Vestnik oftalmologii最新文献

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.

Determining the levels of molecular biomarkers detected in the vitreous body in various pathological conditions (including diabetic retinopathy), allows for a better understanding of their pathogenesis and optimization of treatment approaches. The multiplex assay is a modern alternative to enzyme-linked immunosorbent assay (ELISA), enabling the simultaneous analysis of a large number of biomarkers.

Purpose: This study was performed to identify changes in the levels of vitreous biomarkers in patients with proliferative diabetic retinopathy (PDR) in the early postoperative period following 25-gauge vitrectomy.

Material and methods: The study included 24 patients (24 eyes) with type 2 diabetes mellitus complicated by PDR requiring surgical intervention for tractional retinal detachment, subtotal or total vitreous hemorrhage, or tractional diabetic macular edema (DME). Vitreous samples were collected from all patients at the first stage of vitrectomy and one month after surgery.

Results: One month after surgery, the level of the pro-inflammatory cytokine vascular endothelial growth factor (VEGF) decreased from 203.8±228.0 to 113±95 pg/ml; however, the difference was not statistically significant (p=0.307). A significant reduction was observed in the concentrations of the following pro-inflammatory biomarkers: bFGF, CTACK, Eotaxin, HGF, IL-1β, -1α, -4, -12 (p40), -16, -18, IL-2Rα, IP-10, MIG, SCF, SCGF-β, SDF-1α, MIF, and M-CSF.

Conclusion: The main effect of vitrectomy on pro-inflammatory cytokines is reduction of their concentration, which confirms the buffering role of the vitreous body in the accumulation of molecular biomarkers in diabetic retinopathy.

The involvement of extraocular muscles (EOMs) in the inflammatory process in thyroid eye disease (TED) often leads to fibrosis, persistent restrictive strabismus, and binocular diplopia. The inferior rectus muscle (IRM) is most commonly affected, resulting in vertical strabismus and hypotropia with significant limitation of upward gaze. Surgical management of restrictive strabismus in TED aims to increase the range of binocular eye movements, eliminate binocular diplopia, and correct the cosmetic defect associated with strabismus. The "gold standard" surgery involves weakening of the affected muscles, and is called muscle recession. In cases of severe fibrotic changes, maximal surgical intervention - so-called deep recession - is needed. Due to the anatomical characteristics of the capsulopalpebral fascia (CPF), the main component of the lower eyelid retractors, which originates from the inferior part of the IRM belly, deep IRM recession results in lower eyelid retraction. This significantly affects both the functional state of the lower eyelid (leading to lagophthalmos) and the symmetry of the palpebral fissures. Moderate lower eyelid retraction is typically managed with retractor dissection and lateral canthoplasty, whereas in severe cases various spacers are used. To minimize the number of surgical stages, techniques have been proposed for repositioning and dissecting the Lockwood ligament, specifically the CPF head, simultaneously with IRM recession. However, the effectiveness of these methods remains debatable, and the risk of intraoperative complications is high. Further research is needed to develop an optimal surgical approach for TED patients.

This publication presents a clinical case of a rare ocular anomaly - splitting of the iridocorneal (ICC) complex with duplication of the lens. The article considers epidemiological aspects, clinical manifestations of this pathological condition, diagnostic issues and approaches to the management of patients with congenital ocular abnormalities.

Early changes in choroidal thickness (CT) following the initiation of optical or pharmacological therapy may serve as a predictor of the subsequent rate of axial length (AL) increase and progression of myopia, as well as a biomarker of individual sensitivity to the treatment.

Purpose: This study aimed to investigate the relationship between the dynamics of myopia progression in children wearing newly prescribed spectacles with highly aspherical lenslets (HAL) and the early choroidal response to this optical correction.

Material and methods: The study included 36 children (72 eyes) aged 7-13 years (mean age 10.41±1.14 years) with myopia of 3.74±0.64 D who wore HAL spectacle lenses for 12 months. Based on the choroidal response after the first month of optical correction, patients were divided into two groups: group 1 included 24 children (48 eyes) with an increase in CT of ≥5 µm, and group 2 consisted of 12 children (24 eyes) in which CT either did not change or decreased. Changes in AL and refractive error were assessed after one year.

Results: In group 1 (CT increase), refractive progression was 0.03±0.3 D and axial elongation was 0.04±0.16 mm after one year; in group 2, these values were 0.12±0.2 D and 0.18±0.2 mm, respectively (p<0.05).

