Vestnik oftalmologii最新文献

The combination of keratoconus (KC) with signs of dry eye disease (DES) has been described in numerous scientific publications. At the same time, there is a relationship between KC stage and an increase in the severity of DES symptoms, however, there is still no common understanding of the severity of xerotic process depending on the clinical course of keratectasia.

Purpose: This study assesses the changes in the state of the precorneal tear film in KC relative to the stages of the disease.

Material and methods: The study included 50 patients (100 eyes) with bilateral non-operated KC from subclinical to stage IV. The following methods were used for a comprehensive assessment of the condition of the tear film: biomicroscopy of the anterior segment of the eye using vital dyes, functional tests (Norn, Schirmer, Jones tests), tearscopy of the lipid layer of the tear film with software processing of the results, OCT-meniscometry, as well as filling out the OSDI questionnaire by patients.

Results: The following significant changes were revealed as the KC stage progressed: an increase in the area of staining of the ocular surface with vital dyes, a decrease in the results of the Norn functional test and OCT-meniscometry, an increase in the areas of smaller thickness of lipids and areas of their complete absence according to tearscopy, as well as an increase in scores of the OSDI questionnaire.

Conclusion: A comprehensive assessment of the condition of the tear film in KC indicates the relationship and the strengthening of the signs of DES as keratectasia progresses, and can be considered as justification for the need to prescribe tear replacement and reparative therapy that improves the condition of the ocular surface and stabilizes the precorneal tear film.

Safe and effective glaucoma treatment remains a critical task in ophthalmology. Newly introduced medications, in addition to mandatory registration trials, are also evaluated in real-world clinical settings.

Purpose: This study assesses the efficacy and safety of the fixed combination of dorzolamide/timolol (Dorzotimol) in patients with primary open-angle glaucoma (POAG) in real-world clinical settings.

Material and methods: The study included 55 patients aged 46 to 75 years with stage I and II POAG. The initial mean intraocular pressure (IOP) was 24.07±1.31 mm Hg. All patients were prescribed the fixed combination of dorzolamide/timolol.

Results: The mean IOP after 1, 3, 6, and 12 weeks of therapy was 19.20±2.46, 18.48±2.04, 17.88±1.88, and 17.62±1.63 mm Hg, respectively. After 12 weeks of therapy, IOP reduction to 18 mm Hg was observed in 63.64% of patients, a reduction of 20% or more from baseline in 81.82% of patients, and a reduction of 30% or more in 14.55% of patients. No serious adverse events were recorded during the observation period.

Conclusion: This study confirms the high hypotensive efficacy and safety of the fixed combination of dorzolamide/timolol (Dorzotimol).

Current strategies for treating progressive myopia are closely linked to optical methods based on the theory of peripheral defocus. Myopic defocus causes an increase in choroidal thickness (CT) and a decrease in axial length (AL) of the eye. No comparative studies on the effects of spectacle lenses with highly aspherical lenslets (HAL) and monofocal lenses (MFL) on CT and AL in children with newly diagnosed myopia have been conducted.

Purpose: This study compares changes in CT and AL in children with myopia after one month of continuous wear of newly prescribed glasses with HAL and MFL.

Material and methods: The study included a total of 29 patients (58 eyes) with newly diagnosed mild myopia (mean -1.28±0.64 D) at an average age of 10.41±1.14 years wearing newly prescribed glasses with MFL (group 1) or with HAL (group 2). All patients underwent optical biometry and CT measurement using optical coherence tomography in addition to standard ophthalmological examination methods.

Results: In group 1 (SV), subfoveal CT decreased significantly by 18.13±7.88 μm after 1 month, while in group 2 (HAL), it increased by 12.88±29.86 μm. AL significantly increased by an average of 0.04±0.04 mm in group 1 and decreased by an average of 0.06±0.07 mm in group 2 (p<0.05).

Conclusions: The use of optical means of correction leads to changes in biometric parameters of the eye within a month from the start of wearing them. A decrease in CT from baseline was observed with MFL glasses, while an increase was seen with HAL correction, which can be considered a favorable prognostic sign in the control of progressive myopia in children.

