The article analyzes the clinical observation of a 22-year-old patient with severe recurrent bilateral uveitis complicated by neuroretinitis, probably caused by Behcet’s disease. The presented data demonstrate significant diagnostic difficulties associated with the lack of pathognomonic laboratory markers of Behcet’s disease and the need for a comprehensive assessment of clinical and anamnestic data. The key role was played by the identification of the Human Leukocyte antigen (HLA) B51 allele, a genetic marker of predisposition to Behcet’s disease, in a patient from the Astrakhan region. Taking into account the resistance to glucocorticoids and the high risk of irreversible vision loss, a genetically engineered biological therapy with tumor necrosis factor (TNF)-alpha inhibitor adalimumab was initiated. As a result of the treatment, positive dynamics was achieved with complete restoration of visual acuity, regression of macular edema and signs of neuroretinitis according to optical coherence tomography. The observation highlights the importance of including Behcet’s disease in the differential diagnosis of recurrent uveitis in young patients, the importance of genetic testing for HLA-B51, and the expediency of early prescribing modern targeted drugs, primarily TNF-α inhibitors, to preserve visual functions. The key factor for successful treatment in this case was the coordinated interaction of ophthalmological and rheumatological specialists.
Currently, occupational pathology is a serious medical and social problem. One of the nosological forms of occupational pathology is cataract — an eye disease characterized by a gradual loss of transparency of the lens. The purpose of the study was to describe clinical cases of cataracts as an occupational disease among workers of foundries in the Voronezh region, to carry out hygienic characteristics and analysis of their working conditions, to develop proposals for minimizing the degree of exposure to harmful production factors on the organ of vision. The material of the study were state reports on the sanitary and epidemiological well-being of the population, statistical forms on the registration of occupational diseases, materials on sanitary and hygienic characteristics of workplaces. Occupational risk assessment and working conditions criteria were determined according to hygienic classification in accordance with R 2.2.2006-05. Results. Cases of cataracts diagnosed as a result of exposure to thermal radiation are described in 2 men aged 77 and 46 years. A standard clinical examination was performed. The work of foundries is exposed to a complex of unfavorable production factors, the leading of which is physical: increased air temperature, increased parameters of infrared (thermal radiation). The foundry worker’s working conditions are classified as hazardous class 3.3 according to the hygienic classification. The imperfection of the technological process, low mechanization and automation of the labor process, as well as non-compliance by workers with safety measures are the main reasons for the occurrence of occupational cataracts. In order to prevent occupational diseases of the organ of vision, it is necessary to improve the organization of work, personal protective equipment, as well as conduct sanitary and educational work with employees of enterprises on issues of maintaining health.
Рurpose. Comparative analysis of the results of endoscopic endonasal dacryocystorhinostomy (EEDCR) using a high-speed drill and a piezosurgical device, assessing the impact of the degree of middle meatus narrowing on the complication rate and functional success. Material and methods. This retrospective cohort study included 240 patients with obstruction of the vertical portion of the lacrimal drainage system, divided into two equal groups depending on the osteotomy method (drill vs. piezosurgery). Based on preoperative CT, all patients were stratified by the degree of middle meatus narrowing: grade I (>4 mm), grade II (≤4 mm), grade III (≤2 mm). The groups were comparable in anatomical characteristics. Outcomes were assessed 6 months after surgery. Results. The use of piezosurgery significantly reduced the incidence of intraoperative bleeding (p ≤ 0.01), synechiae (p = 0.040), granulations (p = 0.035), and ostium closure (p = 0.049). The recurrence rate in the piezosurgery group was 3.2 % versus 10.0 % in the drill group (p ≤ 0.05). Subgroup analysis demonstrated that the greatest differences between the methods were achieved in patients with grade III narrowing (≤2 mm), where the risk of iatrogenic mucosal injury and subsequent scarring is highest. The selectivity of ultrasonic impact, which preserves soft tissue integrity, prevents the formation of a “wound mirror” and the development of the synechial process. Conclusion. Piezosurgical osteotomy is the preferred method for primary EEDCR in patients with a narrow middle meatus (grade II–III narrowing), providing a significant reduction in the rate of complications and recurrence of epiphora.