Conclusion: Early increase in CT was associated with greater stability of refractive error and AL during one year of follow-up. The early response of the choroid may serve as a predictor of further treatment effectiveness and a criterion for selecting myopia control strategies.

Functional and anatomical problems associated with lower eyelid retraction (LER) can significantly affect the patient's vision and quality of life. Numerous methods have been proposed for correcting the position and contour of the lower eyelid; however, surgical management is often challenging and insufficiently effective. One of the widely used approaches is the release of lower eyelid retractors with the use of a spacer graft. This article reviews literature on available spacers for correcting lower eyelid position.

Habitual excessive accommodation (HEA) in children is often accompanied by signs of autonomic imbalance, which substantiates the need for a comprehensive study of autonomic regulation in this condition.

Purpose: This study aimed to investigate the features of autonomic regulation in children with habitual excessive accommodation (HEA).

Material and methods: A total of 104 children aged 6-17 years were examined: the main group comprised 54 patients with HEA and the control group included 50 children without this disorder. Mean manifest spherical equivalent was -1.75±0.60 D in the main group and -0.85±0.50 D in the control group (p<0.001); cycloplegic spherical equivalent was -0.72±0.52 D and -0.45±0.46 D, respectively (p<0.01). Ophthalmological examination included assessment of accommodative functions, pupil diameter, and cardiointervalography (CIG).

Results: Children with HEA had lower accommodative amplitude (8.6±1.9 vs. 11.2±2.1 D), reserve (1.4±0.6 vs. 2.6±0.7 D), and facility (5.3±1.8 vs. 9.1±2.0 cycles/min; p<0.01), as well as lower (p<0.001) parasympathetic heart rate variability (HRV) indices - standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), percentage of NN intervals >50 ms (pNN50), and high-frequency power (HF), while sympathetic markers - low-frequency power (LF), sympathovagal index (LF/HF), and stress index (SI) - were higher (p<0.001). Pupil diameter was smaller (3.96±0.75 vs. 5.04±0.49 mm; p<0.001). The amplitude of accommodative miosis (Δ_accom) correlated positively with LF/HF (r=0.34) and negatively with SDNN and HF (r≈-0.34; p<0.05). Autonomic imbalance was most pronounced at ages 14-17 and in grade 3 HEA (LF/HF=2.67±0.3; SI=200±35).

Conclusion: HEA is associated with reduced parasympathetic and increased sympathetic activity. Cardiointervalography and pupillometry are informative for early detection of autonomic maladaptation.

Purpose: This study aimed to assess the changes in structural and functional characteristics of the visual analyzer in patients with advanced primary open-angle glaucoma (POAG) in the course of long-term regular use of Retinalamin (Geropharm, Russia).

Material and methods: The study was conducted from 2022 to 2024 at two clinical centers: the M.M. Krasnov Research Institute of Eye Diseases and the Chelyabinsk Glaucoma Center. This multicenter cohort prospective study examined the structural and functional parameters of the visual analyzer in patients with advanced POAG during long-term regular use of Retinalamin.

The study included a total of 56 patients (98 eyes) divided into two groups. The observation group comprised patients with advanced glaucoma who regularly received 10 intramuscular injections of Retinalamin 5 mg (Geropharm, Russia) diluted in 1.0 mL of 0.9% sodium chloride solution in outpatient setting once every three months over a two-year period. The control group consisted of patients with advanced glaucoma who did not receive neuroprotective therapy.

Results: At baseline, all patients in both groups had achieved target intraocular pressure (IOP) through surgical and/or medical treatment, which remained stable throughout the follow-up period.

The mean deviation (MD) decreased by 0.98 (0.78; 1.76) dB/year in the observation group and by 1.65 (0.59; 1.79) dB/year in the control group. The pattern standard deviation (PSD) increased by 0.02 (-0.3; 1.2) dB/year in the observation group and by 0.3 (0.7; 1.3) dB/year in the control group. Mean retinal nerve fiber layer (RNFL) thickness showed a similar trend. Following repeated courses of Retinalamin therapy, the observation group demonstrated stable, minimal decrease in RNFL thickness amounting to 1.5 (-0.25; 5.0) μm/year. The control group exhibited more pronounced decrease in RNFL thickness averaging 3.0 (0.75; 10.2) μm/year.

Conclusion: Long-term neuroretinoprotective therapy with Retinalamin (Geropharm, Russia) in patients with advanced POAG is justified when administered regularly and the intraocular pressure is stable and well controlled.

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.