Vestnik oftalmologii最新文献

Purpose: This study aimed to investigate the plasma expression levels of microRNA-223, microRNA-27b, and microRNA-155 in patients with choroidal melanoma (CM) T_1-2N₀M₀ before and after brachytherapy (BT).

Material and methods: A total of 41 patients with choroidal melanoma T_1-2N₀M₀ were examined. The mean age was 59.8±15.26 years (ranged 25-81). All patients underwent standard ophthalmologic examination and CT/MRI to exclude metastases. Blood plasma expression levels of microRNA-223, -27b, and -155 were determined using real-time PCR before and after ruthenium-106 brachytherapy at follow-up intervals ranging from 3 to 49 months. In 15 patients, repeat testing was performed at 32-49 months (mean 37.78±5.67 months). Results were expressed as percentages relative to controls (taken as 100%). The control group consisted of volunteers without oncological or inflammatory diseases.

Results: Patients were divided into three groups according to tumor size: small, medium, and large CM. Before treatment, expression levels of microRNA-223 and microRNA-27b increased with tumor growth (p<0.05). No significant differences in microRNA-155 expression were observed between groups. Three months after BT, patients with small CM demonstrated a reduction in the expression of all three microRNAs, which became more pronounced at 12.9±1.3 months (p<0.05). In 10 patients examined 32-49 months after treatment, microRNA expression levels were lower than those in the control group. In one patient with small CM, metastases were detected 48 months after BT; 16 months prior to this, no microRNA deregulation or metastatic signs on CT/MRI had been identified. In patients with medium-sized CM, the decrease in microRNA expression occurred more slowly. In one case, a liver metastasis was detected 5 months after BT; after exclusion of this patient from the analysis, a trend toward decreasing microRNA levels was confirmed in the remaining group. In patients with large CM, no decrease in microRNA expression was observed. Regardless of the degree of tumor regression (complete or partial), the expression levels of microRNA-223, -27b, and -155 remained elevated throughout the follow-up period, which may reflect a persistently high risk of occult metastasis.

Conclusion: Analysis of microRNA expression levels in the blood plasma of CM patients can be used to assess the effectiveness of brachytherapy and to monitor patients within the framework of lifelong follow-up.

Chlamydial conjunctivitis accounts for 3 to 30% cases of conjunctivitis of various etiologies. In such patients, latent clinical manifestations do not correspond to morphological changes in the infected organs and tissues. This paper presents the results of a comprehensive examination of a patient with chronic chlamydial conjunctivitis in the setting of a disseminated form of chlamydial infection (DCI). Direct immunofluorescence (DIF) and polymerase chain reaction (PCR) were used for diagnostics. In addition, conjunctival biopsy specimens were obtained for immunohistochemical (IHC) analysis. Chlamydiae were detected in the conjunctiva, in blood and in clinical materials from the urogenital tract using PCR and DIF. IHC analysis showed that Chlamydia trachomatis was detected to a lesser extent in conjunctival epithelial cells and to a greater extent in endothelial cells of the inner lining of capillaries, mainly in the deep sections. Conjunctival biopsy allows obtaining a pathomorphological picture of tissues infected with chlamydia, providing objective confirmation of the etiopathogenetic role of this pathogen in the development of chronic inflammatory processes in the conjunctiva. An important laboratory diagnostic criterion of DCI is the detection of chlamydiae in peripheral blood neutrophils, as well as in endothelial cells of conjunctival capillaries.

There is only a limited number of studies devoted to the molecular genetic status of patients with iris melanoma.

Purpose: This study aimed to analyze the frequency of chromosomal aberrations in tumor tissue in patients with iris melanoma.

Material and methods: Data from 140 patients with uveal melanoma (UM) treated between 2006 and 2023 were analyzed. Group A included 48 patients with iris melanoma, group B - 62 patients with iris melanoma with extension into the ciliary body. Group C (comparison group) consisted of 30 patients with choroidal melanoma treated in 2012. Subsequently, patients were divided into four subgroups according to chromosomal alterations. Additional subgroups with combinations of two or more aberrations were also identified. All tumors were histologically verified.