A review of the literature data indicates the need for additional research to improve the effectiveness of barley and chalazion treatment, in particular to determine objective indicators of barley transition to chalazion based on instrumental studies, and to study the relationship of the above pathological processes with concomitant pathologies, in particular, acute respiratory diseases and dry eye syndrome. The conducted study allowed us to develop an algorithm for differential diagnosis of barley and chalazion: barley is an acute inflammatory process of the sebaceous glands of Zeiss (external) and meibomian (internal), in 55.2 % of cases it develops against the background of hypothermia and/or acute respiratory viral infections, is stopped by local use of antibiotics and corticosteroids in 65.5 % of cases during an observation period of 7–14 days, in 34.5 % of cases it passes into the stage of chronic inflammation — secondary chalazion; A secondary chalazion is the transition of an acute inflammatory process to a chronic one over an observation period of 14 to 30 days (capsule formation), accompanied by an increase in its density and blood flow velocity, as determined by ultrasound. A chalazion is detected three times less frequently than a primary chalazion due to a disruption of the secretion of the meibomian glands without signs of acute inflammation. Correlation analysis data showed that the longer the chalazion persists, the denser its capsule becomes and the more severe the impairment of blood circulation in the area. The data obtained during the study can serve as a basis for developing a conceptual understanding of the etiopathogenesis of styes and chalazions in practicing physicians. This, in turn, will facilitate the appointment of timely and adequate treatment methods, including the consistent use of local drug therapy, intracapsular glucocorticoid injections, surgical removal of the chalazion, as well as the appointment of preventive treatment in the form of eyelid hygiene and other physiotherapeutic procedures at the stage of stopping this pathological process.
Objective: to present corneal morphological changes in patients with initial keratoconus during 12-month follow-up period after simultaneous transepithelial photorefractive keratectomy with accelerated ultraviolet collagen crosslinking. Patients and methods. The study included 30 patients/eyes aged 18–45 years with progressive stage 1 keratoconus, who underwent laser scanning in vivo confocal microscopy before and after treatment to measure the total, average, minimum and maximum lengths of corneal nerve fibres, as well as the sub-basal nerve plexus density; corneal optical coherence tomography with measurement of the demarcation line depth; Scheimpflug densitometry of the anterior-central layers of corneal stroma at 0–2 and 2–6-mm zones. The examinations were performed 1, 6 and 12 months after surgery. Results. Morphological changes observed by laser scanning in vivo confocal microscopy located in the anterior and middle stroma within 300 μm depth and were temporary: at 1 month — epitheliopathy, subepithelial fibroplasia, honeycomb-type lacunar edema and a sharp decrease in sub-basal nerve plexus density; at 6 months — partial regeneration of the keratocytes and sub-basal nerve plexus, reduction of the lacunar edema; at 12 months — nealrly complete restoration of corneal cellular structure and sub-basal innervation (sub-basal nerve plexus density — 80.5 % of preoperative data, total length of nerve fibres — 82 %). According to Scheimpflug densitometry, the highest values of corneal optical density was detected at 1 month after surgery and subsequently returned to baseline at 12 months, indicating reducing of postoperative corneal haze. According to anterior segment optical coherence tomography, the demarcation line depth was 198.5 (179.25; 214.5) μm visualized at 1 month postoperatively. Conclusion. Simultaneous transepithelial photorefractive keratectomy with accelerated corneal crosslinking can be considered as a safe and effective approach to managing initial keratoconus, that ensures morphological restoration of the cornea and minimal risk of severe fibroblastic complications during one-year follow-up period. Further research is needed to assess the long-term stability of the results.
