Macular Zone Research Articles

Application of optical coherence tomography angiography to study retinal and choroidal vascular changes in patients with first-time coronary artery stenosis

ObjectiveTo study the changes in retinal and choroidal vessels in patients with coronary artery stenosis via optical coherence tomography angiography (OCTA). MethodsA total of 100 subjects were enrolled in this study and divided into two groups:the observation group consisted of 50 patients with angina who were first diagnosed with coronary artery stenosis, and the control group consisted of 50 healthy adults without angina symptoms. All of the subjects underwent OCTA to investigate changes in retinochoroidal vessel density in patients with a first diagnosis of coronary artery stenosis. The parameters included superficial capillary plexus density (SCD), deep capillary plexus density (DCD), retinal peripapillary capillary plexus density(RPD), the choroidal vascular index (CVI), and the macular foveal avascular zone(FAZ area, perimeter, acircularity index, FD-300 vessel density). ResultsSCD and DCD in the coronary artery stenosis group were lower than those in the control group (P=0.045 and P=0.034, respectively), the CVI was lower than that in the control group (P=0.029), the FAZ perimeter and acircularity index were greater than those in the control group (P=0.003,P=0.024). Logistic regression and ROC curve analysis revealed that FAZ perimeter was the most significant risk factor for predicting coronary artery stenosis (P=0.005, AUC=0.664), and the cut-off value for FAZ perimeter was 2.065 mm. ConclusionsIn patients with a first diagnosis of coronary artery stenosis, both retinal and choroidal blood flow are reduced. FAZ perimeter is a risk factor for predicting the occurrence of coronary artery stenosis.

RESULTS OF TREATMENT OF PATIENTS WITH RHEGMATOGENOUS RETINAL DETACHMENT WITH RUPTURE IN THE LOWER HEMISPHERE DEPENDING ON THE SURGICAL METHOD

Purpose: To evalute the efficacy of short-term tamponade of the vitreal cavity by perfluorinated compound and to analyze the morphological changes after surgical treatment of the patients with rhegmatogenous retinal detachment with rupture in the lower retinal hemisphere.Material and methods: The analysis of surgical treatment of 31 patients with the diagnosis of primary rhegmatogenous retinal detachment in combination with proliferative vitreoretinopathy с type 1–2 with inclusion of the macular zone, with the localization of the rupture in the lower retinal hemisphere. All patients were divided into two groups depending on the tamponade vitreous cavity. I group (n = 15): first stage – vitreoretinal surgery with a tamponade of the vitreous cavity of perfluoroorganic compounds for 14 days, second stage – removal of perfluoroorganic compounds from the vitreous cavity + facoemulsification with implantation of the intraocular lens + tamponade of the natural gas mixture (С2F6). Monitoring for at least 6 months after perfluorinated compound or silicone oil removal.Results: The preliminary results of the study showed a high effectiveness of short-term perfluorinated compound tamponade compared to the silicone oil tamponade in patients with rhegmatogenous retinal detachment with rupture in the lower hemisphere. In all 1st group patients complete retinal reattachment was achieved in all observation periods. In 2nd group, partial retinal reattachment in the lower departments in the long-term postoperative period was detected in 37.5% of cases. There was no cystic macular edema in Group 1 patients, while it occurred in Group 2 patients in 18.7%. Epiretinal fibrosis was detected in Group 1 patients in 14.3% of cases and in Group 2 patients in 31.2% of cases during the whole observation period.Conclusion: The results of the conducted study confirm the effectiveness of the use of short-term tamponade of the vitreous cavity of perfluorinated compound in the treatment of patients with retinal detachment at the localization of a tear in the lower retinal hemisphere. This method improves the anatomical results of vitreoretinal surgery in this category of patients and helps to reduce the number of postoperative complications.

A clinical case of successful treatment of the dry form of age-related macular degeneratio

the clinical case is an example of the effectiveness of low-energy pulsed chromatic LED therapy of green (505 nm), red (625 nm) and infrared (940 nm) ranges in the treatment of dry age-related macular degeneration, which was performed with the Spektra Light device (Version MARK III, Vision AidInc., Canada). The patient was examined before treatment, 1 month, 3 months and 6 months after treatment: visual acuity was determined, optical coherence tomography of the macular zone was performed, and the optical density of the macular pigment of both eyes was determined by heterochromatic flicker photometry using a Maculux praxis densitometer (Germany, Ebiga VISION GmbH). In a patient with age-related macular degeneration, after two short-term courses (2 sessions per day with a 5-minute break for 5 days) of low-energy LED therapy, visual acuity increased, the optical density of the macular pigment increased, and positive dynamics was noted in the scans of optical coherence tomography of the macular zone of the retina.

