Vestnik oftalmologii最新文献

The discovery of the air-impermeable pre-Descemet's layer prompted discussions on revising the microanatomy of the cornea, enabled classification of the DALK (deep anterior lamellar keratoplasty) technique based on the location of the bubble relative to the pre-Descemet's layer (PDL), and led to the introduction of a new type of Descemet membrane transplantation - pre-Descemet's endothelial keratoplasty (PDEK). We believe that if it is possible to isolate the PDL, then it can be used it as an analogue (or imitation) of the corneal epithelial basement membrane to separate epithelial and stromal cell populations in the treatment of corneal pathology.

Objective: This study presents a method for obtaining a PDL graft from the corneal stroma for subsequent clinical use (transplantation through sutureless covering of the cornea).

Material and methods: Fifteen donor corneoscleral buttons were used, including five cryopreserved ones. In all 15 corneoscleral discs, the Descemet's membrane with endothelium had previously been peeled and transplanted during Descemet's membrane endothelial keratoplasty (DMEK). In eight discs, the Bowman's layer had also been separated and transplanted during Bowman's layer transplantation. In all cases, the PDL graft was obtained by corneal pneumodissection. The resulting grafts were preserved for further clinical use.

Results: In all 15 cases, type 1 big bubble with PDL detached from the stroma was successfully created in corneoscleral discs without the Descemet's membrane. In two cases, rupture of the big bubble and damage to the PDL occurred. In 13 cases, the PDL was successfully excised (trephined), stained, and preserved after pneumodissection for subsequent transplantation.

Conclusion: The proposed technique does not require expensive equipment, does not increase the demand for donor tissue, fully complies with the concept of multi-transplantation, and carries a minimal risk of donor tissue rejection.

Objective: The effect of the type of topical hypotensive therapy on the hypotensive effect of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma (POAG).

Material and methods: A retrospective analysis was performed on medical records of patients who received SLT for the first time and had no prior laser or surgical glaucoma treatment. SLT was performed according to the standard protocol, with 360° trabecula treatment. Patients were divided into five subgroups based on the number of hypotensive medications used (0 to 4) and into 15 subgroups according to the combinations of medications used before SLT. Intraocular pressure (IOP) levels before and after treatment were compared, and the IOP-lowering effect of SLT was evaluated at 1 day and 1 month postoperatively.

Results: The study included 808 patients (808 eyes) with POAG stages I-III, who either received no hypotensive therapy (n=54) or were on one (n=169), two (n=233), three (n=307), or four (n=45) topical hypotensive medications. The hypotensive effect differed significantly among subgroups with different numbers of medications at 1 day after SLT (F=3.18; p=0.01). The greatest effect was observed in the subgroup receiving maximum therapy (5.0±3.3 (95% confidence interval (CI) 3.9-6.1) mm Hg), which decreased by 1 month and became the lowest among all subgroups (2.6±3.0 (95% CI 1.6-3.7) mm Hg). At 1 month, differences among subgroups were not statistically significant (F=2.21; p=0.07), although the greatest effect was seen in the subgroup without therapy (4.0±2.8 (95% CI 3.2-4.8) mm Hg). The effect of SLT did not significantly differ among the 15 subgroups with different types of pre-surgical therapy at either 1 day (F=1.65; p=0.28) or 1 month (F=1.19; p=0.06) after laser treatment.

Conclusion: Selective laser trabeculoplasty is an effective method for additional IOP reduction in POAG, and its hypotensive effect does not depend on the number, type, or combination of hypotensive eye drops used before laser treatment.

This article analyzes two clinical cases of axial displacement of an intraocular lens (IOL) in the postoperative period in hyperopic patients following cataract surgery with implantation of a monoblock hydrophobic acrylic IOL with S-shaped haptics. In both cases, cataract phacoemulsification was performed using the standard phaco chop technique, with intracapsular IOL implantation targeting emmetropia. It was determined that the refractive shift towards myopia with underlying baseline hyperopia in these cases was not due to errors in calculating the IOL optical power. The cause of ineffective IOL positioning and myopization was the formation of blocks: in the first case - a vitreo-pseudophakic block due to anterior displacement of the pseudophakic diaphragm, and in the second case - a capsular block. It was concluded that when a myopic shift is detected in the postoperative period in patients with cataract surgery targeting emmetropic refraction, it is necessary to thoroughly analyze the obtained results, identify the precise causes of refractive failures, and provide appropriate pathogenetically oriented treatment to achieve the initially planned outcomes.