Purpose: This study assesses the treatment outcomes of patients with thin corneas and/or borderline corneal topography who underwent combined refractive surgery using the SMILE Xtra technique.

Material and methods: The study included 53 patients (105 eyes) with myopia and a risk of developing keratectasia according to the Randleman criteria. All patients underwent prophylactic crosslinking following the SMILE procedure by introducing riboflavin solution into the corneal pocket, followed by ultraviolet irradiation according to the SUB-400 protocol with additional acceleration. The results were evaluated using data from Scheimpflug analyzer, analysis of corneal biomechanical properties, optical coherence tomography (OCT), and standard ophthalmological examinations. Follow-up lasted up to 12 months.

Results: The preoperative spherical equivalent of refraction was -4.09±1.30 D, and postoperative measurements on day 1, day 7, and at 1, 3, 6, and 12 months were: -0.08±0.64; 0.1±0.53; 0.2±0.48; 0.05±0.52; -0.29±0.47; 0.1±0.49 D, respectively. On day 1, uncorrected visual acuity (UCVA) increased to 0.78±0.17, rising to 0.94±0.11 by day 7, and remained stable throughout the follow-up. Mean keratometry values preoperatively were 44.32±1.3 D, and 40.89±1.65 D on day 1, with no statistically significant changes throughout the follow-up. Central corneal thickness decreased from 528.30±28.71 μm preoperatively to 459.32±28.92 μm on day 1 and 440.54±29.12 μm on day 7. Patient complaints of blurred vision on day 1 were associated with mild corneal edema due to residual riboflavin and energy load from UV treatment; these symptoms resolved by day 7. No regression of refractive results or keratectasia was observed throughout the follow-up period.

Conclusion: SMILE Xtra can be used for myopia correction in cases with an increased risk of postoperative keratectasia in patients with thin corneas and/or borderline corneal topography readings.

Purpose: This study assesses the impact of preoperative administration of Oku-Oku eye drops on the severity of conjunctival hyperemia and the risk of hemorrhagic complications in the early postoperative period following glaucoma surgery.

Material and methods: The study included a group of 30 patients (30 eyes) with uncontrolled primary open-angle glaucoma who underwent non-penetrating deep sclerectomy. The main group included 15 eyes, in which Oku-Oku drops were administered twice - on the day before surgery (upon hospital admission) and immediately before the operation. The control group consisted of 15 eyes that underwent surgery without additional medications. Intraocular pressure (IOP) and conjunctival hyperemia were measured before and after surgery. The duration of coagulation during surgery was also recorded. The rate of hemorrhagic complications was compared between the groups.

Results: The performed glaucoma surgery significantly reduced IOP in both groups, with no significant differences in postoperative IOP levels. Conjunctival hyperemia increased in both groups postoperatively, though the increase was slightly less in the main group. There was a significant difference in the duration of scleral vessel coagulation in the surgical area, amounting to 3.8±2.6 seconds in the main group and 6.9±3.0 seconds in the control group. Hemorrhagic complications occurred less frequently in the main group.

Conclusion: Preoperative use of Oku-Oku eye drops reduced the severity of conjunctival hyperemia and the width of scleral vessels. The reduction in hemorrhagic complications in the early postoperative period may contribute to decreased scarring. Oku-Oku can be included in the comprehensive preoperative preparation for glaucoma surgery and other procedures with a risk of bleeding. Further research is needed to evaluate the effectiveness of Oku-Oku in the perioperative period.

Alport syndrome is a hereditary disease characterized by glomerulopathy, manifested by hematuria and/or proteinuria, progressive decline in renal function, often combined with hearing and vision pathology. This article presents a clinical case of spontaneous opening of the anterior lens capsule in a patient with Alport syndrome, accompanied by uveitis and ophthalmic hypertension, and describes the features of the surgical aid and the postoperative period.