Myopic Maculopathy Stabilization in a Child with Progressive Complicated Myopia and Underlying Connective Tissue Dysplasia via Optical Therapy with HAL Spectacle Lenses Inducing Retinal Peripheral Defocus: Clinical Case

Background. Myopia is a serious medical and social problem specifically due to the high risk of such complications as cataracts, myopic maculopathy, glaucoma, and retinal detachment. Children with connective tissue dysplasia (CTD) syndrome are most subjected to myopia. Prevention of myopia progression in children remains the only effective way to prevent myopic maculopathy. Significant progress in this field has been achieved via optical technologies developed on the basis of peripheral defocus theory. Clinical case description. Patient, 10 years old, with CTD, mild myopia of both eyes with rapid progression, myopic maculopathy, grade 1. Ophthalmic status: spheroequivalent refraction — right eye (–)1.5 diopters / left eye (–)1.75 diopters; vision acuity with monocular correction — 1.0. Fundoscopy: optic disc is pale pink, with clear borders, arteries and veins are well-proportioned, their courses and calibers are intact; choriocapillary layer attenuation in the macular and paramacular zones, “parquet fundus”; areas of pigment redistribution on peripheral retina; no atrophic foci detected; anterior-posterior axis of the right and left eyes — 26.2 and 26.3 mm, respectively. Optical coherence tomography (OCT) has revealed retinal thinning in the upper and nasal sectors in the right eye during the first assessment. The left eye has demonstrated losses of retinal thickness within the middle parafoveal zone and significant thinning in the upper segment. Optical therapy with HAL spectacle lenses (inducing volumetric myopic peripheral defocus) was assigned to control myopia to slow down the pathological axial growth of the child's eyes and to stabilize refraction. 4 months of wearing glasses with HAL lenses has led to the stabilization of dystrophic changes in retina, signs of improvement in several sectors by were observed on OCT. No negative changes were revealed in all parafoveal segments of the left eye. The child was recommended to continue wearing glasses with HAL lenses with dynamic follow-up every 3 months. Conclusion. CTD in children is associated with high risk of complications in case of myopia progression, moreover, retinal pathology can occur even with mild myopia. Optical therapy with HAL spectacle lenses is effective and safe first treatment of choice in the control of myopia in children with CTD, and opens new opportunities in prevention of progressive myopia disabling complications in children, whose treatment results were not previously sufficient.

Microstructural changes in the retina in children with retinopathy of prematurity according to optical coherence tomography. Literature review

Retinopathy of prematurity (ROP) is a crucial problem in modern ophthalmology. ROP is a vasoproliferative disease of the eyes in premature infants. Approximately 50,000 children worldwide have become blind because of ROP. The determining indicator in the development of visual acuity is the morphofunctional state of the macula, structural changes of which can lead to disturbances in its functions and, consequently, decreased vision. The present review analyzed available OCT (optical coherence tomography) data on the morphometric and structural state of the retina in children with ROP. Morphometric features of the macular zone in children in the scar period of ROP can be presented by an increase in retinal thickness in the center of the fovea and changes in the profile of the macula by smoothness or absence of foveal depression. These are more pronounced in children after laser coagulation of the retina in the active phase of ROP and in very premature babies. In some cases with increased retinal thickness in the center of the fovea, the presence of internal layers and an increase in the thickness of the outer nuclear layer are noted. Structural features of the macula with favorable outcomes of RP can be expressed by traction displacement of the foveola, photoreceptor layer thinning and pigment epithelium unevenness, intra and epiretinal fibrosis, choriocapillaris layer atrophy, discontinuity of the connection of the outer and internal segments of the photoreceptors and the pigment epithelium–choriocapillaris complex, and central retinoschisis. Furthermore, this review presents mixed results from studies on the impact of structural changes in the macula in cicatricial ROP on visual function.

Comparison of Changes in Retinal Vascular Density and Thickness After Using Low-Level Red Light and 0.01% Atropine in Premyopic Children.