Purpose: to present a clinical case of suturing a toric intraocular lens (tIOL) in a patient with lens luxation into the vitreous body and corneal astigmatism. Patient K., 78, presented with complaints of deteriorating vision. His objective status at presentation was as follows: visual acuity OS 0.02 with correction sph +11.0 cyl –1.25 ax 26° = 0.4. Keratometry OS: strong meridian 45.60 D ax 129, weak meridian 44.43 D ax 39. Biomicroscopic examination of the left eye revealed a clear cornea, deep anterior chamber, clear aqueous humor, subatrophic iris, and lens luxation into the vitreous cavity. The patient was referred for surgical treatment. Scleral fixation of the TIOL was performed, which provided correction of aphakia and compensation for corneal astigmatism. The presented method of scleral fixation of TIOLs allows achieving high visual acuity in patients with luxation of the lens combined with corneal astigmatism.
The article discusses the current state and prospects for the use of artificial intelligence (AI) in ophthalmological practice. The main areas of AI application are described, including automated diagnostics of eye diseases, personalized treatment, prognosis of the course of diseases and support of surgical interventions. An analysis of the existing approaches and technologies, such as deep learning and computer vision, which are used to analyze medical images and data, is provided. Particular attention is paid to data standardization, safety and ethical aspects of introducing AI into clinical practice. The importance of cooperation between specialists in different fields for the effective implementation of innovative technologies and improving the quality of medical care is emphasized.
Introduction. Congenital blepharoptosis represents a significant ophthalmoplastic pathology that substantially impacts the quality of life for patients and their families. Epidemiologically, blepharoptosis frequently coexists with other pathological conditions, predominantly of neurological origin. The presence of concomitant pathologies may considerably influence both surgical strategy and postoperative results.Objective. To evaluate the impact of somatic pathology on the severity of congenital blepharoptosis in pediatric patients and on surgical outcomes. Materials and methods. A retrospective analysis was conducted on 113 pediatric patient records who underwent surgical correction of congenital blepharoptosis of varying severity. Patients were divided into two groups: somatically healthy (n = 90) and with concomitant somatic pathology (n = 23), including congenital cardiovascular, renal, or central nervous system anomalies. Criteria for preoperative surgical planning included: unilateral or bilateral ptosis, degree of ptosis, levator muscle function (LMF), margin-reflex distance 1 (MRD1), palpebral fissure width at the pupillary center, lateral and medial limbus, presence of lagophthalmos, height and presence of eyelid crease, and involvement of accessory muscles (e.g., brow mobility). Surgical interventions comprised levator resection and superior tarsal muscle resection. Postoperative follow-up was performed inpatient on days 1, 3, and 7, and outpatient at 1, 3, 6, and 12 months. Results. In the somatically healthy group, unilateral blepharoptosis predominated, whereas bilateral involvement was more common in the group with somatic pathologies. Statistical analysis revealed a significant correlation between bilateral blepharoptosis and the presence of somatic comorbidities (p = 0.025). Analysis of ptosis severity noted significant differences: grade 3 ptosis was observed in 51.43 % of the second group compared to 28.07 % in the first. Concomitant ophthalmic conditions were distributed as follows: amblyopia (28.89 % in group I and 39.13 % in group II), astigmatism (34.44 % and 47.83 %, respectively), and strabismus (esoor exotropia) in 20.00 % and 17.39 %. The operative time was notably longer in group II: average levator resection duration was 53.7 minutes versus36.2 minutes in group I, with ICU stay averaging 23.6 minutes versus 16.2 minutes. Unsatisfactory outcomes necessitating reoperation were recorded in 23.33% of group I and 30.43% of group II, with no cases of persistent lagophthalmos. Conclusion. The presence of concomitant somatic pathology in pediatric patients with congenital blepharoptosis necessitates meticulous preoperative evaluation in a multidisciplinary hospital setting, with a high level of anesthetic support to optimize surgical planning and outcomes.