Congenital subluxation of the lens as a complication of Marfan syndrome, Weill-Marchesani syndrome, microspherophakia, etc. leads to the development of amblyopia and requires timely surgical treatment with removal of the subluxated lens and implantation of an artificial intraocular lens (IOL). IOL implantation in children with pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery due to the lack of a consensus regarding the IOL fixation method among practitioners.

Purpose: This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation.

Material and methods: The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated.

Results: All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors.

Conclusions: The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.

Myopia and glaucoma are the leading causes of irreversible blindness in the world, and as the number of nearsighted people is predicted to increase sharply in the upcoming decades, an increase in combined pathology is expected. This article analyzes literature sources to assess the epidemiology of glaucoma and myopia both worldwide and in the Russian Federation, examine the anatomical changes of the eyeball associated with these diseases, and identify the diagnostic criteria that facilitate the verification of glaucoma when combined with myopia.

Marfan syndrome (MS) is an orphan hereditary connective tissue disease associated with a mutation in the FBN1 gene, which pathological manifestations are characterized by polysystemic involvement. The fibrillin-1 protein is an integral component of the sclera and cornea of the eye, and in MS its structure is distrubed.

Purpose: This study assesses potential structural and functional changes in the cornea and sclera of a patient with MS.

Material and methods: Two groups were formed, comparable in the axial length of the eye and age: the main group - 19 patients (38 eyes) with a verified diagnosis of MS, and the control group - 24 patients (48 eyes) with myopia of varying degrees. The results obtained from MS patients were analyzed depending on the absence or presence of ectopia lentis. In addition to measuring the basic ophthalmological parameters (refraction, axial length, visual acuity), topographic keratometry, anterior segment optical coherence tomography, and ocular response analyzer were used for structural and functional assessment of the cornea and sclera.

Results: In MS there was a statistically significant increase in the radius of curvature and a decrease in corneal refraction in the central zone compared to the control group. There were no significant differences in central corneal thickness, but there was a significant decrease in the thickness of the sclera in the limbal zone compared to the control group. There were no statistically significant changes in corneal hysteresis and corneal resistance factor in MS.

Conclusion: This study confirmed the previously obtained data on the tendency of the optical power to reliably decrease in MS (flattening of the cornea). This symptom can be considered as a compensatory factor affecting clinical refraction, while the decrease in the thickness of the sclera - as the main reason for aaxial length elongation in MS. There were no clear patterns of dependence of the changes in the cornea and sclera analyzed in this study on the presence or absence of ectopia lentis. Changes in the lens, perhaps, should be regarded only as one of the potential components of the ocular symptom complex in MS.

Effective and atraumatic removal of a soft lens nucleus requires different surgical techniques compared to phacoemulsification of a dense nucleus.

Purpose: This study was conducted to develop a non-ultrasound technique for emulsification of a soft lens nucleus.

Material and methods: Fifty-seven patients (57 eyes) underwent surgery. In 23 cases, early or immature cataracts were detected, and in 34 cases, lens removal was performed for refractive purposes in high myopia and complex myopic astigmatism. Phacoemulsifier Centurion Vision System (Alcon Laboratories, Inc., USA) was used for the surgery. Aspiration of soft lens nucleus was done using a rotational technique. The following aspects were evaluated in the course of the surgery: the volume of the required irrigation solution, and the frequency needing to involve ultrasound for complete emulsification of the lens nucleus. Intraoperative and postoperative complications were also assessed.

Results: The surgery was uneventful in all cases. There were no violations of the integrity of capsulorhexis edge. The need for short pulses of minimal power ultrasound during the removal of the soft lens using this technique arose only in 11 (19.3%) cases. The effective ultrasound time was less than 1 second. The required volume of irrigation solution was 33.0 (24.0; 43.0) ml, which does not differ significantly from that in ultrasonic phacoemulsification.

Conclusions: The use of modern phacoemulsifiers providing a high vacuum level allows successful removal of a soft lens without using ultrasound, which prevents its negative impact on the ocular tissues. The use of adequate surgical techniques, including the optimal direction of rotation of the lens nucleus in the rotational technique, improves the efficiency of soft lens nucleus removal.