To compare changes in superficial retinal vascular density (SRVD), deep retinal vascular density (DRVD), and retinal thickness (RT) of the macular zone after repeated low-level red light (RLRL) and 0.01% atropine exposure in premyopic schoolchildren. Prospective randomized trial. Sixty-nine schoolchildren with cycloplegic refraction >-0.75 D and ≤0.50 D were randomly assigned to RLRL and 0.01% atropine groups. SRVD, DRVD, and RT were measured using swept-source optical coherence tomography at baseline and six months. The macular zone was divided into three concentric rings (fovea, parafovea, and perifovea) using the Early Treatment Diabetic Retinopathy Study. After six months, the whole, parafoveal, and perifoveal SRVD significantly increased in the two groups (all P < 0.05). Multivariate regression analyses showed that none of these changes varied significantly between the two groups (all P > 0.05), whereas foveal SRVD remained stable in both groups (all P > 0.05). In the RLRL group, the whole and perifoveal DRVD increased significantly (all P < 0.05), whereas no statistical difference was observed in the foveal and parafoveal DRVD. DRVD remained stable in the 0.01% atropine group (all P > 0.05). No significant differences were observed in RT changes between the two groups (all P > 0.05). In comparison, there were no significant changes in SRVD, DRVD, or RT after six months in the placebo group in our previous study. SRVD increased similarly in the RLRL and 0.01% atropine groups, whereas DRVD increased only in the former group. There were no significant RT changes in either group after six months of treatment in premyopic schoolchildren. This research observed the effects of low-level red light and 0.01% atropine on retinal vasculature, offering valuable insights into myopia progression prevention.

Study of the retina macular region microvascular bed parameters in healthy people of the older age group according to optical coherence tomography with angiography function

BACKGROUND: To date, there is insufficient data on normal blood flow indicators in the retinal choroid plexuses in healthy people of the older age group. AIM: To create a normative basis for average indicators of vessel density in the superficial and deep plexuses of the retina, parameters of the foveal avascular zone and retinal thickness in the macular region in healthy people of the older age group according to optical coherence tomography with angiography. MATERIAL AND METHODS: The retrospective study included 73 people (146 eyes) aged from 58 to 79 years with preserved visual functions and somatic parameters corresponding to the age norm. Optical coherence tomography with angiography function analyzed the density of vessels in the superficial and deep retinal plexuses, the area and perimeter of the foveal avascular zone, the density of vessels in the area up to 300 μm from the foveal avascular zone, and the thickness of the retina. Statistical processing of the data was performed in MS Office Excel 2016. The data was presented in the format M±σ, where M was the average value of the indicator, σ was the standard deviation. RESULTS: In the study group, the overall average retinal thickness in the macular area was 279.9±14.8 µm. The overall average density of vessels of the superficial retinal plexus in the macular zone of the retina was 48.7±2.5%. The overall average density of vessels in the deep retinal plexus in the macular area was 51.9±3.7%. The area of the foveal avascular zone in healthy people was on average 0.322±0.123 mm2; the density of vessels within 300 µm from the foveal avascular zone was 53.8±3.3%. CONCLUSION: The age-related physiological norm for blood flow indicators in the retinal choroid plexuses in healthy people of the older age group has been established.

Retinal vascular abnormalities in myotonic dystrophy assessed by optical coherence tomography angiography - Cross-sectional study.

The aim of the study was to detect the changes in retinal and choroidal vasculature via optical coherence tomography angiography (OCTA) by comparing the quantitative OCTA parameters in patients with and without myotonic dystrophies (DM). The cross-sectional study. Forty-one consecutive patients affected by DMs were enrolled. The inclusion criteria were molecular diagnosis of DM types 1 and 2. To avoid the age effect on microvascular changes and to justify a comparison between DM1 and DM2 patients, two control groups matched for sex and age were established. The vascular density was found to be significantly decreased in the DM groups compared to the controls in the macular, parafoveal and perifoveal zone of superficial capillary plexus (p < 0.001 for the DM1 group, and p = 0.001, p = 0.005 and p = 0.026, respectively, for the DM2 group), as well as in the macular zone in the deep capillary plexus for DM1 (p = 0.002) and deep macular and perifoveal zone for DM2 (p = 0.007, p = 0.001, respectively). The foveal avascular zone showed no significant differences between DM1 and DM2 compared to their control groups (p = 0.320 and p = 0.945, respectively). Our results show that DM is associated not only with the classic pigmentary changes but also with superficial and deep retinal microvasculature abnormalities, suggesting that these changes may be related to local hypoperfusion. Optical coherence tomography angiography is a useful tool for the diagnosis and characterization of retinal changes in DM and should be part of the standard evaluation of these patients.

