Vestnik oftalmologii最新文献

Salzmann's nodular degeneration (SND) is a condition characterized by superficial subepithelial fibrosis of the cornea. Surgical treatment of SND usually consists of manual keratectomy of fibrotic nodules. When stromal layers of the optical zone are involved in the pathologic process, more technically complicated approaches may be preferred.

Purpose: This study evaluated the effectiveness of surgical treatment of central corneal opacities in SND.

Material and methods: The study analyzed surgical treatment outcomes of 61 eyes in 46 patients following the removal of centrally located fibrous nodules in the anterior stromal layers. Patients were divided into two groups based on the depth of stromal involvement. Patients of group 1 had stromal lesion depth up to 70 μm and underwent either phototherapeutic keratectomy (PTK) (subgroup 1a - 22 eyes) or automated microkeratome-assisted keratectomy (subgroup 1b - 13 eyes). Group 2 included patients with the depth of stromal layers lesion more than 70 μm, they underwent automated anterior lamellar keratoplasty (ALK) using a microkeratome head of either 130 μm (subgroup 2a - 14 eyes) or 200 μm (subgroup 2b - 12 eyes).

Results: In group 1, both methods of keratectomy significantly improved visual acuity. Postoperative sphere-equivalent (SE), astigmatism and keratometry values showed no significant differences between PTK and automated keratectomy. Rate of epithelialization was significantly higher after PTK. In group 2, postoperative visual acuity, SE, astigmatism and keratometry readings had no statistically significant differences between the subgroups. ALK performed using a 200 μm head with graft fixation by continuous suture resulted in a smaller variation of astigmatism values.

All patients were prescribed Stillavit or Stillavit Intensiv, which promoted rapid recovery of corneal epithelium.

Conclusion: Both keratectomy techniques can be effectively used in clinical practice depending on equipment availability. Although ALK with a 200-μm microkeratome head demonstrated more predictable outcomes, further improvement of thin-flap techniques will be beneficial.

Despite the abundance of publications, the interpretation of imaging techniques such as optical coherence tomography (OCT) remains challenging in the differential diagnosis of intraocular tumors (IOTs), particularly - early choroidal melanomas. This article analyzes OCT findings in 15 patients whose initial diagnosis of "choroidal hemangioma" was revised to "choroidal melanoma" in 11 cases and to "progressive nevus" in 4 cases. The mean tumor prominence was 2.22±0.82 mm, and the mean diameter was 8.01±2.72 mm. The analysis identified OCT patterns frequently responsible for diagnostic errors, such as cystoid changes and the "subretinal cleft." Therefore, for accurate diagnosis and to avoid treatment planning errors, OCT findings must be interpreted in conjunction with fundus examination and in the context of patient's medical history.

Ehlers-Danlos syndrome (EDS) is a heterogeneous group of inherited connective tissue diseases characterized by abnormal collagen synthesis and affecting various organs, including the eyes. This review analyses the current data on this disease, focusing on EDS types associated with ophthalmological manifestations: brittle cornea syndrome, kyphoscoliotic, musculocontractural, spondylodysplastic, dermatosparaxis, vascular, and classical types. The article describes ophthalmological diagnostic criteria for the different types of EDS and lists other possible ocular symptoms. The review also emphasizes the need for molecular genetic testing for accurate diagnosis in view of the difficulty in identifying specific genes encoding collagen or collagen interacting proteins, highlights the importance of timely treatment and describes methods of correcting visual disturbances, which are important for preventing severe complications such as globe rupture and retinal detachment.

The quality of life is determined by patients' physical, social, and mental functioning and is based on subjective assessments. No cluster analysis has previously been conducted to evaluate the quality of life (general health and visual function) in patients with small choroidal melanoma after various organ-preserving treatments.

Objective: This study aimed to assess quality of life, including general health and visual function, after different types of organ-preserving treatment in patients with small choroidal melanoma using cluster analysis.

Material and methods: A cluster analysis of the quality of life was performed, assessing changes in visual function (VF-14 - Visual Function Index), and physical and mental health (SF-36 - MOS 36-item Short-Form Health Survey) in 110 patients with small choroidal melanoma (mean age 59.1±11.6 years) after destructive laser photocoagulation, transpupillary thermotherapy, brachytherapy. The follow-up period was 8 [6; 10] years. Statistical analysis included Ward's minimum variance method, Euclidean distance, and the Kruskal-Wallis test.