Purpose: to investigate the nature, intensity and frequency of the main subjective manifestations of digital accommodative asthenopia online, to determine their relationship with basic ophthalmoergonomic indicators.Design and research methods. The online screening study was conducted on 1310 students (average age 21.5 ± 0.1 years; 75.3 % of respondents were female, 24.7 % were male). The psychometric scale used contained 25 items from 5 questions reflecting the main symptoms of accommodative asthenopia, as well as ophthalmoergonomic questions.Results and discussion. The average work experience with mobile screen devices (MSD) was 10.29 ± 0.1 years. At the same time, the average daily duration, as well as the one-time duration of using the digital television, varied widely up to 1 hour and more than 6 hours. The average distance from the eyes to the screen was 36.0 ± 0.5 cm (from 5 to 120 cm). Complaints of varying intensity and nature were expressed by 74.6 % of respondents, with the maximum rating of “constantly” and “very strong” in the percentage of respondents: difficulty focusing at a distance (5.6 % and 5.7 % of respondents, respectively), eye strain when looking at the screen — 2.3 % and 2.7 %, fogginess and blurriness — 1.7 % and 1.2 % of respondents. There were no significant correlation between the length of use of devices and complaints of accommodation problems among the respondents surveyed. A positive weak but significant relationship was found between the indicators “duration of using the digital optics and digital electronic devices per session” and “duration of using the digital optics and digital electronic devices during the day” with complaints of strain when fixing the gaze on the screen, as well as with blurred vision and problems focusing into the distance. The absence of a significant correlation between the length of use of devices and accommodative complaints may indicate the inclusion of some kind of stable, reliable mechanisms of accommodation compensation by the type of long-term adaptation, masking the subjective manifestations of the digital accommodative asthenopia. On the contrary, complaints of accommodative asthenopia associated with the duration of use per session or during the day reflect urgent, “emergency” compensation mechanisms and are manifested more clearly in the form of corresponding complaints of visual discomfort. Conclusion. A conclusion is made about the adequacy and effectiveness of the methodological approach using a multidimensional scale in on-line mode for analyzing the subjective manifestations of digital accommodative asthenopia. The data confirm the important role of ophthalmoergonomic factors in the formation of digital accommodative asthenopia in information technology users.
Transscleral micropulse cyclophotocoagulation is a safe method for reducing ophthalmotonus, which has proven its effectiveness in various forms of glaucoma, including patients with high visual acuity. Рurpose: to study the effectiveness of transscleral micropulse cyclophotocoagulation (MP-TSCPC) in various types of glaucoma. Materials and methods. The data of 193 eyes of 192 patients with decompensated glaucoma (primary open-angle glaucoma, secondary glaucoma, neovascular glaucoma, including after IOL repositioning, primary angle-closure glaucoma) of various stages who underwent MP-TSCPC were analyzed. The observation period was up to 12 months. MP-TSCPC was performed on a Vitra A 810 device (Quantel Medical, France) with the following laser parameters: energy — W = 2000 mW, cycle exposure 31.3 %, total exposure time on four sectors — 160 sec. Results. The MP-TSCPC is effective in POAG, where the IOP reduction was 32 % from the initial value by the end of the observation period, as well as in PACG, where the reduction by the end of 6 months was 51–56 % from the initial values. In secondary glaucoma by the end of the observation period — 37.5 % of the initial IOP, but without achieving the target values, including in neovascular glaucoma — 29 %. The total effectiveness of MP-TSCPC in the POAG group was 76.5 %, secondary glaucoma — 61.5 %, PACG — 100 %, neovascular glaucoma — 70 %, after IOL repositioning — 76.5 %. At the same time, no difference in effectiveness was found between the groups (p = 0.117). MP-TSCPC is more effective in advanced glaucoma, where by the end of the observation the hypotensive effect was 40 % of the initial value, and in advanced glaucoma, where it was 38 % of the initial one. The total effectiveness of MP-TSCPC in the advanced glaucoma group was 73.3 %, in advanced glaucoma — 80.3 %, in terminal glaucoma — 75 %, with no difference in effectiveness between the groups (p = 0.938). After MP-TSCPC, the number of drops of local hypotensive therapy decreased from 3.09 ± 0.6 to 2.95 ± 0.67 (p = 0.011). When performing MP-TSCPC to relieve pain in 43 eyes, the result was achieved in all cases. Conclusion. MP-TSCPC has proven to be an effective and safe intervention for various types of glaucoma, with maximum effectiveness in the case of POAG and PACG at early and advanced stages. In various types of secondary glaucoma, the hypotensive effect is pronounced and persistent, but in a greater number of eyes without achieving compensation. Also, MP-TSCPC can be recommended for pain relief and reducing the drug load.