Changes in the level of some tryptophan metabolites in the blood of patients with type 2 diabetes mellitus complicated by diabetic retinopathy

Aim: To study the content of tryptophan and the intermediate metabolites of kynurenine and serotonin pathways of its metabolism in the blood plasma of patients with type 2 diabetes mellitus (DM) and non-proliferative diabetic retinopathy as candidates for markers of the early stage of the pathological process.Material and Methods. Three groups of people were analyzed: the first group of 10 patients with type 2 diabetes mellitus and without diabetic retinopathy; the second group of 10 people with type 2 diabetes mellitus and non-proliferative stage of diabetic retinopathy; and the control group of 10 healthy people. The features of the first group were a decrease of macula’s photosensitivity in the fundus and a slight increase in the central thickness of the retina. Patients with diabetic retinopathy tended to have a moderate number of microaneurysms and microhemorrhages, moderately presented intraretinal microvascular anomalies in one quadrant, vein dilatation, clearness of the central retinal vein and its branches. In the macular zone there was an edema with hard exudates in the center and lateral to the fovea centralis. All participants of the study gave blood on an empty stomach in the morning, and after that in we measured the content of tryptophan (TRP), kynurenins ((kynurenine (KYN), 3-hydroxykynurenine (3-HKYN), kynurenic acid (KYNA)) and the level of L-5-hydroxytyrptophan (5HTrp) in blood plasma by HPLC method with fluorimetric and spectrophotometric detection.Results. The groups of people with type 2 diabetes mellitus showed the increasing of TRP level in blood relatively to healthy individuals: by 15.1% (p = 0.032) and 17.9% (p = 0.030) in the first and second groups, respectively. As for the patients of the first group, the content of their KYN was increased by 57.7% (p = 0.012) and KYNA by 33.6% (p = 0.012) relatively to the control and the concentration of 3-НKYN decreased by 18.1% (p = 0.020) relatively to healthy people. As for the patients in the second group, the changes in their level of kynurenines had the same direction, but were more visible. Thus, the concentration of KYN exceeded the same parameters of healthy individuals by 84.5% (p = 0.001) and the parameters of the first group by 18.0% (p = 0.049); the KYNA level increased by 56.6% (p = 0.001) relatively to the control and by 17.3% (p = 0.049) from that of the first group. There was a decrease in the content of 3-HKYN amounted to 18.6% of the control (p = 0.038) and an increase in the concentration of 5HTrp – 193,9% (p &lt; 0.001).

Choroidal neovascularization in children: Etiology, diagnosis, and clinical manifestations

Few studies have analyzed choroidal neovascularization (CNV) in children because of the low incidence of this complication in pediatric ophthalmology. However, given the significant effect on visual acuity and diagnostic difficulties in children, the study of this complication is relevant.&#x0D; AIM: This study aimed to analyze the etiological structure and clinical features of CNV in children.&#x0D; MATERIAL AND METHODS: From 2014 to 2022, 61 eyes of 54 children (26 girls and 28 boys) had CNV. The patients underwent standard ophthalmologic examination and optical coherence tomography (OCT) and OCT angiography (OCTA) of the macular zone and optic disc using the RS-3000 Advance 2 Tomograph (Nidek, Japan).&#x0D; RESULTS: At the time of CNV diagnosis, the children were 5–17 years old, with a mean of 11±3 years. In 30 children (55.6%), CNV was caused by inflammatory lesions of the retina and choroid. Of these cases, 11 occurred during remission, whereas 21 occurred alongside pathologies of the retina, choroid, and optic nerve of noninflammatory genesis (8 of which were associated with Best’s disease). In three children, CNV was considered idiopathic. The development time of postinflammatory CNV ranged from 1 month to 12 years, with an average of 7.3±5 months from disease onset. Type 2 CNV was found in most cases (48 eyes, 78.7%).&#x0D; CONCLUSION: CNV is a rare complication of various ocular diseases in children. In our cohort, it was most frequently observed in children with inflammatory lesions of the retina and choroid, even during remission. Patients at risk of CNV must be actively monitored because it occurs in various forms.

