Vestnik oftalmologii最新文献

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.

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.

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.

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.

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.

Dry eye syndrome (DES) is one of the most common conditions among patients visiting ophthalmologists. Traditional methods for assessing tear production have significant limitations as they depend on multiple factors and demonstrate low reproducibility. Therefore, there is a need for more accurate and objective assessment approaches, such as the direct assessment of tear secretion (DATS) method.

Purpose: This study aimed to evaluate the diagnostic value of DATS compared to conventional tear production assessment methods.

Material and methods: The prospective study included 35 patients (70 observations): 34 observations in healthy volunteers, and 36 in patients with DES. The technique for DATS involved visualization of lacrimal gland ducts using fluorescein staining, video recording of secretion, and quantitative analysis of tear fluid volume using specialized software. All participants additionally underwent Schirmer's test, lacrimal meniscometry, and Ocular Surface Diseases Index (OSDI) questionnaire. Statistical analysis was performed using non-parametric tests (Mann-Whitney, Spearman) and ROC analysis with construction of AUC curves and determination of optimal diagnostic thresholds.

Results: DATS values differed significantly between groups: 0.68 (0.41; 1.11) μl/min in healthy subjects versus 0.25 (0.04; 0.62) μl/min in dry eye patients (p=0.006). A moderate inverse correlation was found between DATS and OSDI scores (r=-0.41, p<0.001). ROC analysis demonstrated high diagnostic efficacy of DATS (AUC=0.85) with an optimal threshold of 0.3 μl/min (sensitivity 85.3%, specificity 52.8%), outperforming conventional methods.

Conclusion: DATS proved its diagnostic value as a method for direct assessment of lacrimal gland function and may become a promising tool in clinical practice. Further studies are needed to standardize the protocol and validate the method in larger patient cohorts with different forms of DES.