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.

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.

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.

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.

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 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.