New Approaches to Surgical Treatment of Patients with Advanced Stage of Proliferative Diabetic Retinopathy

Purpose. Development and evaluation of the clinical effectiveness and safety of a vitrectomy (VE) technique for patients with advanced stage proliferative diabetic retinopathy (ASPDR).Materials and methods. We observed 132 patients (mean age 62.8 ± 2.4 years) with the following criteria for inclusion in the study, corresponding to the classification criteria of ASPDR: it is impossible to estimate the area of neovascularization; the fundus of the eye is partially ophthalmoscoped or not ophthalmoscoped in the posterior pole; preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs; retinoschisis in the macular zone. All patients were divided into the following two groups, equal in age, gender and visual status of the “healthy” eye: the main group (MG, 69 patients, 69 eyes), who underwent VE was performed according to the developed method and a control group (CG, 63 patients, 63 eyes), in which VE was performed according to the traditional method.Results. The incidence of intraoperative complications in patients in the MG (5.8 %) was 8.1 % (p &lt; 0.05) lower than in the CG (13.9 %). The incidence of postoperative complications in patients from the MG (5.5 ± 0.5 %) was 4.2 % (p &lt; 0.01) lower than in the CG (9.7 ± 1.0 %). The increase in best-corrected visual acuity after surgery in patients from the MG was significantly (by 0.13 rel. units, p &lt; 0.001) higher than in the CG. The value of the average decrease in the developed qualitative criteria for the condition of the fundus in patients in the MG (1.6 ± 0.1) was 23.1 % (p &lt; 0.05), higher than in the CG (1.3 ± 0.1).Conclusion. Surgical treatment of patients with ASPDR using the developed technique provides (compared to the traditional approach) a higher level of safety and clinical effectiveness. The main advantage of the developed technique is an integrated approach to surgical intervention, including the improvement of ophthalmological “techniques” (use of one-stage combined surgery, endolaser coagulation technology, etc.) and drug support (administration of ranibizumab at a dose of 0.05 mg 3–5 days before surgery) and the choice of intravenous sedation as the optimal anesthetic aid.

Dynamics of Structural and Functional Changes of Patients with Dry Form Age-related Macular Degeneration after Double Filtration Plasmapheresis

Actuality. One of the significant ophthalmic diseases is a dry form age-related macular degeneration (dAMD). The issues of etiology and pathogenesis are not completely cleared nowadays and they signify the subject of discussion. There are risk factors of dAMD (age, heredity, lifestyle etc.) which can cause metabolic disorders, changes hemorheological parameters which promote activation of druseogenesis and as a result an angiogenesis. Mostly an outcome of dAMD is geographical atrophy and decrease of central visual acuity. At the same time, it is known that similar metabolic and rheological disorders detected in other diseases are effectively corrected by extracorporeal rheoaferesis, in particular, using double filtration plasmapheresis. Thus, using of extracorporeal rheoaferesis with dAMD patients is pathogenetically well-reasoned, but in the available literature, a correct analysis of the effectiveness and safety of double filtration plasmapheresis in patients with intermediate stage of dAMD is presented poorly.Objective. To study along with data of OCT, OCT angiography, visometry, microperimetry and electroretinography structural and functional changes in the macular zone in patients with a dry form of age-related macular degeneration after the using of double filtration plasmapheresis.Patients and methods. The study included 63 patients (94 eyes) with an intermediate stage of dAMD. The patients were separated into two groups randomly. The first (main) group included 34 patients (52 eyes) who were performed double filtration plasmapheresis (DFPP) on an OctoNova device using a Plasmaflo plasma filter and a Cascadeflo EC40 fractionator in the amount of 4 procedures with a frequency of 1 time per week for 1 month. The second group (control) included 29 patients (42 eyes) who did not receive any specific treatment. In the main group of patients, OCT, OCT angiography, microperimetry and electroretinography were additionally performed in addition to standard ophthalmological examination before the DFPP course, after the DFPP course (1 month after the start of follow-up), 6 and 12 months later. Patients in the control group also underwent a similar examination at the specified time — 1, 6, 12 months after the start of follow-up.Results. In this study we found according to optical coherence tomography, optical coherence tomography-angiography, visometry, microperimetry and electroretinography, positive dynamics of structural and functional parameters of the macular retina is observed in patients with a dry form of age-related macular degeneration with using double filtration plasmapheresis. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, which points to stabilization of the pathological process during the specified period.Conclusions. This study showed that after applying the double filtration plasmapheresis in patients with dry form of age-related macular degeneration, there is an improvement in structural and functional parameters of the macular zone, consisting in a decrease volume DOPES and stabilization of retinal light sensitivity.

