Vestnik oftalmologii最新文献

The use of femtosecond (FS) laser in LASIK procedures for myopia correction can lead to the formation of an opaque bubble layer (OBL) in stromal layers of different densities and in various areas of the cornea.

Purpose: This study evaluated the functional outcomes and the condition of the cornea in eyes with and without OBL in randomized groups.

Material and methods: The study included 93 patients (186 eyes) with varying degrees of myopia (from 2.25 to 7.5 D): the main group consisted of 137 eyes with OBL, the control group - 49 eyes without OBL. The average age of patients was 30±5 and 32±4 years, respectively, with spherical equivalent refractive errors of -4.9 D and -4.3 D, astigmatism up to 1.75 D and 1.25 D, respectively. The assessment included uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), clinical refraction, lower-order aberrations (RMS LOA), higher-order aberrations (RMS HOA), spherical aberration (Z40; Pentacam HR Oculus), confocal microscopy of all corneal layers, and tear film assessment (Medmont; TFSQ; TFBUT; TFSQ area). All patients underwent FS-LASIK [Technolas VICTUS; corneal flap thickness of 110-120 μm (optical zone 6.0 mm), pulse energy >1 mJ, frequency 80 kHz]. Follow-up visits were conducted at day 7, and 1, 3, and 6 months.

Results: No statistically significant differences were observed between the groups in terms of functional outcomes and optical aberrations. However, the OBL group showed significantly higher TFSQ values and more pronounced keratocyte changes visualized in the deep stromal layers (under the OBL) at the depth of 130-160 μm. The extent of keratocyte alterations decreased over time, from 118.3±5.1 mm/mm² on day 7 to 71.1±4.8 mm/mm² at 6 months, as observed via confocal microscopy.

Conclusion: While there was no difference in functional outcomes for myopia correction between eyes with and without OBL, the presence of OBL was associated with a higher extent of destructive changes in keratocytes, necessitating a longer healing period.

The introduction of bidirectional corneal applanation technologies into clinical practice made possible the in vivo assessment of biomechanical properties of the fibrous tunic in myopic eyes.

Purpose: This study analyzes the potential of bidirectional corneal applanation with high-speed video recording for biomechanical control of myopia, focusing on the biomechanical parameters of the sclera and cornea.

Material and methods: The study included 129 patients (168 eyes) with myopia ranging from -0.75 to -13.25 D in spherical equivalent. The axial length (AL) and central corneal thickness (CCT) ranged from 22.64 to 29.05 mm and from 492 to 644 µm, respectively. AL was measured using laser biometry, CCT with a rotating Scheimpflug camera, and the biomechanical properties of the fibrous tunic were assessed using bidirectional corneal pneumatic applanation with high-speed video recording using the Corvis ST device.

Results: A weak positive correlation was found between AL and CCT, while no significant correlation was observed between CCT and the stress-strain index (SSI). However, there was a significant negative correlation between SSI and AL. Additionally, a clear and statistically significant trend of decreasing SSI with increasing AL was identified.

Conclusion: The stress-strain index (SSI), determined using bidirectional corneal pneumatic applanation with high-speed video recording, could potentially be considered a clinical indicator characterizing the scleral component of the ocular fibrous tunic in the biomechanical control of myopia.

The second part of the literature review on the application of artificial intelligence (AI) methods for screening, diagnosing, monitoring, and treating glaucoma provides information on how AI methods enhance the effectiveness of glaucoma monitoring and treatment, presents technologies that use machine learning, including neural networks, to predict disease progression and determine the need for anti-glaucoma surgery. The article also discusses the methods of personalized treatment based on projection machine learning methods and outlines the problems and prospects of using AI in solving tasks related to screening, diagnosing, and treating glaucoma.

A group of patients was found to have a special form of recurrent corneal erosion caused by types I and II herpes virus. This form represents an independent form of ophthalmic herpes - herpetic recurrent erosion (HRE) of the cornea. The herpetic etiology of recurrent corneal erosion was confirmed by the immunofluorescence study of scraping from the conjunctiva, which revealed a high concentration of the herpes simplex virus antigen. Treatment of patients (171 patients, 182 eyes) with HRE included 2 consecutive stages: stage I - relief of acute symptoms of the disease with the help of conservative treatment (instillations of interferon inducers, autologous serum, corneal protectors, tear substitutes, use of therapeutic soft contact lenses); in some cases, phototherapeutic keratectomy was used in the absence of the effect of conservative therapy, as well as in the localization of the focus in the optical zone. Stage II involved anti-relapse therapy based on the use of a Russian-produced herpes vaccine in the intercurrent period. After vaccination, observation for 2 years or more showed that 81.3% of patients achieved clinical recovery (complete cessation of HRE recurrences), 15.8% had a decrease in the frequency and severity of relapses, while 2.9% of patients did not respond to the treatment.

