Vestnik oftalmologii最新文献

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.

Modern surgical strategies for keratoconus aim to both stabilize disease progression and correct induced refractive errors. Effectively and simultaneously achieving both goals remains a relevant challenge. This study presents a clinical case of femtosecond laser-assisted intrastromal keratoplasty with implantation of a biosynthetic complex, demonstrating the efficacy of this surgical approach in treating keratoconus. The use of a biosynthetic complex stabilizes corneal ectasia and reduces irregularities in the central corneal zone and the degree of ametropia. The resulting refractive parameters and visual acuity support the potential application of this method in future clinical practice.

The diagnostic potential of computer accommodography remains insufficiently studied. At the same time, accommodative and refractive disorders are extremely common today among the youth.

Objective: This study investigated objective accommodative parameters using computer accommodography in samples of individuals aged 17-19 and 20-23 years with and without a diagnosis of myopia.

Material and methods: This cross-sectional study was conducted on a random sample of young working-age individuals (aged 17-19 and 20-23 years) residing in Arkhangelsk. The sample included 210 individuals (420 eyes). All participants underwent a standard ophthalmological examination with diagnosis established in accordance with ICD-10, as well as an assessment of accommodative function using objective computer accommodography with subsequent analysis of accommodograms.

Results: The main accommodogram indicators in individuals without ophthalmic pathology and with a normal accommodative response were calculated for the 17-19 and 20-23 age groups. Data were obtained on the ranges of accommodography indicators in individuals without ophthalmic pathology in the combined 17-23-year age group. Statistically significant differences were identified in the accommodative response stability coefficient (σARS) in individuals without ophthalmic pathology but at risk of developing computer vision syndrome.

Conclusion: Thus, in order to standardize accommodogram results in individuals without ophthalmic pathology and with a normal accommodative response, it is recommended to consider the combined age group of 17-23 years. At the same time, the σARS parameter may be recommended for identifying individuals without ophthalmic pathology but with predictors of myopia development.

Iris melanoma is a rare malignant tumor of melanocytic origin. Oncogenic viruses, whose invasion of the cell alters proliferation regulation mechanisms, play an important role in tumor development and progression.

Purpose: To identify clinical, morphometric, and pathomorphological correlations with infectious status in patients with iris melanoma and to determine predictors of unfavorable prognosis.

Material and methods: Sixteen patients with iris melanoma were examined. Anterior segment optical coherence tomography (AS-OCT) was performed using the RS-3000 Advance system (Nidek, Japan) with OCT-Angiography software. The specific humoral response to herpesviruses was assessed by detecting IgG and IgM antibodies in blood serum via enzyme-linked immunosorbent assay (ELISA) using an automated immunoassay analyzer LAZURITE (Dynex Technologies Inc., USA). Statistical analysis employed Spearman's rank correlation coefficient (r_s).

Results: Iris melanoma was predominantly observed in female patients (n=11) of advanced age (n=8). Biomicroscopy revealed 10 pigmented, 1 hypopigmented, and 5 non-pigmented tumors. The mean prominence on OCT was 1461.7±740.5 μm, the basal diameter was 3409.6±1822.8 μm, and the volume was 4.7±3.7 mm³. Ciliary body involvement was detected in 10 patients. Iris melanomas were classified as epithelioid-cell (n=1), spindle-cell (n=12), and mixed-cell (n=3) types. Extrabulbar growth was noted in three patients. Serological markers of viral reactivation were identified: herpes simplex virus type 1 (n=11) and type 2 (n=5), and cytomegalovirus (n=3).

Direct correlations (r_s=0.5-0.8) were identified between the presence of serological markers of herpesvirus reactivation and unfavorable prognostic features, including advanced age, maximum tumor basal diameter, ciliary body involvement, dense pigmentation, and extrabulbar growth. The mean follow-up period was 18.5±2.97 months, and all patients were alive, with no evidence of recurrence.

Conclusion: The findings of this study demonstrated a correlation between herpesvirus reactivation and unfavorable prognostic features of iris melanoma. Further research is needed to deepen the understanding of the role of herpesviruses in the pathogenesis of iris melanoma and to develop personalized approaches to prevention and treatment.

Purpose: This study evaluated the hypotensive efficacy of resorbable, slowly resorbable, and non-resorbable implants in the surgical treatment of primary open-angle glaucoma (POAG) in pseudophakic patients.