Proteins and lipids in the meibum help maintain the balanced chemical composition of the tear film. However, the secretion of the meibomian glands contains various protein fractions, the function and effects of which on the lipid profile remain incompletely understood. This literature review provides a description of the main proteins of the meibum and their roles in the pathogenesis of meibomian gland dysfunction associated with age-related changes and metabolic disorders that lead to impaired tear film functionality. The article also analyzes modern methods for studying meibomian gland secretion.

Purpose: This study investigates the clinical features and outcome dimensions of neovascular age-related macular degeneration (nAMD).

Material and methods: This retrospective study analyzed 80 subjects diagnosed with nAMD. The patients received successful treatment through intravitreal administration of anti-vascular endothelial growth factor (anti-VEGF) agents. The subjects were classified into three groups based on the final integrity of their inner segment/outer segment (IS/OS) layer of the retina, assessed using spectral-domain optical coherence tomography (SD-OCT). This classification helped to understand the extent of retinal damage and the progression of nAMD. The primary evaluation was to examine the association between final IS/OS integrity and final visual acuity in the groups. The study also evaluated foveal microstructures (choroidal neovascularization size, external limiting membrane, outer nuclear layer thickness, and central macular thickness) at the initial and final visits, and their relationships with final IS/OS integrity.

Results: The study found a significant association (P<0.001) between final visual acuity and IS/OS integrity. The V group had the best visual acuity (0.12±0.09) compared to the P group (0.39±0.45) and I group (0.92±0.42). Improved visual acuity was strongly correlated with less disrupted IS/OS and ELM. Intact photoreceptor integrity was linked to preserved IS/OS and ELM, thinner CMT, and shorter CNV height before treatment. However, photoreceptor integrity was not significantly correlated with CMT, RPE regularity, or ONL thickness at the final examination, suggesting it may be independently affected by nAMD.

Conclusion: Final visual acuity in nAMD patients post-treatment was strongly linked to foveal photoreceptor integrity. Photoreceptor integrity correlated with initial visual acuity, CMT, ELM integrity, CNV height, and IS/OS layer integrity. These factors can predict visual outcomes after resolution of exudaiton.

The development of biological therapeutic agents has provided new opportunities for treating neovascular age-related macular degeneration (nAMD) using humanized monoclonal antibodies (mAbs) targeting vascular endothelial growth factor A (VEGF-A). The emergence of biosimilars of anti-VEGF agents can significantly improve treatment accessibility and its effectiveness by increasing patient adherence. The development of biosimilars involves comparative studies with the original drug to establish equivalence in physicochemical and biological properties, efficacy, and safety. Biosimilar development programs include extensive analytical and preclinical studies to compare structural and functional components with the original bioproduct, and clinical trials are conducted to prove bioequivalence and therapeutic equivalence. The process of development and registration of the biosimilars is strictly regulated and has no significant differences in Russia, the EU and the US. Currently, more than 10 biosimilars of ranibizumab have been approved worldwide, in Russia it is the drug Laxolan (AO GENERIUM). The introduction of a domestic biosimilar of ranibizumab into clinical practice allows reduction of the costs of retinal disease treatment while maintaining the efficacy and safety of antiangiogenic therapy.

To date, the nature of micro-level changes in retinoblastoma (RB) foci following combination chemotherapy (CT) remains poorly studied.

Purpose: This study analyzed the morphometric characteristics of small RBs in children who underwent combination CT.

Material and methods: The study included 31 patients - 17 girls and 14 boys (n=31) - who had undergone combination CT and transpupillary thermotherapy (TTT). The children's ages ranged from 1 to 20 months (mean 9.7±6.9 months). The average follow-up period was 60.8±4.6 months. Spectral-domain optical coherence tomography (SD-OCT) was performed for tumors located in the central parts of the ocular fundus and in the middle periphery.

Results: The mean tumor height (prominence) was 2154±29 µm, and the mean basal diameter was 7998±122 µm. Microcalcifications (n=5; 16.1%) and confluent calcifications (n=26; 83.9%) were visualized in the tumor stroma, producing "shadow track" effects in these regions; confluent calcifications were observed in 83.9% (n=26) of cases, while microcalcifications were detected in 16.1% (n=5). All examined tumors were highly reflective. The incidence of endophytic and exophytic growth patterns was 65.6% and 34.4%, respectively. Detachment of the neuroepithelium above the tumor and in adjacent areas was diagnosed in 6.5% of cases. Additional morphometric characteristics of small RBs following combination CT included the formation of calcifications and hyperreflective changes in the inner, middle, and outer tumor layers, perifocal areas, and adjacent choroid in the area of neoplasms.

