related complications may occur, one of which is the formation of an opaque bubble layer (OBL). This necessitates careful postoperative monitoring of corneal status. One of the most effective diagnostic methods in such clinical situations is corneal confocal microscopy (CCM), which has proven to be a reliable tool for visualizing all corneal layers, including in keratorefractive surgery. However, the characteristics of OBL revealed using this technique have not yet been adequately studied.

Purpose: This study aimed to evaluate the potential of CCM using an original algorithm for confocal image analysis in patients with and without OBL in randomized groups.

Material and methods: The study included 45 patients (90 eyes) with myopia (mean -5.0 D). Participants were divided into two groups: the study group consisting of individuals with OPL, and the comparison group (patients without this complication). In all cases, visual acuity assessment, refractometry, and CCM were performed with acquisition of images of various corneal layers before femto-LASIK and at 1, 4, 12, and 24 weeks postoperatively. Liner Calculate, a proprietary software program, was used to analyze the dimensions of the OPL zone.

Results: Destructive changes in keratocytes were more pronounced in patients with OBL compared to those in the femtosecond LASIK group without the complication. The depth of stromal damage was also increased; blurred cell boundaries and increased size and reflectivity of keratocyte nuclei were observed in all study participants. At 6 months postoperatively, complete restoration of the corneal stromal layers was not achieved in either group. Morphological and structural keratocyte abnormalities persisted by the end of this period, and were more pronounced in patients with OBL.

Conclusion: The formation of OBL after femtosecond LASIK is associated with more extensive destructive keratocyte changes, which prolongs the corneal stromal recovery period.

The biography and multifaceted professional activities of Sergey Nikolaevich Lozhechnikov (1838 - March 6, 1911), one of the most respected figures of the Moscow ophthalmological school and Chief Physician of the Moscow Eye Hospital, remain insufficiently explored. This report attempts to generalize scattered and extremely scarce journalistic accounts along with some discovered archival documents that shed light on the key stages of S.N. Lozhechnikov's life, as well as his contributions to the development of ophthalmology and advancement of public healthcare in Russia. The article highlights the close and historically significant connection of the Moscow Eye Hospital with the Moscow University and its medical faculty and clinical infrastructure.

Primary open-angle glaucoma (POAG) is characterized by chronic progressive damage to the retinal ganglion cell layer (GCL) and their axons, leading to gradual visual function loss. Currently, the gold standards for structural and functional assessment of the retina in glaucoma are static automated perimetry (SAP) and optical coherence tomography (OCT). However, in clinical practice, data from SAP and OCT may be insufficient to reliably determine the stage of glaucomatous optic neuropathy, monitor its progression, or differentiate it from other causes of visual dysfunction. For these purposes we can use various modifications of electroretinography (ERG), visual evoked cortical potentials (VECPs), as well as electrophosphene testing - threshold retinal electrical sensitivity (TRES) and lability of the optic nerve (LON).

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.