Purpose: The study investigates the influence of changes in keratometric parameters after refractive surgery on the results of Maklakov tonometry.

Material and methods: The study examined a total of 61 people (121 eyes). The patients were divided into a control group with no history of surgery (16 people, 31 eyes), a LASIK group (13 people, 26 eyes), a femtosecond-assisted LASIK (FS-LASIK) group (16 people, 32 eyes), and a photorefractive keratectomy (PRK) group (16 people, 32 eyes). The patients underwent standard examination, keratometry (Km), Maklakov tonometry with a 10 g weight, and elastotonometry with 5, 7.5, and 15 g weights.

Results: In the LASIK group, the indentation diameter with 5 and 7.5 g weights correlated with Km in the central and near-paracentral zone (r=0.3-0.5). Tonometry with a 10 g weight did not correlate with anything. Tonometry with a 15 g weight inversely correlated with Km in the paracentral points (4 mm) of the strong meridian (r= -0.5 ... -0.7). In the FS-LASIK group, a significant inverse correlation with Km was observed only for the indentation diameter with a 10 g weight in the paracentral (3-4 mm) zone (r= -0.4 ... -0.5). In the PRK group, weak (r<0.4) correlations were found between Km and the indentation diameter of the 7.5 and 10 g weights for the central zone (1-2 mm). No significant correlations were found for 5 and 15 g weights.

In the control group, there were practically no correlations for 5 and 7.5 g weights. The indentation diameter of the 10 g weight evenly correlated with Km at all points (r= -0.38 ... -0.60), the indentation of the 15 g weight correlated mainly with the curvature of the horizontal meridian (r= -0.37 ... -0.49).

Conclusion: Tonometry readings with the 10 g weight are the most dependent on Km in different groups, and the readings with the 5 g weight are the least dependent. LASIK is characterized by the largest scatter of dependencies for weights of different masses, FS-LASIK - by the smallest. Tonometry readings with the 5 g weight correlated with Km only in the LASIK group, and this was the only direct correlation. Considering the inverse nature of most correlations, higher Km may be associated with an overestimation of tonometry results, and lower Km - with its underestimation.

The incidence of diabetic retinopathy (DR) requiring vitreorentinal surgery is increasing. The search for new effective and safe methods of treatment, the choice of the optimal time for surgery, and the assessment of long-term treatment outcomes are relevant problems.

Purpose: This study evaluates the long-term results of vitreorentinal surgery using the bimanual technique in DR with different stages of fibrovascular proliferation.

Material and methods: The study included 135 patients (135 eyes) who were divided into groups depending on the predominant type of proliferation - vascular or fibrous. Patients underwent vitrectomy with membranectomy using the bimanual technique, with peripheral panretinal endolaser coagulation of the retina and tamponade of the vitreous cavity with balanced salt solution. The postoperative observation period lasted up to 12 months.

Results: Both groups showed statistically significant improvement in visual function and anatomical changes in central retinal thickness. A statistically significant improvement in best corrected visual acuity (BCVA) was found in patients with initially predominantly vascular proliferation. Correlation analysis showed that initially higher BCVA tends to persist in the postoperative period. A negative correlation was found between the final BCVA and the presence of type 2 diabetes mellitus, fibrous stage of proliferation, high central retinal thickness, and the presence of diabetic macular edema (DME) - both initially and after treatment. The frequency of complications in the groups was comparable, except for postoperative DME, which was more often detected in patients with fibrous proliferation.

Conclusion: The bimanual technique of vitreorentinal surgery for complications of DR allows achieving high anatomical and functional results. Higher BCVA is noted in patients with the vascular stage of proliferation and initially high BCVA. The obtained data allow us to form a hypothesis about the possibility of earlier surgery in patients with high BCVA, but require further investigation.

Accurate measurement of astigmatism parameters is the basis for prescribing modern means of optical correction. In recent years, another direction for correcting astigmatism has emerged - implantation of toric intraocular lenses (TIOL).

Purpose: This study evaluates the diagnostic accuracy of various methods for measuring the parameters of regular astigmatism.

Material and methods: The study included 83 patients (122 eyes) with regular astigmatism exceeding 1.0 D. Three groups were formed depending on the type of astigmatism. Spherical and cylindrical (power and axis) components of refraction were determined using automatic refractometry. The results were refined with subjective tests: power and axis tests with a cross-cylinder. The criterion for diagnostic accuracy was the level of corrected visual acuity. To assess the impact of cylinder position on visual acuity, discrete deviations of the axis of trial astigmatic lenses from the correct position (determined based on subjective tests) were modeled at 5, 10, and 15 degrees in both clockwise and counterclockwise directions.