Thyroid Eye Disease (TED) is an autoimmune condition requiring precise imaging for diagnosis, assessment of severity/activity, and treatment planning. The lack of unified orbital Computed Tomography (CT) protocols leads to variability in results and unjustified radiation exposure. Currently, Multi-Slice Computed Tomography (MSCT) is widely used due to its high resolution, short scanning time, low artifact generation, and cost-effectiveness. Standardization of orbital CT is essential to improve reproducibility, diagnostic accuracy, and minimize risks. The aim of the study is to optimize the orbital CT protocol to ensure reproducible and accurate measurements with minimal radiation exposure, in order to obtain reliable data for diagnosing TED, assessing the severity and activity of the process, and for planning and monitoring treatment. The article clearly outlines the indications for orbital CT in TED. Standardized parameters for performing orbital MSCT are presented. A unified setup of key technical scanning parameters, such as tube voltage and current with mandatory use of automatic modulation, along with optimized slice thickness and reconstruction interval, ensures not only high reproducibility and image detail but also guarantees strict adherence to the principle of minimizing radiation exposure for each individual patient. A comparative characteristic of alternative diagnostic methods without radiation exposure (magnetic resonance imaging and ultrasound examination of the orbits) is provided. Parameters for assessment and criteria for evaluating the orbital structures during CT are described in detail. The role of specialized software and deep learning for automating segmentation and volumetric analysis is noted. A structured protocol for a radiologist’s report is proposed. The article presents a comprehensive approach to standardizing orbital CT examination in TED, focusing on optimizing scanning parameters to balance image quality and radiation dose, clear criteria for describing pathology, and the integration of modern technologies. This is necessary to improve diagnosis, prognosis, treatment planning (especially decompression), and minimize risks for patients.
Purpose. To evaluate the anatomical and functional efficacy of a modified autologous retinal transplantation (ART) technique in the surgical treatment of large full-thickness macular holes (FTMH). Material and Methods. The study included 41 patients (42 eyes) with a minimum FTMH diameter greater than 800 µm who had previously undergone vitrectomy with internal limiting membrane peeling and gas tamponade due to FTHM. Patients were divided into two groups. In the main group, a modified ART was performed using preoperative navigated flap planning, intraoperative optical coherence tomography guidance, and fixation with autologous platelet-rich plasma. In the control group, macular hole edges were closed using an aspiration technique followed by application of autologous platelet-rich plasma. Anatomical outcomes were assessed by optical coherence tomography, while functional outcomes included bestcorrected visual acuity and central retinal sensitivity. The follow-up period was 6 months. Results. Stable anatomical closure of the FTMH was achieved in all cases in the main group. In the control group, macular hole recurrence was observed in 22 % of patients (p = 0.049). Both groups demonstrated a statistically significant improvement in best-corrected visual acuity and retinal sensitivity as early as 1 month postoperatively, with no significant intergroup differences in cases with successful anatomical closure. Conclusions. Modified ART provides a higher and more stable anatomical success rate in the treatment of large FTMH compared with the edge approximation technique. Functional outcomes are characterized by early improvement followed by stabilization during follow-up.