Results: The spindle cell tumor type was observed significantly more frequently in the 1p+8p subgroup (A) compared with the M3+1p subgroup (A) (p<0.05), whereas the mixed cell type was more common in the M3+1p subgroup (A) than in the 1p+8p subgroup (A) (p<0.05). A significant association was found between the frequency of partial monosomy of chromosome 3 and mixed cell and epithelioid cell tumor types (p<0.05) in the partial M3 subgroup (C). In iris melanoma, deletion of the entire short arm of chromosome 1 was detected in 68.7% of cases and of chromosome 8 in 47.9%; in tumors with extension into the ciliary body, this was observed in 77.4% and 51.6% of cases, respectively, whereas in choroidal melanoma - in 30% and 20% of cases, respectively.

Conclusion: The present study showed for the first time that deletions of the short arms of chromosomes 1 and 8 are detected 2.5 times more frequently, and monosomy of chromosome 3 occurs 1.5 times less frequently in iris melanoma compared to choroidal melanoma. The revealed features confirm the more favorable biological behavior of iris melanomas compared to choroidal melanomas.

This article presents two clinical cases of medulloepithelioma of the nonpigmented epithelium of the ciliary body, an extremely rare congenital intraocular tumor that may follow either a benign or malignant course. In the presented cases, late disease manifestation was observed in the presence of similar medical histories and comparable clinical and instrumental findings; in both cases, histopathological examination revealed fungal flora. The article also discusses epidemiological aspects, clinical manifestations, and morphological features of this pathological condition, aiming to improve early diagnosis and enable organ-preserving treatment.

According to publications from 2016-2025, the prevalence of dry eye disease (DED) based on the assessment of clinical signs and symptoms in young and middle-aged adults may exceed 30.8-41.43%, while based on symptoms the prevalence ranges from 41.5% to 55%, highlighting the need for further evaluation and investigation. In these age groups, evaporative DED (DEWS II criteria), corresponding to hypersecretory DED, is more commonly diagnosed. One of its major risk factors is computer vision syndrome, which leads to increased tear film evaporation due to reduced blink rate, an increased number of incomplete blinks, and the development of meibomian gland dysfunction (MGD). Other DED risk factors may include exogenous and systemic stimuli, as well as changes of the ocular surface, including MGD. This article presents an analysis of data on the epidemiology and clinical features of DED in young and middle-aged adults, as well as potential therapeutic strategies, including elimination of modifiable risk factors, differentiated tear replacement therapy, anti-inflammatory treatment, and eyelid hygiene, including the use of Blepharogel Ochischenie cleansing gel, Blepharolosion lotion, Blepharosalfetka wipes, Blepharogel 1, Blepharogel 2, and Blepharogel Forte.

The least studied component of idiopathic epiretinal membranes (iERMs), one of the manifestations of which is known as idiopathic epiretinal fibrosis (iERF), is the extracellular matrix (ECM). Investigation of the qualitative and quantitative composition of the ECM, as well as the structural organization of its components, may be useful for determining the clinical course of iERF.

Purpose: This study aimed to identify features of the protein profile and architecture of iERMs and to assess various variants of development and clinical course of the disease.

Material and methods: The study included 32 patients who underwent surgery for iERF. Standard ophthalmologic examinations and optical coherence tomography (OCT) were performed. During surgical treatment, excised tissue was collected for immunohistochemical (IHC) analysis. Membrane specimens were fixed according to the proposed method of the author, followed by IHC analysis.

Results: Three morphological types of iERMs were identified, differing in ECM composition, degree of adhesion to the retinal internal limiting membrane (ILM), postoperative visual acuity and visual quality parameters, and the dynamics of their growth.

Conclusion: Determination of iERM morphological types using IHC methods may serve as a prognostic factor for postoperative visual acuity and the dynamics of visual recovery in iERF.

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.

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.