Conclusion: This study is the first to investigate the morphometric changes in small RBs following combination CT. These findings may aid in selecting the optimal method, parameters, and timing of focal therapy for more effective destruction of tumor foci.

Processing large datasets using artificial intelligence is a promising approach in disease diagnosis and monitoring that focuses on improving research algorithms for existing technologies. Interest in studying corneal nerve fibers (CNFs) arises not only from the need to understand the pathogenesis and progression of various ocular diseases but also from the potential for thin, unmyelinated corneal nerves to be used as biomarkers for systemic polyneuropathies.

Purpose: This study evaluates the preliminary results of using a neural network-based algorithm for analysis of confocal images of CNFs.

Material and methods: The comparative study of CNFs was conducted in a group of 50 healthy volunteers (100 eyes) aged 25 to 55 years without concomitant ocular or systemic diseases. Confocal microscopy of the central cornea was performed to assess the state of CNFs. Image analysis and nerve recognition were carried out using special software (Liner calculate, Liner 1.2S) and a newly developed neural network-based algorithm.

Results: The study considered suitable encoders for image processing, including ResNet_50, VGG_16, and InceptionResNetV2. Among these, images processed with the VGG_16 encoder in Imagenet mode demonstrated the highest quality. Quantitative CNF parameters (length and density of the main trunks, macrophage count, anisotropy and symmetry coefficients) were comparable between the regular software and the neural network-based algorithm.

Conclusion: The results indicate the potential of using neural networks, particularly the VGG_16 encoder family, for structural assessment of the CNFs. Key advantages of the proposed algorithm include improved quality of image interpretation and reduced time required for analysis.

This article presents a clinical case of pigmentary chorioretinopathy associated with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD-associated retinopathy) in a 5-year-old female patient. The condition manifested clinically as localized retinal pigment epithelium (RPE) hyperplasia in the foveal region, areas of localized chorioretinal atrophy with RPE hyperplasia in the posterior pole, as well as retroequatorial and equatorial regions. In the left eye, a localized area of subretinal fibrosis was observed in the fovea as a consequence of prior focal chorioretinitis, resulting in reduced visual acuity to 0.03 sc and decreased cone-mediated retinal electrical activity as evidenced by electroretinography. In the right eye, uncorrected visual acuity remained high at 0.8 sc; visual evoked potentials showed no abnormalities, and both full-field and multifocal electroretinography yielded values within normal limits. Optical coherence tomography (OCT) data are presented, illustrating specific structural retinal changes associated with LCHADD-associated retinopathy.

Primary full-thickness macular holes (FTMHs) are one of the causes of persistent visual acuity reduction. Currently, higher demands are placed on the anatomical and functional outcomes of treatment for this pathology, which has stimulated the development and improvement of surgical techniques.

Purpose: This study aimed to evaluate the clinical effectiveness of the developed surgical technique for primary small- and medium-sized FTMHs that preserves the intact internal limiting membrane (ILM) of the retina in the papillomacular bundle (PMB) area of the nerve fibers (keyhole technique).

Material and methods: The study included 72 patients who underwent surgery for retinal FTMH between 2021 and 2023. The subjects were divided into two groups: the main group (41 patients) and the control group (31 patients). In all cases, a standard three-port vitrectomy was performed. ILM peeling was carried out through sequential, targeted removal of its local areas concentrically to the macular hole. In the main group, the ILM in the projection of the PMB was preserved intact, in contrast to the surgical technique used in the control group. The follow-up period lasted up to 12 months after surgery.

Results: Anatomical closure of the FTMH was achieved in all patients. The main group demonstrated a more pronounced positive dynamic across all functional parameters compared to the control group. Intergroup differences were statistically significant (except for visual acuity), indicating significantly more favorable therapeutic outcomes in the main group.

Conclusion: The proposed surgical technique for primary FTMHs with a minimal diameter of no more than 400 μm with preservation of the intact papillomacular area of the retina provides better anatomical and functional outcomes in comparison with the method that involves peeling of the ILM around the macular hole in a concentric pattern.