Vestnik oftalmologii最新文献

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.

The biography and multifaceted professional activities of Sergey Nikolaevich Lozhechnikov (1838 - March 6, 1911), one of the most respected figures of the Moscow ophthalmological school and Chief Physician of the Moscow Eye Hospital, remain insufficiently explored. This report attempts to generalize scattered and extremely scarce journalistic accounts along with some discovered archival documents that shed light on the key stages of S.N. Lozhechnikov's life, as well as his contributions to the development of ophthalmology and advancement of public healthcare in Russia. The article highlights the close and historically significant connection of the Moscow Eye Hospital with the Moscow University and its medical faculty and clinical infrastructure.

Primary open-angle glaucoma (POAG) is characterized by chronic progressive damage to the retinal ganglion cell layer (GCL) and their axons, leading to gradual visual function loss. Currently, the gold standards for structural and functional assessment of the retina in glaucoma are static automated perimetry (SAP) and optical coherence tomography (OCT). However, in clinical practice, data from SAP and OCT may be insufficient to reliably determine the stage of glaucomatous optic neuropathy, monitor its progression, or differentiate it from other causes of visual dysfunction. For these purposes we can use various modifications of electroretinography (ERG), visual evoked cortical potentials (VECPs), as well as electrophosphene testing - threshold retinal electrical sensitivity (TRES) and lability of the optic nerve (LON).

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.

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.

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.