Vestnik oftalmologii最新文献

Glaucoma, one of the leading causes of blindness, often develops asymptomatically, necessitating early diagnosis and prediction of the progression rate of glaucomatous optic neuropathy (GON).

Purpose: To develop a classification model using machine learning methods for predicting the rate of GON progression, and to identify the most significant predictors of progression in patients with newly diagnosed early primary open-angle glaucoma (POAG).

Material and methods: The study included 59 patients (59 eyes) with early POAG, categorized into three groups based on the expert assessment of GON progression rate over a 36-month follow-up using dynamic morphofunctional evaluation. A classification model incorporating 35 clinical parameters, including optical coherence tomography (OCT) and OCT-angiography (OCT-A) data, was developed using partial least squares discriminant analysis (PLS-DA).

Results: Over the 36-month follow-up, slow GON progression was recorded in 21 patients, moderate in 18, and rapid in 20. The mean progression rates were -0.77±1.27%/year for visual field area, -1.21±1.48 µm/year for retinal nerve fiber layer (RNFL) thickness, and -1.23±1.77 µm/year for ganglion cell complex (GCC) thickness. The model demonstrated sensitivity of 90%, specificity of 95%, and efficiency of 92%. The most significant predictors of GON progression were mean vessel density in the deep vascular plexus of the macular region (wiVD_Deep), choriocapillaris dropout in the inferior-nasal peripapillary region, choroidal thickness in the fovea, and lamina cribrosa thickness.

Conclusion: The developed model effectively classifies patients based on the predicted progression rate of GON, which is important for individualized approach to glaucoma treatment planning.

Purpose: This study evaluated the effectiveness of the implantable collamer lens (ICL) V4c in the surgical treatment of myopia.

Material and methods: The study analyzed the outcomes of ICL V4c implantation in 616 eyes with myopia. Visual acuity, refraction, intraocular pressure (IOP), anterior chamber angle (ACA), vault height, and corneal endothelial cell density (ECD) were evaluated. Patients were examined preoperatively and followed up for one year.

Results: Preoperative uncorrected and best-corrected visual acuity were 0.04±0.02 and 0.83±0.12, respectively, improving to 0.97±0.10 and 0.97±0.10 one year postoperatively. The efficacy index was 1.17±0.17, and the safety index was 1.18±0.18. The spherical equivalent (SE) decreased from a preoperative value of -8.79±2.62 to 0.20±0.58 D at one year (p<0.0001). The ACA decreased from 39.46±4.97° preoperatively to 22.79±4.74° at one year. Vault height was 747±280 μm on the first postoperative day and 755±285 μm at one year (p<0.72), with no tendency for reduction over time. ECD was 2784±244 cells/mm² preoperatively and 2755±254 cells/mm² at one year (p<0.29).

No significant linear regression was found between IOP, vault, and ACA.

Conclusion: In a large cohort of patients who underwent ICL V4c implantation using the standardized technique, the procedure was demonstrated to be a highly effective, safe, and predictable refractive surgery option for correction of myopia of various degrees, and helped achieve stable visual outcomes. The decrease in spatial relationships in the anterior chamber following standard ICL V4c implantation did not lead to increased IOP.

Phacoemulsification with intraocular lens (IOL) implantation has become the standard method for cataract extraction regardless of its etiology. In modern phaco surgery, implantation of multifocal IOLs is considered the most advanced method for correcting aphakia following lens extraction. The wide range of available multifocal IOLs is promoting the ongoing discussion regarding the advantages of each type, as well as potential strategies for optimizing surgical outcomes. This literature review presents current methods for improving the performance of various types of multifocal and extended depth of focus IOLs.

Choroidal detachment is one of the most common complications of glaucoma surgery. It frequently develops following filtering and drainage glaucoma operations, as well as some laser interventions. The onset of this condition is associated with a variety of factors, most notably fluctuations in intraocular pressure and the anatomical and biomechanical features of the eye. This article reviews the main theories of pathogenesis, symptoms and diagnosis12 of this pathology. Understanding the underlying pathogenetic mechanisms of ciliochoroidal detachment is essential for ophthalmologists to ensure proper management and prevention of this condition.

The introduction of new methods of surgical treatment of glaucoma reduces the risks, but does not exclude the development of choroidal detachment. The incidence of this complication has been reduced thanks to microinvasive techniques. This article analyzes the most widely recognized medical and surgical approaches to the treatment of ciliochoroidal detachment. The correct choice of preventive measures may help reduce the occurrence of this complication of glaucoma surgery.

Neovascular age-related macular degeneration (nAMD) is a progressive retinal disease that can lead to severe and irreversible vision loss despite the availability of effective anti-VEGF agents. One of the potential causes of suboptimal treatment outcomes in nAMD is undertreatment, which may result from the need for frequent injections and follow-up visits, limitations in public healthcare funding, and challenges in achieving sustained and long-term control of disease activity (DA). Aflibercept 8 mg is a novel formulation with a higher concentration and improved molecular stability, enabling a fourfold increase in the molar dose of the active substance delivered to the vitreous body. The phase III PULSAR trial, a 96-week randomized, double-masked, active-controlled study, evaluated the efficacy and safety of 8 mg aflibercept compared with the standard 2 mg dose in treatment-naïve patients with nAMD. Participants were randomized 1:1:1 into three groups: aflibercept 2 mg every 8 weeks (2q8), 8 mg every 12 weeks (8q12), or 8 mg every 16 weeks (8q16) after three initial monthly loading doses. The study demonstrated the benefits of the 8 mg dose in extending interinjection intervals. By week 96, 88% of patients achieved an interval of ≥12 weeks, 71% ≥16 weeks, and 47% ≥20 weeks; in the 8q16 group, 53% of patients reached an interval of ≥20 weeks and 31% - 24 weeks. Over the 2-year period, patients in the 8q16 group received approximately 8 injections, compared to around 13 in the 2q8 group, with comparable anatomical and functional outcomes and no additional safety concerns. Given the proven effectiveness in improving best-corrected visual acuity (BCVA), superior outcomes in resolving intra- and/or subretinal fluid (IRF/SRF), and reduced treatment burden, it appears optimal to broadly transition patients already receiving aflibercept 2 mg to the higher molar concentration (aflibercept 8 mg) regardless of treatment phase or the interinjection interval. This approach aims to achieve a longer anti-VEGF effect duration and sustained DA control with the fewest possible injections.