Material and methods: The study involved patients with pseudophakia and stage II-III POAG who underwent glaucoma surgeries using various types of implants. A total of 140 eyes were evaluated. Group 1 included patients with resorbable implants made of polylactide and polyethylene glycol (40 eyes, 28.3%); group 2 consisted of patients with partially resorbable hydrophilic collagen implants (40 eyes, 28.3%); group 3 comprised patients with non-resorbable collagen implants (40 eyes, 28.3%). The control group consisted of patients who underwent sinus trabeculectomy with basal iridectomy (STE+BI) without drainage implantation (20 eyes, 14.9%).

Results: After two years, intraocular pressure (IOP) decreased from 29.4±7.8 to 18.29±3.67 mm Hg in group 1, from 29.8±7.5 to 18.6±2.15 mm Hg in group 2, from 29.6±3.12 to 18.3±0.47 mm Hg in group 3, and from 31.6±4.8 to 20.6±3.95 mm Hg in the control group. These results correlated with hydrodynamic indicators assessed by tonography and examination of surgically created aqueous outflow pathways using ultrasound biomicroscopy (UBM) of the anterior segment and optical coherence tomography (OCT).

Conclusions: In the late postoperative period (24 months post-surgery), the complete success rate of the surgeries showed a decreasing trend. All groups eventually required the reintroduction of hypotensive therapy. The most sustained success was observed in groups with resorbable and non-resorbable implants. Further dynamic monitoring will determine which implant type is the most favorable for surgical treatment of glaucoma.

Burning eye syndrome (BES) is a subtype of dry eye syndrome (DES) characterized by neuropathic pain that is resistant to conventional DES therapy aimed at restoring tear film stability. The lack of impact on the corneal neural pathways is the reason for ineffectiveness of such treatment.

Purpose: This study evaluated the effectiveness of a novel treatment regimen for BES.

Material and methods: The study included patients aged 18-45 years diagnosed with BES. The criterion for exclusion from the study was the presence of clinical signs of blepharitis, meibomian gland dysfunction, as well as existing rheumatologic or oncologic diseases. The follow-up period was 12 months. All patients underwent standard and specialized ophthalmic examinations. They were randomly assigned to two groups: group 1 received gabapentin combined with neuroprotective therapy (thioctic acid, ipidacrine, and B vitamins) and topical 0.4% hyaluronic acid (HA) four times daily, while group 2 received only tear substitution therapy with 0.4% HA four times daily. Treatment efficacy was assessed using subjective (the Russian version of the Central Sensitization Inventory (CSI-20) and Visual Analog Scale (VAS)) and objective (laser corneal confocal microscopy and tearscopy) evaluation methods. Therapeutic effectiveness was assessed at 3, 6, and 12 months.

Results: By the third month, patients in group 1 reported subjective improvement based on CSI-20 and VAS scores, while objective findings demonstrated decreased tear osmolarity, increased anisotropy coefficient of nerve fiber orientation, and an increase in nerve fiber length. No significant changes were observed in group 2 over the same period.

Conclusion: The proposed treatment regimen, incorporating gabapentin along with neuroprotective therapy (thioctic acid, ipidacrine, and B vitamins) and topical 0.4% HA, proved more effective in alleviating neuropathic pain in BES compared to isolated topical therapy.

An objective assessment of the lacrimal punctum (LP) and peripunctal area, essential for appropriate treatment planning, is only possible through optical coherence tomography (OCT). To date, global experience with this method remains limited, underscoring the need for further investigation of its diagnostic value.

Purpose: This study evaluated the diagnostic capabilities of OCT in cases of obstruction of the upper lacrimal pathway.

Material and methods: The study included 26 patients (39 LP and canaliculi) with epiphora, in whom stenosis or obliteration of the LP by a membranous structure was identified. All patients underwent OCT of the LP and lacrimal canaliculus (LC) using the SD-OCT Optovue RTVue-100 system. The following morphological parameters were assessed: external LP diameter, LP depth, depth of the tear well, thickness of the epithelial, connective tissue, and muscle layers in the peripunctal area, epithelial thickness and lumen width of lacrimal canaliculus, as well as the thickness of the LP membrane. Histological structure, location, membrane thickness, and degree of canalicular lumen obstruction were also evaluated. Comparative and correlation analyses were performed.

Results: The following types of membranes have been identified: thick, complete, superficial epithelial-connective tissue membrane (33%); thin, complete, deep epithelial membrane (23%); and thick, complete, superficial epithelial membrane (15%). The most pronounced differences were found when comparing epithelial and epithelial-connective tissue membranes. Some OCT signs were found to be potential markers of ocular surface inflammation and inflammation of the upper lacrimal pathway, indicating a need for conservative etiopathogenetic therapy before surgical intervention.