Quality of life of patients with an advanced stage of proliferative diabetic retinopathy after application of various vitrectomy technologies

Purpose: A comparative assessment of quality of life (QL) after the use of various vitrectomy (VE) technologies in patients with an advanced stage of proliferative diabetic retinopathy (ASPDR).Material and methods. We examined 132 patients aged 42 to 76 (average age 62.8 ± 2.4 years) who met the classification criteria of ASPDR: impossibility to estimate the area of neovascularization; the fundus of the eye in the posterior pole cannot be seen or can only partialy be seen using an ophthalmoscope; evidence of preretinal or vitreal hemorrhage in the posterior pole with an area of more than 4 optic discs and retinoschisis in the macular zone. All patients were divided into two groups, comparable in age, gender and visual status of the “healthy” eye: the main group (69 eyes), in which VE was performed according to the technique developed by the authors, and the control (63 eyes), in which the traditional VE technique was used. QL was assessed before surgery and 3 months after it using the VFQ-25 and QL-20 questionnaires.Results. QL was found to be higher when the new surgery technique was used: the data of VFA-25 showed a 12.9% increase (p &lt; 0.05) and QL-20 showed a 29.2% increase (p &lt; 0.01), which points to a higher clinical effectiveness of the newly developed surgical treatment technique than that of the traditional technique.Conclusion. The results obtained are related to the ophthalmological features of the developed surgical treatment of ASPDR: combined (phacoemulsification of cataracts + IOL + vitrectomy) one-stage intervention, lack of drainage of subretinal fluid, etc.), medication support (preliminary intravitreal administration of an angiogenesis inhibitor) and anesthesia (intervention under local anesthesia with intravenous sedation). The differences are most effectively identified using the special QL-20 questionnaire.

Расширение интраоперационных диагностических возможностей в хирургии регматогенной отслойки сетчатки методом двойного контрастирования

On average, the risk of recurrence increased in the postoperative period varies from 3 to 30 %. Among the relapses of ROS after successful surgical treatment, the progression of PVR is an established cause in 60 % of cases, being one of the most serious complications encountered in the postoperative period. It is also often the cause of a recurrence of retinal detachment after resorption of the tamponing agent, or after its removal (with endotamponade with silicone oil) is the banal failure to detect a retinal rupture during surgery. Objective. To compare intraoperative diagnostic techniques in surgery of regmatogenic retinal detachment. Material and methods. The study included 68 patients of different sexes with up to 1 month of age and different detachment configurations. After the standard stages of central vitrectomy, the patients were divided into 2 equal groups: the 1st (main) group consisted of patients who underwent the double-cauterization method, the 2nd (control) group consisted of patients operated in the standard way. Results and discussions. We have recorded a significantly frequent occurrence of relapses in patients in the control group. It was also found that an increase in the number of retinal tears increases the likelihood of ROS involving the macular zone, it was possible to statistically reliably confirm that the absence of ZOST and tight adhesion of the posterior hyaloid membrane to the retina, as well as the lower localization of retinal tears, increases the likelihood of recurrence of ROS due to the development of PVR. Keywords: retinal surface staining, double contrast, proliferative vitreoretinopathy, silicone oil, avitria, retinal detachment

Клиническая оценка частоты и нозологической структуры патологии заднего отрезка глаза

Purpose. Clinical assessment of frequency and nosological structure of the posterior eye segment’s pathology. Material and methods. Using a continuous sampling method, 235 patients with posterior eye segment’s pathology were selected, who underwent examinations and courses of treatment in our clinic in the period from 2021 to 2023. Results. In 47 patients with uveitis, the presence of concomitant diseases was revealed: ankylosing spondylitis, rheumatoid arthritis, and toxoplasmosis. Biomicroscopy of the posterior eye segment of patients with posterior uveitis revealed the presence of inflammatory cells and protein in the vitreous cavity, grayish-yellow prominence foci in the macular zone of various sizes and configurations, hyperemia of the optic disc (OD), and newly formed vessels on OD in 5 patients, macular edema. In 45 patients with anterior ischemic optic neuropathy (AION), the following concomitant diseases were identified: coronary heart disease in 22 people (49 %), hypertension in 20 people (44 %), sickle cell anemia in 2 people (4.5 %), giant cell arteritis in 1 person (2.5 %). Conclusions. 1. The structure of the posterior eye segment’s pathology of patients undergoing treatment in the conservative treatment department included uveitis of various localizations and AION. 2. In almost 93 % of patients with AION, the presence of concomitant diseases of the cardiovascular system is confirmed, which corresponds to literature data. Keywords: posterior eye segment’s pathology, uveitis, anterior ischemic optic neuropathy

Предварительные результаты хирургического лечения пациентов с регматогенной отслойкой сетчатки с разрывами в нижних отделах