The manifestation of herpetic keratitis is influenced by a variety of pathological factors. Coronavirus infection is both a precipitating and triggering factor for ophthalmic herpes, both in the acute phase of the disease and in post-COVID syndrome. Given the combined attack on the immune system by the coronavirus itself, herpes viruses, and iatrogenic immunosuppression, is difficult to overestimate the pathological role of secondary bacterial infection. The aim of this study is a retrospective analysis the results of microbial associations in conjunctival and nasopharyngeal swabs in patients with complicated ophthalmic herpes following coronavirus pneumonia. Material and methods. The retrospective analysis included 11 patients with various forms of herpetic keratitis with ulceration (recurrent/sluggish flow), which developed late after severe coronavirus pneumonia. All patients underwent a standard ophthalmic examination and were questioned about the presence of trigger factors and comorbid conditions. Microbiological samples from the conjunctiva and nasopharynx were cultured on solid nutrient media. Colony growth was quantified in colony-forming units (CFU/ml) per 1.0 ml of biological material using standard grading methods. Identified pathogens were tested for sensitivity to the main groups of antibacterial drugs using the disk method. Results: In only one case, conjunctival culture yielded two pathogenic cultures — Staphylococcus aureus and Moraxella catarrhalis — at 104–106 CFU/ml. The results of nasopharyngeal culture on nutrient media turned out to be informative with respect to the dominant pathogens. Among the nasopharyngeal culture results (25 cultures), the leading ones were Staphylococcus aureus (10 cases, 40 %) and Streptococcus pneumoniae (7 cases, 28 %). Less frequently, the growth of cultures of such pathogens as Klebsiella pneumoniae (4 cases, 16 %), Escherichia coli (8 %), Moraxella catarrhalis and Hemophilus influenzae (4 % each) was determined. When determining the sensitivity to groups of antibiotics, the microflora showed high sensitivity to fluoroquinolones (15 samples, 60 % of cases), mainly moderate sensitivity was determined to macrolides and aminoglycosides (15 and 14 samples, respectively). Moderate sensitivity was determined to penicillins (19 samples), and the highest proportion of resistance was found to cephalosporins. Conclusion. The high sensitivity of the isolated microflora to fluoroquinolones indicates their use in the treatment of complicated forms of herpetic keratitis with activation of polybacterial flora. One of the possible drugs of choice is besifloxacin, which is not used systemically and has minimal risks of potential resistance of microbial associations to it. A comprehensive treatment approach, including thorough laboratory testing and consultation with related specialists (otolaryngologist and immunologist), is crucial for achieving recovery in the development of protracted forms of ophthalmic herpes associated with chronic inflammatory diseases of the nasopharynx.
Purpose: to evaluate the normal microstructure of the cornea in Chinchilla rabbits using confocal microscopy data. Material and methods. Confocal microscopy of the cornea was performed on 10 male Chinchilla rabbits. The weight of rabbits is from 3500 to 4200 grams. One (right) eye of the animal was included in the study. Confocal microscopy of the cornea was performed on a laser scanning microscope HRT-3 (Heidelberg Engineering, Germany) using a special corneal module Rostock Cornea Module (RCM). The scanning area is 400×400 µm, with transverse and axial resolutions of 1–2 and 4 µm, respectively, the scanning speed is 30 frames per second, and the size of the resulting images is 384×384 pixels. Results. During confocal microscopy of the cornea, it was possible to obtain images with differentiation of its substructures in all animals. The corneal thickness of rabbits varied within the range of 340–359 µm. The obtained data from confocal microscopy have showed that the structure of the cornea of the Chinchilla rabbit does not differ significantly from the normal structure of the human cornea. Conclusion. The use of Chinchilla rabbits is advisable in experimental models associated with the imitation of diseases of the epithelium, stroma and endothelium of the cornea. When modeling diseases and studying the pathogenetic mechanisms of their development in animals, it is necessary to remember that the same diseases in the body of laboratory animals and humans can develop according to different scenarios due to differences in cellular metabolism.