Diseases of the eye and the adnexa, particularly accommodation disorders and refractive errors, including myopia, occupy a leading position in the morbidity structure of schoolchildren, and their prevalence shows a steady upward trend. Delayed diagnosis of visual impairment is a risk factor for deterioration of the quality of life.

Objective: This study aimed to determine the age of myopia onset in schoolchildren based on medical examination data.

Material and methods: The study included a total of 1450 students in grades 1-11 of general education schools, they were examined by an ophthalmologist. The subsequent analysis included healthy students and those diagnosed with accommodation and refractive disorders (H52) (1378 children, including 669 boys and 709 girls). Statistical analysis was performed using Jamovi software.

Results: Accommodation and refractive disorders were detected in 37% of the examined schoolchildren, myopia - in 24.8%, and accommodation disorders - in 12.2%. Mathematical analysis revealed a direct correlation between age and myopia (r=0.28; p<0.001). Logistic regression analysis identified age as the primary predictor of myopia development, with gender exerting a minor effect. Receiver operating characteristic (ROC) analysis showed that age had moderate prognostic value for predicting the risk of myopia; the area under the curve (AUC) was 0.684. The optimal cutoff point was 11 years of age.

Conclusion: The pathological prevalence of myopia among adolescents is up to 2.5 times higher than the morbidity reported in official statistics. According to medical examination results, every third student has accommodation and refractive disorders. The age of 11 years can be recommended as an additional ophthalmological screening point during preventive medical examinations of minors.

Objective: This study aimed to analyze the dynamics of corneal wavefront aberration changes after local corneal cross-linking and assess their impact on visual acuity in patients with keratoconus.

Material and methods: The study group included 22 patients (37 eyes) aged 17 to 36 years with stage I-III keratoconus. All patients underwent local corneal cross-linking according to the Dresden protocol. The follow-up period was 12 months. In addition to standard ophthalmological examinations, specialized diagnostics were performed using the topographers-aberrometers Orbscan III, Sirius, and the optical coherence tomograph Revo. Higher-order aberrations were analyzed preoperatively and at 1, 6, and 12 months postoperatively. Corneal morphology parameters were also assessed at the same time points.

Results: At 1 month postoperatively, there was a slight increase in higher-order aberrations compared to baseline. However, by the 6th month, higher-order aberrations began to decrease, reaching their lowest levels by month 12. The improvement in best-corrected visual acuity (BCVA) correlated with the reduction in higher-order aberrations: following a slight decline during the first month, BCVA began to improve by month 6 and peaked by the end of the follow-up period, increasing by 35% (t>2.0; p<0.05) compared with the preoperative level.

Conclusion: Local cross-linking has a positive effect on higher-order aberrations. The reduction in higher-order aberrations correlates with improved visual acuity after local crosslinking.

Proliferative diabetic retinopathy (PDR) remains a primary cause of blindness, as it can lead to tractional retinal detachment and vitreous hemorrhage. Although advanced treatments such as panretinal laser photocoagulation and anti-angiogenic therapy reduce the risk of vision loss, a substantial proportion of diabetic retinopathy cases may still progress to severe complications. With the advent of modern instruments, high-tech imaging systems, and minimally invasive vitrectomy techniques, surgical intervention should increasingly be considered as a preventive measure rather than a rescue therapy. This review highlights the evolution of vitreoretinal surgery for PDR and current advances in this field. Early vitrectomy, performed before the angiofibrotic shift and before the need for silicone oil tamponade, represents an additional option for preserving visual function.

The article presents a comprehensive review of current studies devoted to diagnostic approaches involving molecular markers of subretinal fluid (SRF) in rhegmatogenous retinal detachment (RRD). The qualitative and quantitative features of SRF components are examined, including proteins associated with coagulation cascade, proteolysis, and neuronal injury, as well as the dynamics of these components in the early stages of the disease. Particular attention is given to the role of inflammatory cytokines (IL-6, -1α, CCL19) and proliferation factors (TGF-β2) involved in the pathogenesis of RRD and the development of proliferative changes, highlighting their potential as biomarkers for assessing damage severity and predicting outcomes. The review also presents modern methods for noninvasive evaluation of SRF, specifically optical coherence tomography (OCT) that provides new diagnostic opportunities. The article emphasizes the importance of an integrated approach, combining clinical data, laboratory parameters, and noninvasive methods to improve prognostic accuracy and effectiveness of therapy, and outlines the prospects for further research into novel molecular markers and the development of corresponding diagnostic algorithms, which will help optimize the management of patients with RRD, reduce time and resource costs, and improve the quality of life of patients.