Retinal regmatogenic detachment is a serious disease that causes complete irreversible blindness in the absence of operative treatment [1]. Despite the use of the latest technology, the risk of relapse of regmatogenic detachment with lower breaks in the conditions of tamponade of the real cavity with silicone oil is 10–25 % of cases, and after extrusion silicone oil — up to 34 % due to the preservation of the space between the retina surface and the lower meniscus of the silicone bubble, increasing the risk of progression of proliferative vitreoretinopathy [2, 3]. At present, in cases of pronounced proliferative vitreoretinopathy, where there is no intraoperative retinal attachment, a high risk of immediate retinal detachment, breaks in the lower quadrants, the tamponade of choice is the perfluorinated compound [4]. Purpose. To assess the effectiveness of short-term tamponade of the vitreal cavity by perfluorinated compound in patients with retinal regmatogenic detachment when localizing a tear in the lower retina. Material and methods. Analysis of treatment of 30 patients (30 eyes) with diagnosis of the primary regmatogenic retinal detachment with proliferative vitreoretinopathy C type 1–3 with macular zone capture has been performed, with the localization of rupture in the lower retina. All the patients were divided into two groups depending on the vitreal tamponade. I group (n = 14): vitreoretinal surgery was performed at the first stage with a 14 days twist tamponade of the perfluorinated compound cavity, and perfluorinated compound removal with subsequent tamponade of the gas-air mixture (C2F6) was performed at the second stage combined with facoemulsification and implantation of intraocular lens. II group (n = 16): the first step was vitreoretinal surgery with silicone oil tamponade 1300, the second step was silicone oil removal with a tamponade of the vitreal cavity with balanced saline solution. The observations were at least 6 months after perfluorinated compound or silicone oil removal. Results. According to our study, short-term perfluorinated compound tamponade was found to be more effective than silicone oil tamponade in patients with retinal detachment with lower lacerations, only 37.5 % of relapses were detected in group II. Conclusion: The effectiveness of the use of short-term tamponade of the vitreal cavity of perfluorinated compound in the treatment of patients with retinal detachment with lower retinal ruptures is confirmed by the results of the study. This method makes it possible to improve the anatomical and functional results of vitreoretinal surgery in this category of patients, reducing the risk of postoperative complications. Keywords: rhegmatogenous retinal detachment, tamponade of the vitreal cavity, perfluorinated compound

Клинический случай трансплантации аутологичной сетчатки у пациента с оперированным рефрактерным макулярным разрывом

In the last few years, autologous retina transplantation has been repeatedly mentioned in foreign literature as a new method of treating primary through and recurrent refractory macular holes of large diameter. Purpose. To discuss the results of a clinical case of autologous retina transplantation in a patient with recurrent macular hole. Material and methods. A patient with recurrent macular hole, partial optic nerve atrophy, operated on in 2017, was under observation. There is a MH with a diameter of 1600 microns on the OCT of the macular zone. The course of the operation. At the first stage, the remains of the anterior vitreous were removed. Next, the vitreous chamber was tamponaded with perfluorodecalin. The retinal flap was cut out in the lower part of the middle periphery. With the help of endothermocoagulation, the flap is delimited and mobilized. Next, the flap was dislocated to the macular area. The MH is closed by the dislocated retina. A fringing laser coagulation of the retina was performed around the removed part of it. After that, the patient is left lying on his back on the operating table for 1 hour. After a double examination after 30 minutes and 1 hour, after making sure that the flap is in the correct position, the tamponade of the glassy chamber of perfluorodecalin, the trocars are removed, stitches are applied. After 4 days, perfluorodecalin was replaced with silicone oil. Results. On the first day, according to the results of OCT, the macular opening is closed, the thickness of the retina in the central zone is 619 microns. The corrected visual acuity remained at the same level. 2 weeks after surgery, the retinal thickness is 505 microns, the corrected visual acuity is 0.02, the flap is fixed, the macular rupture is closed. 1.5 months after surgery, after removal of silicone oil, visual acuity was without correction, retinal thickness. Conclusion. The autologous retina transplantation method can be used in the treatment of recurrent macular hole. Keywords: transplantation, autologous retina, macular hole

Динамика анатомических и функциональных показателей после хирургии сквозных макулярных разрывов большого диаметра