Purpose. To evaluate the clinical and functional significance of the use of ophthalmic drugs in elderly patients at different stages of AMD development. Patients and methods. The study included 23 patients (46 eyes; 65.8 ± 6.3 years; 5 men, 18 women) with “dry” (AREDS-2 and AREDS-3 categories) and “wet” (AREDS-4 category) forms of AMD, who took the vitamin and mineral complex with antioxidant and neuroprotective properties “Oftolik®” for a month (2 capsules daily with meals) in combination with a dietary supplement from sea urchin caviar “The power of the sea: longevity” (1 capsule 3 times a day with meals). Standard ophthalmological examination was performed; optical coherence tomography (OCT; OPTOPOL), computer perimetry (Octopus 600 Haag-Streit) took into account the presence of possible systemic side effects of exposure and the comfort of taking ophthalmic drugs. Effectiveness criteria: stabilization of AMD manifestations (based on OCT data), stabilization of corrected visual acuity (COC). Statistical analysis: arithmetic mean (M), standard deviation (σ), Me — median, lower (LQ) and upper (UQ) quartiles, Student’s t-test, W-Wilcoxon criterion, MannWhitney criterion. Results. The use of the vitamin and mineral complex “Oftolik®” by AMD patients in combination with the dietary supplement from sea urchin caviar “Sea Power: longevity” helps to stabilize visual functions — visual acuity, ophthalmotonus, improve the functional state of the retina (reduce visual field defects, improve photosensitivity) and is accompanied by an increase in the total activity of antioxidant systems of blood plasma, normalization increased levels of lipid and carbohydrate metabolism. The level of proinflammatory cytokines in the blood serum of patients with the “dry” form of AMD is not a significant diagnostic feature. VEGF concentration can be used in clinical laboratory diagnostics as an additional diagnostic marker of the severity and prognosis of the disease course. Conclusion. The use of the vitamin and mineral complex “Oftolik®” in combination with the dietary supplement from sea urchin caviar “Sea Power: longevity” helps to stabilize visual functions and improve the functional state of the retina of patients with AMD.
The international experiment SIRIUS-23 studied the effect of long-term isolation in a closed space (hermetic object — artificial station), simulating an interplanetary flight with accompanying stress factors, on the bioelectrical activity of the retina.The aim of the study was to evaluate changes in the different types of electroretinogram (ERG), and in visual evoked cortical potentials (VEP) in the participants of the 12-month experiment. Changes in ocular blood flow were also assessed using Doppler researchMethods. All diagnostic examinations were conducted before and during the week after the crew exited isolation (conditional “landing”). The results indicate the general stability of the most studied parameters after the end of isolation. A slight decrease in the amplitude of flicker ERG (F-ERG) to 30 and 12 Hz flickers and P50 and N95 components of transient pattern ERG (PERG) with characteristic changes in peak latency was revealed, which indicate a mild dysfunction of retinal ganglion cells and their axons without organic damage to the visual pathways. A positive trend towards an increase in the amplitude of the photopic negative response (PhNR) to a medium-strength stimulus and the amplitude of the P100 component of VEP to a pattern-reversal to a pattern-reversal chessboard stimuli after the crew exited isolation was found. A statistically significant increase in the peripheral resistance index and pulsatility index in the ophthalmic artery, central retinal artery and lateral posterior short ciliary arteries was recorded, which may indicate a change in vascular tone in the retinal and choroidal circulation system of the eye after a 12-month experiment.
Purpose: to evaluate the results of combined treatment of hereditary epithelial-stromal corneal dystrophies. Patients and methods. The study included 5 patients with hereditary epithelial-stromal corneal dystrophies (HESCD), 8 of whom underwent phototherapeutic keratectomy (PTK) and laser-induced corneal crosslinking. All patients were women aged 27 to 63 years. Two of the patients were directly related (mother and daughter), while the remaining three patients had a family history of similar corneal pathology. Two patients had lattice dystrophy, two more patients had Reis-Bucklers dystrophy, and one patient had granular type II HESCD. The inclusion criterion for the study group was corrected visual acuity of no more than 0.3. In all cases, PTK was initially performed using a MEL 90 excimer laser (ZEISS, Germany) with an ablation diameter of 7.5–8.0 mm. Ablation of the epithelium and altered stroma was performed in two stages. The depth of the first stage of PTK was calculated based on the total depth of pathological changes minus 100 µm, but not less than the maximum epithelial thickness. The cornea was then saturated with riboflavin by instilling “Dextralink” for 30 minutes. At the final stage of treatment, the second stage of PTK was performed to ablate the stroma to a depth of 100 µm and induce photopolymerization of corneal collagen. When calculating the total ablation depth, the minimum thickness of the residual stroma was at least 450 µm. Results. The total ablation depth ranged from 170 to 215 µm. One month after surgery, uncorrected and best-corrected visual acuity improved in all eyes. These values increased further six months after treatment and remained virtually unchanged at the final follow-up (one year). Conclusion. The results of the combined treatment for HESCD demonstrated its safety and high efficacy, as all treated eyes demonstrated improved visual acuity due to improved corneal transparency and the absence of significant induced ametropia. Corneal condition remained stable for one year after surgery in all eyes, and for three years in four eyes of two patients.