Results: In the overall sample of observations, coincidence of results was found only in one-third of cases, with a tendency for discrepancies in data between the two methods in nearly 70% of cases. Statistical processing revealed significant differences only in the magnitude of the cylinder in the group with against-the-rule astigmatism (p<0.0005). An increase in maximum visual acuity corrected based on subjective test data was noted. With a deviation of the cylinder axis from the correct position by 10-15 degrees, regardless of the type of astigmatism, a significant tendency for a decrease in visual acuity was identified. At the same time, with a deviation of the cylinder axis within 5 degrees, a significant decrease in visual acuity was noted only in with-the-rule astigmatism and counterclockwise deviation.

Conclusion: To achieve maximum visual acuity in the correction of regular astigmatism, objective method data must be refined with subjective tests. The results of modeling the deviation of the axis of the corrective lens from the proper position can be considered when evaluating the functional outcomes of TIOL implantation.

Purpose: This study was performed to assess the prevalence of the vascularized foveal zone, including macular-foveal capillaries (MFC) and congenital retinal macrovessels (CRM), and to analyze the structural characteristics of the macular area in patients with MFC.

Material and methods: The first phase of the study evaluated the prevalence of MFC and CRM. Optical coherence tomography angiography (OCT-A) was performed, and OCT-A images of the foveal avascular zone were analyzed. In the second phase, two groups were formed: the MFC group (12 eyes, 9 patients, mean age 43.8±10.7 years) and the control group (18 eyes, 17 patients, mean age 43.0±11.8 years). A comparative analysis was performed assessing central retinal thickness (CRT), thickness of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), and foveal pit depth.

Results: MFCs were detected in 45 eyes from a total sample of 1031 eyes of 536 patients. The presence of CRM was recorded in three eyes of three patients. RNFL thickness was significantly higher in the MFC group in the inferior parafoveal sector (26.50 [26.00; 29.50] and 24.50 [21.75; 26.50] μm; p=0.022) and in the foveal zone (15.50 [14.00; 16.00] and 12.00 [11.00; 14.00] μm; p=0.017). Additionally, patients with MFC had a higher thickness of GCL and IPL in the fovea, inferior, nasal, and temporal parafoveal sectors. The depth of the foveal pit was significantly lower in the MFC group compared to the control group (83.0 [77.4; 101.6] and 128.0 [107.5; 147.05] μm; p=0.001).

Conclusion: The prevalence of MFC was 4.36% (calculated per number of eyes), while the prevalence of CRM - 0.29%. The macular area in patients with MFC had increased thickness of the inner retinal layers and decreased depth of the foveal pit, suggesting potential disruption in the natural process of ganglion cell migration and apoptosis during embryogenesis.

The conducted archival research and analysis of literary publications allowed us to supplement the biography and creative path in science, clinical and social activities of the outstanding Russian ophthalmologist A.N. Maklakov. This article emphasizes the urgency of the problem of teaching in medical universities, and gives special attention to the thoughts of the scientist about providing clarity in the process of teaching students. The article notes his role in the arrangement and equipment of the new eye clinic of the Moscow University, and presents fragments of memoirs of his student and mentee, another famous Russian ophthalmologist S.S. Golovin. A remark is made about the need to clarify the terms traditionally accepted in the history of medicine in relation to surgery and ophthalmology. An assessment is given on the contribution of A.N. Maklakov to the establishment of the Moscow Ophthalmological Circle, his efforts to unite doctors, and the development of the statutory documents of the All-Russian Society of Eye Doctors.

Purpose: This study analyzes the main changes in retinal microcirculation in patients with multiple sclerosis (MS) and their relationship with the type of disease course.

Material and methods: 159 patients (318 eyes) were examined. The groups were formed according to the type of course and duration of MS: group 1 - 37 patients (74 eyes; 23.27%) with relapsing-remitting MS (RRMS) less than 1 year; group 2 - 47 patients (94 eyes; 29.56%) with RRMS from 1 year to 10 years; group 3 - 44 patients (86 eyes; 27.05%) with RRMS >10 years; group 4 - 32 patients (64 eyes; 20.12%) with secondary progressive MS (SPMS). Subgroups A and B were allocated within each group depending on the absence or presence of optic neuritis (ON). Patients underwent standard ophthalmological examination, including optical coherence tomography angiography (OCTA).

Results: A decrease in the vessel density (wiVD) and perfusion density (wiPD) in the macular and peripapillary regions was revealed, progressing with the duration of the disease and with its transition to the progressive type. The minimum values were observed in patients with SPMS (group 4), with the most pronounced in the subgroup with ON (wiVD = 16.06±3.65 mm/mm², wiPD = 39.38±9.46%, ppwiPD = 44.06±3.09%, ppwiF = 0.41±0.05).

Conclusion: OCTA provides the ability to detect subclinical vascular changes and can be considered a comprehensive, reliable method for early diagnosis and monitoring of MS progression.