Vestnik oftalmologii最新文献

Purpose: This study aimed to develop a surgical technique for the treatment of full-thickness macular holes (MH) with proliferative epiretinal structures (epiretinal membrane (ERM) with or without epiretinal proliferation), and to assess its clinical efficacy.

Material and methods: The study included 34 patients (34 eyes) with secondary MH of small and medium diameter (minimum diameter ≤400 µm) with ERM structures. The main group consisted of 16 patients (16 eyes) who underwent surgical treatment using the developed technique of inverted internal limiting membrane (ILM)/ERM flap, preserving an intact retinal zone 0.5 mm wide concentrically around the MH. The control group included 18 patients (18 eyes) who underwent surgery using the peeling technique, classic circular maculorrhexis, and tamponade of the vitreous cavity with a gas-air mixture (SF6).

Results: Postoperatively in all patients of the main group the edges of the hole were aligned with a preserved local hyporeflective area in the ellipsoid zone of the photoreceptors, and its size gradually decreased with the course of the follow-up (3, 6, and 12 months). The macular hole remained unclosed in two patients from the control group. In the main group there was a statistically significant increase in the mean best-corrected visual acuity (BCVA) from 0.19±0.11 preoperatively to 0.57±0.21 by the end of the follow-up (p<0.05). The improvement in BCVA in the main group was more pronounced compared to the control group (p<0.05). The main group also showed a gradual increase in central retinal sensitivity at all follow-up points. The control group exhibited similar changes, but the increase in central retinal sensitivity was less significant compared to the main group (p<0.05).

Conclusion: The proposed surgical technique allows achieving high anatomical and functional outcomes without prolonged vitreous cavity tamponade by removing all ERMs that create tangential traction at the edges of the hole, and peeling of the ILM, which serves as a substrate for the subsequent development of epiretinal fibrosis. Additionally, it delicately preserves the proliferative epiretinal tissue at the hole's edge and the retinal structures, establishing the long-term functional outcome of surgical treatment.

Heavy eye syndrome (HES) is an atypical form of strabismus, primarily caused by a significant elongation of the axial length of the eye, which leads to a disruption of normal topographic relationships between the posterior pole and the extraocular muscles. Clinical symptoms of HES include late-onset convergent strabismus (esotropia) with a vertical component and restricted ocular motility in the context of substantial eye enlargement associated with high myopia. Identification of the pathognomonic sign (dislocation of the posterior pole from the muscle cone) requires the use of multislice computed tomography (MSCT) of the orbits. Considering the mechanism of HES development, the surgical treatment of choice is various techniques for approximating the superior and lateral rectus muscles, which can be regarded as pathogenetically oriented treatment. If necessary, these procedures may be supplemented by classical interventions. The use of classical surgical techniques (recession and resection) as standalone first-stage treatments for HES is inadvisable, not only due to their insufficient efficacy but also because they may complicate subsequent pathogenetically oriented interventions.

This article commemorates the 150th anniversary of the birth of prominent early 20th-century Russian ophthalmologist Professor Alexey Alekseevich Maklakov of Moscow University and aims to explore his biography, which remains relatively obscure. His scientific, pedagogical, and public activities have not been subjected to comprehensive analysis until now. The study clarifies key dates in his life through examination of archival documents. The biography is further supplemented with new facts concerning his work at the medical faculty of Moscow University.

One critical aspect of managing pediatric glaucoma is the compliance of parents, who are responsible for the care of their children. Achieving consensus between specialists and parents on the organization of comprehensive care is essential for the effective rehabilitation of young patients with glaucoma.

Purpose: This study assesses the level of parental compliance with rehabilitation measures and attempts to identify the factors affecting it during the rehabilitation period of children after surgical treatment of congenital glaucoma.

Material and methods: The study was conducted through a survey involving 62 parents of children who underwent surgical treatment for glaucoma at the ophthalmology department of the Tashkent Pediatric Medical Institute. Parents were provided with a link to the online survey after giving their consent. The questionnaire consisted of eight questions with multiple-choice answers.

Results: Analysis of the answers showed the following trends: the majority of parents had either a secondary or vocational education (59.7%); most parents lived in rural areas (64.5%); a significant portion had partial or no knowledge about the course and outcomes of glaucoma (51.6%); unreliable sources for information (45.2%); irregular adherence to the doctor's recommendations (29%); significant difficulties in following the prescribed recommendations (64.5%).

Conclusion: It was found that the level of parental compliance with rehabilitation measures is low in a significant portion of families (37.2%) with children who underwent surgery for glaucoma. The main factors contributing to poor parental compliance include living in rural areas, insufficient knowledge about the disease, lack of strict adherence to medical recommendations, and various difficulties in implementing the prescribed recommendations (p<0.05).

In recent years, there has been a growing interest in the contribution of neuroretinal degeneration to the pathogenesis of diabetic retinopathy (DR).

Purpose: This study assesses the effect of the drug Retinalamin on the functional state of the retina in patients with DR using the Diopsys NOVA Vision Testing System that utilizes electrophysiological (EP) technology.