Results: Subjectively assessed visual acuity was dependent on the treatment method, predominantly among female patients (p<0.01). Destructive laser photocoagulation demonstrated the best quality-of-life results (79.7±21.1%), transpupillary thermotherapy - intermediate (70.2±22%), and brachytherapy - low results (61±27.4%). No differences in physical and mental health indicators were detected after the three treatment methods. Pairwise analysis of individual physical and mental health parameters showed no differences between groups for both sexes.

Conclusion: The visual acuity in patients with small choroidal melanoma subjectively assessed by cluster analysis depends on the treatment method, tumor localization, and significantly decreases after brachytherapy, affecting the quality of life mainly in women (p<0.017). Cluster analysis of the quality of life of patients with small choroidal melanoma revealed stable mental and physical state of health of patients with small choroidal melanoma after various types of organ-preserving treatment (p>0.05) regardless of gender.

Objective: The is study evaluated the possibilities of using optical fluorescence to determine the components of meibum.

Material and methods: Meibum samples from 16 volunteers were analyzed using fluorescence spectroscopy in the visible optical range. The meibum spectrum was decomposed into three spectral components corresponding to the fluorescence of three reference substances: native keratin, lactoferrin, and riboflavin-mononucleotide. Each meibum sample was characterized by the spectral fraction of each of the three dominant fluorophores.

Results: The meibum spectra of 16 studied samples were obtained by fluorescence spectroscopy in the visible optical range under 440 nm laser excitation. Fluorescence of the meibum sample was detected in all cases. Using the proposed algorithm, the relative spectral component of one of the proposed reference substances was calculated for each real spectrum.

Conclusion: Fluorescence spectroscopy in the visible optical range, alongside other methods, allows the identification of major compartments constituting the bulk of meibum mass.

Component analysis of regular astigmatism (AS) involves determining the contribution of the cornea and the lens to the development of this type of ametropia. Most research in this area focuses on assessing corneal asphericity, while issues related to the lenticular AS remain less studied.

Objective: This study evaluated the influence of the lenticular component on the formation of regular total AS in older patients.

Material and methods: The potential impact of lenticular AS on total AS was assessed by analyzing the changes in parameters (magnitude and orientation of one of the principal meridians) after phacoemulsification with implantation of a monofocal intraocular lens (IOL). The study included 35 patients (41 eyes) aged 60-72 years. Preoperative AS ranged from 0.75 to 2.75 D.

Results: No significant changes in magnitude or orientation of one of the principal meridians of total AS were found postoperatively (p=0.737 and p=0.965, respectively). Analysis of potential differences between total and corneal AS after surgery showed the following: in 13 cases (31.7%) values were identical, in 14 (34.2%) they differed by 0.25 D, in 5 (12.1%) - by 0.5 D, in 4 (9.8%) - by 0.75 D, and only in 5 cases (12.1%) the difference exceeded 1 D. Greater variability was noted in the orientation of one of the principal meridians: no cases had results coincide, and differences of 0-10°, 11-20°, 21-30°, and >30° occurred in 19 (46.4%), 13 (31.7%), 6 (14.6%), and 3 (7.3%) cases, respectively.

Conclusion: The clinical model of pseudophakia after implantation of a monofocal IOL can be considered as a method for eliminating the impact of the lenticular component on total (clinical) AS. The need to refine keratometry data using subjective tests when determining the axis for toric IOL implantation remains due to the identified significant postoperative discrepancies in the orientation of one of the principal meridians of corneal and total AS.

Objective: This study evaluated changes in ocular parameters in patients with progressive myopia receiving 0.01% atropine.

Material and methods: The study included 35 children (18 girls, 51.4%; and 17 boys, 48.6%) aged 4-15 years. Among them, 20 (57.2%) had one myopic parent and 2 (5.7%) had both parents with myopia. The study consisted of four stages: stage 1 - initial examination; stage 2 - follow-up after 8 months without treatment; stage 3 - follow-up after 12 months of treatment; stage 4 - follow-up 6 months after treatment cessation. Atropine 0.01% was instilled daily at bedtime in four courses of 1.5 months each, totaling 12 months of follow-up. All patients had an astigmatic component.

Results: At stage 2, nearly all children showed progression of myopia, with a statistically significant increase in spherical equivalent in 63 (90%) eyes by an average of 0.70 D (p=0.000; p<0.001). A similar trend was observed in axial length, which increased by 0.35±0.09 mm (p=0.000; p<0.001). At stage 3, stabilization was observed in both spherical equivalent and axial length. The mean difference in spherical equivalent between stages 2 and 3 was minor (-0.08 D) and not statistically significant (p=0.127; p<0.050). Stabilization was also noted for axial length, with a change of 0.04 mm (p=0.034; p<0.050). Differences between stages 3 and 4 in spherical equivalent were minimal and statistically insignificant (-0.01 D; p=0.012).

