Vestnik oftalmologii最新文献

The causes of monocular transient visual loss (TVL) are diverse, necessitating a careful approach to diagnosis and differential evaluation of multiple conditions. In rare cases, TVL may occur in association with optic disc anomalies such as morning glory syndrome (MGS), coloboma, or optic disc drusen. The purpose of this article is to present a clinical case of TVL in a patient with MGS. A 25-year-old patient reported experiencing TVL in the left eye over the past 3-4 years, triggered by physical exertion, straining, or visual tasks requiring concentration. Ophthalmoscopy revealed MGS in the left eye, as well as exercise-induced contractile movements of the optic disc accompanied by TVL. Ultrasonography revealed an avascular hyperechoic structure displacing the central retinal artery and vein laterally, which likely contributed to compromised blood flow in the posterior segment of the eye and the occurrence of TVL. The optic nerve changes causing TVD were found to be local and unrelated to systemic status.

The rising prevalence of diabetes mellitus increases the need for treatment of diabetic maculopathy (DM). Evaluation of surgical outcomes in DM, including postoperative microstructural changes in the retina and its vascular plexuses, remains a relevant challenge.

Purpose: This article assesses changes in angiographic parameters of the retinal capillary plexuses after surgical treatment of DM using various methods of internal limiting membrane (ILM) peeling.

Material and methods: Vitreoretinal surgery, including vitrectomy with membrane peeling, was performed in comparable groups of patients with proliferative diabetic retinopathy and DM. The surgical methods differed in the approach to retinal ILM peeling: in group 1 the ILM was completely removed; group 2 underwent dosed fovea-sparing peeling (DFSP) of the ILM; in group 3 the ILM was left intact. Postoperative outcomes were compared between groups using optical coherence tomography angiography (OCT-A).

Results: Intergroup comparisons across all time points and parameters did not reveal statistically significant differences. The analysis showed no significant changes in angiographic parameters in groups 1 and 3. In group 2 significant changes were observed in the parameters of deep capillary plexus: increased vessel density, vessel skeleton density and vessel perimeter index, as well as reduced foveal avascular zone (FAZ) area. Correlation analysis revealed that high FAZ area values in the deep capillary plexus were predictors of the development of retinal atrophy in the long-term.

Conclusion: The obtained results demonstrate the dynamics of changes following DFSP of the ILM in both the neuronal structures of the retina and its capillary plexuses, with these changes tending toward normalization of retinal structure.

Objective: This study presents a comparative analysis of outcomes of lateral orbital wall decompression performed using ultrasonic bone removal with standard and modified techniques.

Material and methods: The study included 78 patients (109 orbits) with exophthalmos without visual impairment (subgroups 1A and 1B) and with optic neuropathy (ON) due to thyroid eye disease (TED) (subgroups 2A and 2B). Lateral wall decompression (LWD) was performed using ultrasonic bone removal with a modified (n=58, patient subgroups 1A and 2A) or standard (n=51, subgroups 1B and 2B) technique. Postoperative evaluation included visual function, degree of exophthalmos, and palpebral fissure parameters.

Results: In subgroup 1A, exophthalmos regression averaged 3.8±0.9 mm, while in subgroup 1B it amounted to 2.9±0.8 mm. Comparable improvement in visual acuity was observed in subgroups 2A and 2B, with a median gain of 0.4, along with positive changes in perimetry and color vision.

Conclusion: The modified LWD technique using ultrasonic bone removal achieved a mean exophthalmos reduction of approximately 4 mm. In cases complicated by ON, improvement in visual function was observed for up to 4 years.

This review analyzes Russian and international literature on the treatment of bilateral limbal stem cell deficiency (LSCD), focusing on the use of Simple Oral Mucosal Epithelial Transplantation (SOMET) as a surgical method for restoring the ocular surface. Contemporary sources report 64 cases of SOMET used in the treatment of bilateral LSCD: 35 cases of chemical burns, 16 of thermal burns, 7 cases of Stevens-Johnson syndrome, 1 keratitis, 1 cicatricial pemphigoid, 1 dermoid, 1 case of drug-induced LSCD (mitomycin C), etc. Notably, all transplantations resulted in complete epithelialization, and in 3 cases, penetrating keratoplasty was subsequently performed with favorable functional and anatomical outcomes.