Material and methods: The study included patients with type 1 and 2 diabetes mellitus (DM) with DR of any stage without macular edema. Patients underwent standard ophthalmological examination and objective functional examination of the retina using the Diopsys NOVA Vision Testing System. The control group consisted of patients with type 1 and 2 DM with DR who did not receive Retinalamin.

Results: Significant changes in pattern electroretinography and flash electroretinography parameters were recorded in patients who received a course of Retinalamin. Two clinical examples are presented, which can be designated as the first experience of objective functional monitoring of treatment of patients with DR with Retinalamin.

Conclusion: Retinoprotective therapy is necessary already at the early stages of DR. Electroretinography is an objective tool for functional analysis of the earliest changes in retinal cells in DR. It is necessary to use the identified "therapeutic" window for the appointment of retinoprotective agents.

This review is devoted to the English- and Russian-language terminology of quantitative metrics that are used in the evaluation of images obtained by optical coherence tomography angiography (OCT-A). The paper presents an analysis of the use of terms characterizing intraretinal blood flow (vascular density, perfusion density, skeletonized density, etc.), area and shape of the foveal avascular zone, and choriocapillaris blood flow. The factors causing the heterogeneity of OCT-A terminology are described, including the lack of a unified international nomenclature for OCT-A, features of their Russian translation, inconsistency of the parameters in optical coherence tomography systems of different manufacturers. The article also considers ways to standardize the terminology.

The lacrimal gland (LG) is a tubuloacinar exocrine gland composed of acinar, ductal, and myoepithelial cells. Three-dimensional distribution of acinar lobules, ducts, and myoepithelial cells is necessary for the effective functioning of the organ. LG is the main organ of immune surveillance of the ocular surface system. The embryogenesis of the gland is regulated by the interaction of genetic mechanisms, internal epigenetic (enzyme systems, hormones) and exogenous factors. There is no doubt that there is a clear genetic program for the implementation of the complex process of embryonic development. The mechanisms regulating LG organogenesis initiate the work of a huge number of structural oncogenes, transcription and growth factors, etc. Studying the expression and selective activity of regulatory genes during organ development, their participation in the differentiation of different cell types is a current trend at the nexus of clinical genetics, molecular biology, embryology and immunocytochemistry. Due to its relatively simple structure and accessibility, human LG is a suitable object for potential application in regenerative medicine. Development of a universal protocol for obtaining functional differentiated secretory epithelium of LG capable of expressing tissue-specific markers is an urgent task. Determining the nature and origin of stem cells and progenitor cells will allow the isolation and multiplication of these cells in culture. After obtaining a functionally active culture of LG cells, it is possible to create a model of autoimmune diseases.

Loading of the upper eyelid with palpebral implants made of noble metals is the modern standard of surgical treatment for paralytic lagophthalmos, and is aimed at increasing the mobility of the upper eyelid and normalizing involuntary blinking movements. This review presents the results of morphological studies, including immunohistochemical studies, reflecting the features of biointegration of palpebral implants in uncomplicated and complicated course of the postoperative period, and describes the modern understanding of the causes and immunopathological processes underlying the development of nonspecific inflammatory response, which is one of the most serious complications that often becomes an indication for implant removal.

Pterygium is a common inflammatory-proliferative disease characterized by the invasion of degeneratively altered fibrovascular tissue into the cornea. This literature review analyzes the etiological factors and pathogenetic concepts of its development, describes modern methods of diagnostics and surgical treatment of pterygium, and pays particular attention to the assessment of structural and functional changes in the cornea occurring during the growth of pterygium and after its excision.

Purpose: This study compares the changes in the parameters of the anterior chamber of the eye using anterior segment optical coherence tomography (AS-OCT) in patients with a natural and artificial lens after treatment of neovascular age-related macular degeneration (nAMD) by multiple intravitreal injections (IVI) of anti-VEGF drugs.

Material and methods: The patients were divided into 2 groups: group 1 (control) included 30 patients (30 eyes) with a natural lens, group 2 - 30 patients (30 eyes) with an intraocular lens (IOL). AS-OCT was performed using the Revo NX tomograph (Optopol, Poland) to analyze anterior chamber depth (ACD) and the parameters of anterior chamber angle (ACA). Intraocular pressure (IOP) was measured with a contact tonometer ICare Pro.

Results: In patients with an IOL, the IOP level 1 minute after intravitreal injection (IVI) of an anti-VEGF drug was statistically lower than in the control group, on average by 17.8% during the first IVI and by 28.7% after 1 year of observation (p<0.001). ACD before treatment was statistically significantly higher in patients with IOL compared to patients of group 1 by an average of 39.3% (p<0.001). ACA from the nasal and temporal sides in the meridian 0°-180° before the start of treatment was statistically significantly wider in phakic patients than in the control group, by an average of 15.9±9.3° (p<0.001) and 16.9±8.2° (p<0.001), respectively. According to AS-OCT, there was no shift of the iris-lens diaphragm in patients with an IOL after multiple IVI of an anti-VEGF drug, in contrast to the control group.

Conclusions: AS-OCT was used to determine for the first time the changes in the parameters of the anterior chamber of the eye in patients with a natural and artificial lens after multiple injections of an anti-VEGF drug in the treatment of nAMD.