Conclusion: OCT is a valuable diagnostic tool, and its findings may serve as the foundation for developing rational approaches to both conservative and surgical treatment in patients with idiopathic inflammation of the LP and LC, as well as with stenosis or obliteration of the upper lacrimal pathway.

Cytomegalovirus retinitis affecting the posterior pole of the eye is the most common opportunistic infection in acquired immunodeficiency syndrome (AIDS). It typically develops at CD₄ lymphocyte levels below 50-100 cells/μL and, if untreated, leads to blindness. Much less frequently, cytomegalovirus infection results in choroiditis, followed by secondary retinal changes. This article presents a clinical case of cytomegalovirus chorioretinitis in a human immunodeficiency virus-infected patient.

One of the priority areas in healthcare is the concept of predictive, preventive and personalized medicine, which is based on an individualized approach to the patient, including before the onset of diseases such as glaucoma.

Purpose: This study was conducted to substantiate the necessity of close monitoring of primary angle closure suspects (PACs) by comparing their clinical and anatomical parameters with those in normal eyes and in primary angle closure (PAC) before and after lens extraction (LE) or laser peripheral iridotomy (LPI).

Material and methods: This prospective study included 30 PACs patients. The comparison group consisted of 60 patients with PAC: 30 patients underwent LE with intraocular lens implantation, and 30 patients underwent LPI. Control group - 30 eyes without ophthalmic pathology. All subjects underwent swept-source optical coherence tomography (SS-OCT), including analysis of choroidal thickness in the macula, lens vault (LV), iris thickness and curvature (ICurv), and anterior chamber angle (ACA) profile. Machine learning methods were used, including data driven soft independent modelling of class analogies (DD-SIMCA).

Results: The parameters of PACs eyes occupied an intermediate position between those of PAC before treatment (according to DD-SIMCA classification) and normal eyes, but remained distinct from PAC eyes after treatment, falling outside the "safety zone" relative to normal values. Compared with the PAC group after LE, the PACs group had a shallower anterior chamber (2.60±0.13 mm vs. 3.63±0.199 mm, p=0.00), a narrower ACA profile (all p=0.00), a steeper iris (all p=0.00), lower uncorrected visual acuity (0.50±0.24 vs. 0.95±0.08, p=0.00), and a higher spherical equivalent (SE). Compared with PAC eyes after PLI, the PACs had greater LV (0.84±0.11 mm vs. 0.58±0.07 mm, p=0.00), higher intraocular pressure (19.7±0.8 mm Hg vs. 16.9±2.0 mm Hg, p=0.00), greater ICurv (all p<0.05), higher SE, and a narrower ACA profile.

Conclusion: Untreated PACs have significantly worse clinical and anatomical parameters, both in comparison with the norm and with PAC patients after treatment. This substantiates the need for closer monitoring of PACs.

Retinoblastoma is a malignant retinal tumor characterized by an aggressive clinical course, with frequent recurrences and the emergence of new foci even during chemotherapy.

Objective: This study investigated the subpopulation composition of peripheral blood lymphocytes in children with newly diagnosed untreated retinoblastoma.

Material and methods: A total of 24 children (48 eyes) were examined between December 20, 2023, and September 1, 2024; retinoblastoma was diagnosed in 28 eyes. Immunological assessment was performed using whole blood samples. Lymphocyte subpopulations were analyzed by flow cytometry on a BD FACS Canto II (Becton Dickinson, USA) using the Multitest 6-Color TBNK Reagent monoclonal antibodies in BD TruCount tubes (Becton Dickinson, USA).

Results: Analysis of the lymphocyte subpopulation profile revealed an imbalance in key cellular components of both the innate (natural killer cells, NK) and adaptive (T- and B-lymphocytes) branches of the immune system. Significant alterations were observed in NK lymphocytes (CD16⁺CD56⁺), with decreased absolute and relative counts identified in 54.5% and 45.5% of children, respectively. More severe disease stages were associated with marked abnormalities in NK cell populations and adaptive immune cell subsets (T- and B-lymphocytes); in this group, a reduction in the absolute number of NK cells was observed in 60% of patients, while nearly one-third of these children exhibited reduction in absolute and relative counts of B-lymphocytes (CD19⁺), as well as in key regulatory subpopulations of T-helper and T-cytotoxic lymphocytes.

Conclusion: The findings indicate significant deviations in the cellular immune status (lymphocyte subpopulation composition) of children with newly diagnosed untreated retinoblastoma.