The introduction of autologous neurosensory retinal transplantation (ANRT) into vitreoretinal surgery has significantly improved the success rates of closure of refractory full-thickness macular holes (FTMH). In recent years, the technique has gained wide acceptance and its indications have expanded; however, certain aspects remain debatable - particularly the optimal graft size to ensure the best anatomical and functional outcomes. To address this issue, the study proposes a surgical technique for treating FTMH using ANRT that involves precise marking of the neurosensory retinal graft. The effectiveness of this method is demonstrated in a series of three clinical cases.

Currently, there is no universally accepted classification of vitreomacular interface (VMI) pathology, which complicates professional communication and the choice of treatment strategies.

Purpose: This article presents our perspective on a feasible and prognostically significant clinical and pathogenetic OCT-based classification of surgical VMI pathologies.

Material and methods: In order to develop a classification approach to categorize the most common changes in VMI based on pathogenesis we summarized published literature and our own observations.

Results: Based on pathogenesis, classification begins with vitreomacular adhesion. The formation of an epiretinal membrane (ERM) can result from the development of posterior vitreous detachment (PVD) along the path of vitreoschisis. The severity of retinal changes and the presence of ectopic internal foveal layers distinguish four stages of ERM. ERM can exhibit various contraction patterns. If proliferative tissue contracts with centripetal tension on the retina, it may result in ERM with a macular pseudohole. Centrifugal contraction may may lead to the formation of intraretinal cystic spaces, resulting in ERM with foveoschisis. If PVD occurs in the presence of strong local vitreomacular fixation, vitreomacular traction (VMT) may develop, which is also classified into four stages. VMT can resolve either asymptomatically or with the formation of a retinal tissue defect, leading to the development of a full-thickness macular hole (FTMH). In cases where tractional forces during PVD create a retinal defect without causing an FTMH, secondary processes may be initiated, leading to an OCT pattern of lamellar macular hole, which in rare instances may progress to FTMH.

Conclusion: The proposed classification scheme encompasses the full spectrum of primary surgical VMI pathologies, is based on modern pathogenetic concepts, and relies on clear OCT-defined criteria for each nosological entity. The scheme relies on specific morphological criteria and delineates the stages of pathological processes, facilitating research standardization and streamlining treatment decision-making.

Recently, hydrophilic acrylic intraocular lenses (IOLs) have become the most widely used in clinical practice due to simpler manufacturing process and known optical disadvantages of hydrophobic lenses (e.g., dysphotopsia effect). Acrylic hydrophilic lenses, similar to polymethylmethacrylate and silicone IOLs, are susceptible to both reversible and irreversible optical changes intraoperatively and in the early postoperative period. The optical properties of the IOL may be affected by its transfer from one medium to another with a short-term shock effect on the lens polymer followed by chemical relaxation within the IOL-medium system.

Purpose: This study evaluated potential changes in the optical power and light-scattering properties of the IOL material resulting from rapid changes in the osmolarity of the surrounding medium.

Material and methods: Physical models based on a commercially available hydrophilic IOL were created to assess changes in the refractive index of the polymer and the quality of light transmission in response to the change of bathing solution. An original photometer and a series of test saline solutions with varying osmolarities were prepared for this purpose.

Results: The most pronounced refractive effect was observed when the bathing solution was switched from isotonic to hypertonic. The increase in the refractive index of the IOL material amounted to Δn = +0.0038, which could translate into clinically significant changes of 0.25-0.6 diopters depending on the initial IOL power. Returning the IOL to isotonic conditions after prolonged exposure to hypo- or hyperosmolar environments led to reversible opacification of the lens material. Optical destabilization effects were observed within the first hours (refraction) and could persist for up to 24 hours.

Conclusion: The conducted experiments model potential violations of IOL storage and transportation guidelines prior to implantation. The findings provide insights into certain reversible optical phenomena in hydrophilic IOLs, and can help explain the results of clinical assessments in the early postoperative period.

In recent years, glaucoma has been considered as a common pathological process with neurohormonal dysregulation of many pathophysiological mechanisms due to disturbances in the biological rhythms of metabolic and vascular homeostasis. Changes in hemocirculation in the internal carotid arteries can be considered as a vascular risk factor for glaucoma.

Objective: This study investigated the variability of the circadian rhythm of peak systolic velocity (PSV) in the internal carotid arteries (ICA) depending on retinal ganglion cell (RGC) loss in patients with different stages of primary open-angle glaucoma (POAG).

