Vestnik oftalmologii最新文献

Purpose: The purpose of this study was to analyze the outcomes of treatment of acute postoperative endophthalmitis and verify its main causative agents.

Material and methods: The study included 49 patients (49 eyes) with acute postoperative endophthalmitis that developed following surgical interventions in various clinics. At the onset of endophthalmitis, 3 patients (6.1%) retained object vision with visual acuity ranging from 0.05 to 0.20, while 7 patients (14.3%) had visual acuity between 0.01 and 0.05. Visual acuity deteriorated to finger counting near face in 15 patients (30.6%), to 1/∞ pr.l.certa in 21 patients (42.9%), and to 1/∞ pr.l.incerta in 3 patients (6.1%).

All patients were treated using a new technique we developed, which involved short-term tamponade of the vitreous cavity with perfluorodecalin and intravitreal administration of antibiotics. Before treatment start, biological material was collected for bacteriological examination.

Results: Visual function was preserved in 46 patients (93.9%). Clinically significant improvement in visual acuity (0.3-0.4) was observed in 36 patients (73.5%), while 6 patients (12.2%) achieved visual acuity greater than 0.5. No cases of recurrent inflammation were recorded; however, laser tyndallometry indicated a persistent disruption of the blood-ocular barrier for up to 6 months post-treatment, with a protein flow value of 14.6 (8.4; 19.2) ph/ms (p=0.002).

The most informative method for identifying the etiological cause of endophthalmitis was vitreous sampling (81.6% effectiveness), compared to anterior chamber sampling (38.8% effectiveness).

Conclusion: The best functional outcomes were achieved in patients with endophthalmitis caused by S. epidermidis and S. aureus. Endophthalmitis caused by gram-negative bacteria had a poor visual prognosis.

Mucopolysaccharidoses (MPSs) are a group of rare disorders caused by inherited defects of lysosomal enzymes, leading to widespread intra- and extracellular accumulation of glycosaminoglycans (GAGs). The use of enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation has significantly reduced the systemic manifestations of MPS but has little effect on the severity of corneal opacity in ophthalmic involvement. Therefore, the choice of the management strategy for patients with these disorders remains a complex and relevant issue. Only a limited number of studies have addressed the treatment of corneal opacity in MPS, and publications by Russian authors on this topic are lacking. We observed 3 patients (6 eyes) with genetically confirmed MPS type VI and corneal opacity. All of them received systemic therapy; however, despite that, functional outcomes did not improve, leading to the need for keratoplasty in one of the patients. This article presents these clinical cases and discusses the therapeutic strategy for corneal opacity in patients with MPS type VI.

Purpose: To uncover the negative impacts of heavy metals on carbohydrate metabolism, their mechanisms and contributory factors, as well as their role on the etiopathogenesis, pathophysiology, and progression of eye diseases.

Material and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), various databases were searched (e.g., Scopus, PubMed, etc.) to collect evidence on the link and role of heavy metals in carbohydrate metabolism and pathogenesis of eye diseases. Included studies were appraised for quality using the Critical Appraisal Skills Programme checklists and extracted data were analyzed using the narrative synthesis method.

Results: Of the 128 papers retrieved, 24 papers met the inclusion criteria. Heavy metals are associated with the onset and progression of diabetes and eye diseases secondary to diabetes (age-related macular degeneration, cataract, and diabetic retinopathy) majorly via toxic interference (induction, inhibition and/or deactivation) of glucose metabolizing enzymes and oxidative stress. The etiology of DR is intricate and includes the simultaneous disruption of several metabolic and signaling mechanisms within the retinal neurovascular unit. The retina is more susceptible to metal-induced toxicities due to the high affinity of heavy metals to melanin content of the retinal epithelium.

Conclusion: This study emphasizes the harmful effects of chronic and intermittent exposure to heavy metals, suggesting no safe exposure levels. To prevent eye diseases secondary to heavy metals-induced altered carbohydrate metabolism, metal chelators, low glycemic diets, and lifestyle modifications should be exploited among vulnerable populations.

Purpose: This study investigated the correlation between iridotrabecular contact (ITC) and clinical-anatomical parameters in patients with primary angle closure disease (PACD) based on anterior segment imaging data obtained via swept-source optical coherence tomography (SS-OCT).

Material and methods: The study analyzed data from 92 patients aged 32-89 years, including 56 patients with PACD (43 phakic and 13 pseudophakic) and 36 control group participants (21 phakic and 15 pseudophakic). All participants underwent SS-OCT imaging of the anterior segment, including measurements of the ITC index and ITC area.