Objective: to describe the clinical and functional results of using scleral contact lenses (SCL) in patients with limbal stem cell deficiency (LSCD) to correct refractive errors, also as a therapeutic system to manage chronic dry eye syndrome. Materials and methods. The study included 22 patients, 25 eyes with diagnosed LSCD with various etiology and laterality, who had undergone SCL fittings for daily use. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), intraocular pressure (IOP), Schirmer test 1 and lens parameters: diameter (D), base curvature radii (BC), average ratio of lens thickness to apical clearance (AK), duration of lens wear before and after fitting SCL were analyzed. Subjectively, the severity of complaints to redness, lacrimation, photophobia, and dryness in the eyes was assessed on a 5-point scale in all patients before and after fitting. Results. BCVA before fitting SCL was 0.10 (0.05; 0.50), in the SCL 0.60 (0.20; 0.70), the average sphere is 0 dpt, and the cylind is -0.5 dpt, the significance of the difference between pre- and post-SCL wear was assessed by the paired t test (p < 0.05) which is considered statistically significant. The average D was 15.2 mm, BC 8.35 mm, the average ratio of lens thickness to AK after “shrinkage” was 1:1. The average time of wearing lenses during the day was 7 hours. There was a statistically significant decrease in the intensity of complaints to lacrimation, photophobia, dry eyes, and redness before SCL fitting and after 1 month of active wear (p < 0.05). The severity of dry eye syndrome was assessed using the Schirmer-1 test, according to which the average tear production before SCL fitting and 3 months after increased from 4.0 (2.0; 5.0) mm to 7.0 (5.0; 8.0) mm, respectively. Conclusion. The use of SCL, considering the anatomical eye’s features and ocular surface in patients with stable LSCD or with LSCD after surgical treatment provides a double effect — increased visual acuity and constant moistening of the ocular surface.
Purpose. To optimize a-constants for intraocular lenses (IOL) on the Clareon® (Alcon, USA) platform. Material and methods. The study included 206 patients (206 eyes) divided into 4 groups depending on IOL implanted model: the 1st — SY60WF (n = 71); the 2nd — Clareon Toric CNW0T2-9 (n = 76); the 3rd — Clareon PanOptix CNWTT0-Т6 (n = 32); the 4th — Clareon Vivity CNWET0-Т6 (n = 27). Optical biometry was performed by IOL-Master 700 (Carl Zeiss, Germany). For toric IOL calculation keratotopography by CASIA Corneal/Anterior Segment OCT SS-1000 (Tomey, Japan) was performed. A month after phacoemulsification spherical equivalent of refraction was evaluated. Mean IOL calculation error (ME) was used to calculation accuracy assessment. A-constant optimization performed by ME zeroing. Results. ME was 0.32 ± 0.42 D for Clareon SY60WF, 0.31 ± 0.36 D for Clareon Toric CNW0T2-9, 0.38 ± 0.34 D for Clareon PanOptix CNWTT0-Т6 and 0.10 ± 0.34 D for Clareon Vivity CNWET0-Т6. ME zeroing allows to define real a-constants for IOLs: 119.38 for Clareon SY60WF, 119.46 for Clareon Toric CNW0T2-9, 119.54 for Clareon PanOptix CNWTT0-Т6 and 119.30 for Clareon Vivity CNWET0-Т6. Conclusion. Using of proposed a-constants for IOLs on Clareon® platform could help with target refraction achievement and to avoid a hyperopic refraction shift.