Full-thickness macular hole (FTMH) is the macular zone pathology, leading to a significant decrease in visual acuity. According to the literature, classical surgery of FTMH allows to achieve anatomical closure only in 73.3 % of cases. The task of developing a method of surgical treatment of FTMH with the possibility of evaluating its closure intraoperatively is relevant and of strategically important interest for the development of ophthalmic surgery. The purpose of this study is to evaluate the dynamics of functional and anatomical results of large diameter FTMH surgery. Material and methods. A randomized study was conducted on two comparable groups of patients. Surgical treatment of FTMH was performed in both groups, the difference was in the FTMH closure method: in the first group, treatment was carried out according to the proposed method, in the second group, autologous conditioned plasma was used during the surgery. Patients underwent a standard ophthalmological examination, as well as optical coherence tomography of the retina before surgery, 1, 3 and 6 months after surgery. Results and discussion. In the control group, 4 cases of FTMH recurrence were recorded in the postoperative period up to 1 month after surgery. U-shaped closure pattern (Fig. 1) was more often observed in the first group, while in the second group V-shaped closure pattern was more often observed (Fig. 2). Visual acuity 6 months after surgery was higher on average in patients in the first group (p = 0,05). Conclusions. The results obtained indicate a decrease in the risk of recurrence of FTMH, as well as higher visual acuity and close-to-normal retinal histological state in the postoperative period for a period of 6 months when closing the FTMH according to the proposed method. The use of the FTMH closure method under the intraoperative optical coherence tomography control makes it possible to minimize the time of the patient's forced position in the postoperative period, which facilitates its course. Keywords: vitreoretinal surgery, macular hole, optical coherence tomography, autologous conditioned plasma

Клинические случаи повреждений глаз физическими факторами

INTRODUCTION: Injuries of the organ of vision are the most severe cases of ophthalmopathy. This report describes clinical cases of eye damage by different physical factors (light emission of the Sun, light emission of a laser pointer, explosion of a firecracker) in everyday life. An eye damage by the light emission of the Sun may occur in observing a solar eclipse without means of eye protection. Clinical cases of solar retinopathy in three children aged 12–13 years who referred to an ophthalmologist in different periods after observation of a solar eclipse (2 days, a month, three months) are presented. The outcomes of the process: in early start of treatment, the function of the eye restored; in later stages, the visual acuity remained reduced, retinal edema and hyperemia of fovea persisted. A laser pointer widely used in everyday life, may cause damage to the macular zone of the retina in case a laser beam gets into an eye. We followed up two patients aged 12 and 30 years with retinal burn caused by direct looking into a laser beam. After the treatment, visual acuity remained impaired in both cases, the residual edema, redistribution of pigment, pigment epithelium destruction foci were observed in the retina. Incorrect use of safe pyrotechnics may result in a severe eye damage. We observed two cases of a severe contusion trauma of eyes caused by explosion of a firecracker. In one case (patient aged 45 years), a severe contusion with crush injury of the eyeball resulted in nucleation of eye; in another case (a child aged 15 years), there were a persistent impairment of visual acuity and hemorrhages into the retina. CONCLUSION: The possibility of eye damage by the described physical factors indicates the need for sanitary and educational work aimed at preventing these injuries, especially in children.

Results of treatment of optic disc pit maculopathy in children

Purpose: to analyze the anatomical and functional results of the differentiated treatment of optic disc pit maculopathy in children.Material and methods. We examined 23 children aged 5–17 years with an o ptic disc pit maculopathy. 10 children underwent retinal laser coagulation (LC) along the borders of the optic disc pit (1–3 sessions), 13 children underwent pars plana vitrectomy with gas tamponade (C2F6) in combination with retinal LC. In addition to the standard ophthalmological examination, all children underwent optical coherence tomography of the macular area of the retina before treatment and at different times after it.Results. In the group of children who underwent LC, the initial value of the maximum retina elevation averaged 525 ± 140 μm (from 346 to 882 μm). After laser treatment, all children showed a decrease in retinal elevation by 32 to 602 μm. 3 children had complete resorption of subretinal fluid during follow-up periods from 5 to 13 months. Best corrected visual acuity (BCVA) remained stable in 5 children, increased by 0.04–0.6 in 4 children, and decreased by 0.1 in one child. In the group of surgically treated children, the elevation of the retina before the intervention averaged 919 ± 143 μm (from 614 to 1420 μm) (p &lt; 0.05). After the intervention, this parameter decreased in all children by 91 to 811 μm, complete resorption of subretinal fluid was observed in 4 children during follow-up periods from 4 to 6 months. BCVA remained stable in 5 children, increased in 7 children by 0.1–0.7, and decreased by 0.4 in one child due to the progression of the cataract.Conclusion. The differentiated approach to the treatment of optic disc pit maculopathy in children proved to be highly efficient, depending on the height of retinal elevation in the macular zone before the start of treatment.