Material and methods: The study included 240 patients with POAG at various stages. In addition to ophthalmological examination, the amplitude-phase parameters of the daily PSV patterns in the ICAs were assessed using ultrasound examination and analyzed in relation to RGC loss as determined by optical coherence tomography (OCT).

Results: Ultrasound assessment of carotid blood flow over a 12-hour period (8:00-20:00) in patients with advanced POAG revealed the absence of pronounced daytime PSV peaks in the ICAs. Analysis of daily PSV patterns demonstrated significant intergroup differences in daily PSV dynamics in patients with advanced glaucoma compared with the control group (p<0.00001) and early-stage glaucoma (p<0.00001). Advanced glaucoma was associated with a reduction in the percentage contribution of the PSV rhythm in ocular and major blood flow to the 24-hour and 12-hour harmonics (p<0.0001). A strong correlation was found between amplitude-phase disturbances of ICA PSV rhythm and the global ganglion cell loss volume (GLV, %) according to OCT data (r=0.425; p=0.0002).

Conclusion: Phase instability of major hemodynamics may impair ocular perfusion and be the cause of POAG progression.

Objective: This study analyzed the outcomes of corneal epithelium reconstruction using the method of paralimbal oral mucosal epithelial transplantation (PLOMET) in patients with bilateral limbal stem cell deficiency.

Material and methods: PLOMET surgery was performed in 10 patients with bilateral limbal stem cell deficiency. Surgical outcomes were monitored for 12 months postoperatively. Impression cytology of the ocular surface with immunohistochemical (IHC) analysis for specific keratins (K3, K4, K7, K12) was performed before and after surgery in addition to standard and supplementary diagnostic methods.

Results: Corneal re-epithelialization within 1-2 months was achieved in all patients. In the late postoperative period, 2 out of 10 patients experienced spontaneous epithelial erosions, associated with systemic comorbidities and certain environmental factors. At 12 months postoperatively, 9 out of 10 patients demonstrated slight improvement in visual acuity, and best-corrected visual acuity exceeded 0.1 in 2 out of 10 patients. Grading of corneal status by three independent experts demonstrated a reduction in conjunctivalization, decreased neovascularization, and improved corneal transparency in 8 out of 10 patients. IHC results showed positive staining for K4, characteristic of oral mucosal epithelial cells, in 7 out of 8 patients, whereas only one patient exhibited marked K12 expression characteristic of corneal epithelium.

Conclusion: Paralimbal oral mucosa epithelial transplantation (PLOMET) enables stable corneal re-epithelialization and partial improvement in visual acuity. The latter is limited by the degree of corneal stromal opacification, providing a rationale for optical keratoplasty as a second stage of visual rehabilitation in this patient population.

Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss in the elderly. Monocyte telomere length is proposed as a marker of cellular senescence in this condition.

Purpose: This study investigated the association between monocyte telomere length and retinal parameters in different forms of AMD, as well as in patients receiving antiangiogenic therapy.

Material and methods: Monocyte telomere length was measured in 84 patients (mean age 79±9 years) divided into four groups: non-exudative AMD with geographic atrophy (neAMD-GA), neovascular AMD (nAMD) with macular atrophy (nAMD-MA), nAMD without MA, and controls. Monocytes were isolated using immunomagnetic separation, and telomere length was determined by quantitative PCR (qPCR). Retinal parameters were assessed via optical coherence tomography (OCT) of the macular region.

Results: Significant telomere shortening was observed in AMD compared to the controls (p<0.05). In the nAMD-MA group, telomere length correlated positively with best-corrected visual acuity (BCVA) after treatment (rs=0.661; p=0.0014) and the type of atrophy (p<0.0001); shorter telomeres were associated with greater BCVA decline after therapy (rs=-0.452; p=0.0419). In nAMD without MA, telomere length correlated with reduced height of neuroepithelial detachment (NED) under anti-VEGF treatment (rs=0.50; p=0.0252). No significant associations were found in the neAMD-GA and control groups.

Conclusion: These findings highlight monocyte telomere length as a potential biomarker for predicting macular atrophy progression and treatment outcomes in AMD. Further research is needed to confirm these associations and to explore sex/ethnic disparities in telomere length in this disease.