Results: The study revealed that in phakic PACD patients, ITC parameters (ITC Index and ITC Area) were significantly correlated with anterior chamber depth (ACD; r=-0.42, p=0.01 and r=-0.43, p=0.00, respectively), lens vault (LV; r=0.35, p=0.02 and r=0.36, p=0.02, respectively), lens thickness (LT; r=0.47, p=0.01 and r=0.44, p=0.01, respectively), all anterior chamber angle (ACA) parameters (all p=0.00), and the number of hypotensive medications used (r=0.63, p=0.01 and r=0.68, p=0.01, respectively). In pseudophakic PACD patients, ITC Index and ITC Area were associated with the number of hypotensive medications (r=0.71, p=0.02 and r=0.72, p=0.02, respectively) and the iridotrabecular space area in the nasal sector (r=0.62, p=0.02). No significant correlations were observed in the control group, regardless of lens status.

Conclusion: ITC parameters in phakic PACD patients demonstrated the highest number of correlations compared to pseudophakic patients. The persistence of a direct relationship between ITC parameters and the number of hypotensive medications in primary angle-closure glaucoma following lens extraction supports the rationale for early surgical intervention.

Destruction of tumor foci in retinoblastoma (RB) is performed using both chemotherapeutic and local treatment methods. The number of published works devoted to the use of transpupillary thermotherapy (TTT) of small RBs in combined systemic and local chemotherapy is very limited, which determined the relevance of this study.

Purpose: This study analyzed the outcomes of using TTT as an addition to combination chemotherapy in children with small RBs.

Material and methods: The study included 42 patients (144 tumor foci) with small RBs treated between 2015 and 2020 using TTT and combination chemotherapy (systemic chemotherapy with local chemotherapy). Patients were aged 1 to 26 months (mean age 9.1±7.4 months). The mean follow-up period was 61.2±4.3 months.

Results: Patients received 3-5 courses of systemic neoadjuvant polychemotherapy (NAPCT), superselective intra-arterial chemotherapy (SIAC), and intravitreal chemotherapy (IVC), which led to tumor size reduction. TTT was performed 3 to 16 months (mean 8.5±3.3 months) after initiation of chemotherapy. The number of coagulates in the treatment of resorbable tumors ranged from 5 to 16 (mean 10.5±3.5) and did not depend on the localization of small RBs. The diameter of coagulates ranged from 1000 to 2500 μm (mean 1600±600 μm). Addition of TTT to combination chemotherapy of small RBs resulted in partial tumor regression in 32.6% and complete tumor resorption in 68.1% of cases.

Conclusion: This study provides the first analysis of TTT outcomes in RB patients undergoing combined chemotherapy. TTT is a method of choice for the treatment of small RBs with height of ≤3.0 mm and any localization.

Objective: This study evaluated the effect of sequential therapy with different dosages of Mexidol on the stabilization of glaucomatous optic neuropathy (GON) in patients with primary open-angle glaucoma (POAG).

Material and methods: The study included 80 patients (160 eyes) with stage II and III POAG, randomized into three groups comparable by age, gender, and distribution of glaucoma stage. All patients received sequential therapy with Mexidol (14 days parenterally followed by 90 days orally). Groups were defined as follows: group 1 - "high dosage", group 2 - "low dosage", and group 3 - "placebo". Before therapy initiation and at completion, static automated perimetry was used to determine the mean deviation (MD) and pattern standard deviation (PSD) of retinal light sensitivity, as well as the number of first- and second-order scotomas. Subgroup analysis was performed based on treatment response. Glaucoma progression during therapy was analyzed using the Kaplan-Meier method.

Results: A statistically significant improvement in MD compared with baseline was observed after the course of therapy in both the high- and low-dose groups for moderate (p<0.001) and advanced (p<0.05) stages of POAG. There was a trend toward PSD improvement in the groups of both dosages, but absent in the placebo group. Unlike the treatment groups, the placebo group showed a negative trend toward an increase in relative first- and second-order scotomas. Subgroup comparison revealed significant differences among the "high dosage", "low dosage", and "placebo" groups (p=0.002, Pearson's χ² test). Kaplan-Meier analysis demonstrated a high probability of glaucoma progression in the "placebo" group and a significantly lower probability (p<0.01) in both "high dosage" and "low dosage" Mexidol groups.

Conclusion: Mexidol therapy improves retinal light sensitivity, stabilizes the number of relative first- and second-order scotomas, and reduces the likelihood of GON progression. The dose-dependent effect of Mexidol was demonstrated.

Objective: This study evaluated the outcomes of a 36-month follow-up after treatment with the ELLEX 2RT nanosecond laser.

Material and methods: The study included 72 patients divided into two groups. Group 1 received 2RT nanosecond laser therapy, while group 2 did not undergo laser treatment. Patients with early and intermediate stages of age-related macular degeneration (AMD) were enrolled. The exclusion criteria from the study were the presence of reticular pseudodrusen, drusenoid detachment (avascular pigment epithelial detachment) measuring >1000 μm, and areas of retinal pigment epithelium (RPE) atrophy detected by optical coherence tomography (OCT).