Conclusion: The use of 0.01% atropine over one year in four 1.5-month courses stabilizes the progression of myopia in children. This method is an effective and acceptable option for controlling myopia in preschool and school-aged children.

One of the applied areas of biomechanics in ophthalmology involves studying changes in the fibrous coat of the eye in myopia. A series of studies using various methods has revealed alterations in the biomechanical properties of the sclera associated with progressive myopia due to structural and metabolic altering. However, corneal changes associated with myopia, and specifically those potentially influenced by the increase in axial length, remain less studied.

Purpose: To study the biomechanical properties of the corneal stroma removed during small-incision lenticule extraction (SMILE) in myopia with varying axial length (AL).

Material and methods: The study included 122 lenticules (stromal corneal fragments) obtained from patients aged 17-47 years during SMILE refractive correction for myopia. The preoperative spherical equivalent ranged from -0.75 to -13.25 D, and the AL varied between 22.64 and 29.05 mm. Baseline central corneal thickness (CCT) was 493.00-622.00 μm (mean 560.64±25.62 μm). Measurements were performed using a Bruker Bioscope Resolve atomic force microscope (Bruker, USA).

Results: Selective assessment of the Young's modulus (Y) for the anterior and posterior lenticule surfaces revealed comparable values (medians 51.00 and 53.60 kPa; minimum-maximum range 5.20-222.00 and 7.30-214.30 kPa, respectively). Analysis of the relationship between Y values and axial length showed a statistically significant but weak positive correlation for the anterior surface, in contrast to the posterior surface. A statistically significant inverse correlation was observed between Y and CCT: weak for the anterior surface and moderate for the posterior surface.

Conclusion: Corneal fragments obtained during SMILE myopia correction provide a valuable model for biomechanical testing of the corneal stroma under conditions closely resembling in vivo physiology. The Young's modulus values for the anterior and posterior lenticule surfaces were comparable and significantly correlated. The weak correlation between lenticule stiffness and axial length indirectly suggests minimal corneal biomechanical alterations associated with fibrous coat enlargement. The potential relationship between CCT and stromal biomechanics requires further investigation.

Salzmann's nodular degeneration (SND) is a corneal disease characterized by superficial subepithelial fibrosis. The exact pathophysiological mechanism of corneal damage in SND is unclear. It is likely related to the disruption of the structural integrity of corneal epithelial cells due to chronic inflammation and impaired homeostasis of the ocular surface.

Purpose: This study aimed to evaluate tear film (TF) status and meibomian gland (MG) function in SND.

Material and methods: The study included 196 patients (386 eyes) with typical clinical features of SND (the main group) and 50 nominally healthy individuals (100 eyes) who underwent routine ophthalmic screening (the control group). The mean age in the study group was 48.0±12.7 years, with women comprising 85% of participants. Keratotopography and the dry eye disease (DED) diagnostic system were used to assess the first tear film break-up time (FTBUT) and the average tear film break-up time (ATBUT), tear meniscus height, lipid layer thickness, degree of MG loss (atrophy), eyelid margin condition, and conjunctival/limbal hyperemia.

Results: All patients in the study group exhibited DED and grade 2-3 meibomian gland dysfunction (MGD); FTBUT and ATBUT were 5.2±1.5 s and 6.4±1.7 s, respectively. In the control group, mean FTBUT (11.4±3.7 s) and ATBUT (12.2±4.1 s) values were within normal limits, and MG atrophy corresponded to grade 1 MGD, showing statistically significant differences from the study group. No significant intergroup differences were found in tear meniscus height (21.2±4.3 mm vs. 22.4±3.6 mm), lipid layer thickness (41.3±1.6 nm vs. 56.6±1.4 nm), eyelid margin and conjunctival/limbal hyperemia.

Conclusion: SND predominantly affects women aged 45-50 years. The main risk factor for the disease is stage II-III MGD (MG atrophy of more than ⅓), accompanied by DED. Significant irregularity of the corneal surface in SND further exacerbates the course of DED.

A clinical classification, appropriate to its time, should reflect updated views on diseases, etiopathogenetic mechanisms, and imply subsequent areas of diagnostic and therapeutic measures. In this work we propose a clinical classification of keratitis and corneal erosions, and provide definitions of the main pathological processes accompanying corneal inflammation.