Results: After treatment, visual acuity in group 1 did not change and remained stable at 0.99, while in group 2 there was a decrease in mean uncorrected visual acuity (UCVA) from 0.98 to 0.86. In addition, OCT findings in group 1 showed no progression in 96% (41 eyes) of cases. At the same time, in 2% (1 eye) of cases, there was a significant positive trend in relation to retinal anatomy according to OCT, and in 2% (1 eye) of cases, despite some negative dynamics in retinal anatomy, there was no decrease in vision. In contrast, the disease progressed to the wet form in 19% of group 2 patients after 36 months of follow-up. According to microperimetry, retinal sensitivity in the macular area and in 2RT foci in group 1 was stable or slightly improved. There was a trend toward improved fixation on microperimetry.

Conclusion: Results of the study show that after 2RT therapy the condition of the retina can stabilize or even improve, supporting the broader use of retinal laser stimulation using a nanosecond laser in patients with early forms of AMD to prevent the progression of the disease and its transition to the wet form.

Automated analysis of optical coherence tomography (OCT) biomarkers improves the prediction of results of loading anti-VEGF therapy of vascular pigment epithelial detachment (PED) associated with neovascular age-related macular degeneration (nAMD).

Objective: This study evaluated the effectiveness of OCT biomarker analysis algorithm in predicting the anatomical outcomes of loading anti-VEGF therapy for vascular PED in nAMD.

Material and methods: OCT scans performed prior to loading anti-VEGF therapy were analyzed using the algorithm in 69 treatment-naïve nAMD patients (70 eyes) with vascular PED exceeding 200 µm in height. Qualitative biomarkers included subretinal fluid (SRF), intraretinal fluid (IRF), hyperreflective material beneath the PED, PED defects, and hyperreflective foci in the outer retinal layers. Quantitative parameters - height, width, and area of PED - were manually measured and segmented using a U-NET-based neural network.

Results: The algorithm predicted flattening of higher (499.2±198.1 μm) and wider (3205.6±734.2 μm) PEDs containing large hyperreflective foci in the mid-retinal layers and defects in PED (n=35 eyes). Resistance to loading therapy was predicted in lower (430.1±126.4 μm) and narrower (2824.1±732.8 μm) PEDs with sub-PED hyperreflective material without IRF (n=31 eyes). Risk of retinal pigment epithelium (RPE) tear was predicted for PEDs higher than 600 μm (mean 587.4±193.6 μm) in the presence of SRF but without PED defects (n=4 eyes). The automated OCT biomarker analysis algorithm effectively predicted resistance of PEDs with the lowest height, width, and area. Greater PED area and width were predictive of flattening, while PED height over 600 μm, calculated using the algorithm, was a predictor of RPE tear.

Conclusion: The developed OCT biomarker analysis algorithm enables effective prediction of anatomical outcomes following loading anti-VEGF therapy in vascular PED in nAMD.

Choroidal neovascularization (CNV) is a pathological angiogenic process observed in various fundus diseases, including choroidal nevi. This article reviews key information on the pathogenesis of CNV associated with choroidal nevi, examines diagnostic methods using optical coherence tomography (OCT) and optical coherence tomography angiography (OCT-A), including modern classifications and criteria for assessing disease activity. The article also discusses approaches to the differential diagnosis of nevi combined with neovascular age-related macular degeneration, progressive nevi, and melanomas, and analyzes the features of treatment with antiangiogenic agents and their effects on pigmented choroidal lesions.

Purpose: This study aimed to investigate the local mechanical properties and determine the Young's modulus (Y) of corneal lenticules (stromal layer fragments) using scanning ion-conductance microscopy (SICM) in patients with myopia and myopic astigmatism who underwent femtosecond laser surgery using the corneal lenticule extraction for advance refractive correction (CLEAR) technique.

Material and methods: The study included 19 patients aged 21-48 years, comprising 11 men (58%) and 8 women (42%) (38 eyes), from whom 34 lenticules were extracted. Participants were divided into two groups: group 1 - patients aged 26-36 years, and group 2 - patients aged 41-48 years. The analysis of extracted lenticules was performed 6-10 hours postoperatively. The preoperative, intraoperative, and postoperative parameters were as follows: spherical equivalent from -1.75 to -8.25 D, cylindrical component from -0.0 to -1.75 D, central corneal thickness 511-607 μm, lenticule thickness 78-159 μm, percentage of tissue altered (PTA) index 33.1-47.1, and posterior lenticule surface depth 288-402 μm.

Results: In group 1, the Young's modulus values of stromal fibrils (at a depth of 302-402 μm) ranged from 128.7 to 920 Pa, whereas in group 2 (depth 288-377 μm), the values ranged from 252.2 to 641.1 Pa.

Conclusion: For the first time, the biomechanical properties of the fibrils in the middle stroma were studied in vivo and described using the Young's modulus. Elasticity was higher in the lenticules extracted from patients aged 21-36 years than in those from patients aged 41-48 years.