Retinal Detachment Research Articles

THE MINI-STEAMROLL: An Abbreviated Variation of the Steamroller Maneuver After Pneumatic Retinopexy for Rhegmatogenous Retinal Detachment.

To describe a novel positioning maneuver for patients with rhegmatogenous retinal detachment after pneumatic retinopexy (PnR). Single-center prospective case series of primary rhegmatogenous retinal detachments referred to St. Michael's Hospital, Toronto, Canada, between 2021 and 2023. All patients underwent PnR. Baseline ultra-widefield fundus imaging and repeat imaging 10 minutes after the gas injection was performed. After PnR, patients were instructed to perform the mini-steamroll maneuver, which consists of a face-down position for 10 minutes followed by positioning to the retinal break. The reduction of subretinal fluid volume after the initial face-down position was evaluated with clinical examination and ultra-widefield imaging. Six patients who presented with primary bullous rhegmatogenous retinal detachment and a sizable superior break were enrolled. The mini-steamroll maneuver resulted in a rapid and significant reduction of subretinal fluid in all patients with bullous rhegmatogenous retinal detachment and large superior breaks, allowing subretinal fluid to be expressed into the vitreous cavity with 10 minutes of face-down positioning. One patient required a sequential PnR. Primary retinal reattachment was achieved in all cases. This approach was well-tolerated by patients. This case series demonstrates that the mini-steamroll maneuver may be a suitable alternative for patient positioning after PnR in certain cases. The mini-steamroll is a simpler positioning regimen with the potential benefits of direct-to-break and full steamroller maneuver.

Visualizing the obscure- Chromophore-assisted retinal break detection.

Finding a retinal break which is responsible for retinal detachment is a critical step in the surgical treatment of this condition. In spite of improvement in visualization systems in pars plana vitrectomy, identifying the break which is the source of subretinal fluid (SRF) could pose a challenge, especially in complex retinal detachments or re-detachments with extensive laser scars. The current technique of break identification involves direct detection of the break via peripheral indentation or using perfluorocarbon liquid (PFCL) to displace SRF from the posterior retina to the periphery and visualizing the proteinaceous SRF egress from the retinal break. In retinal detachments, if no peripheral breaks are visualized, surgeons tend to make a posterior draining retinotomy and drain SRF, the necessity of which can be confirmed after subretinal brilliant blue green (BBG) dye injection. In addition, in already vitrectomized eyes where it can be difficult to identify SRF egressing via the break, subretinal BBG dye provides a color contrast that enhances break visualization. A method to identify these occult breaks was required, which is described in this video. Hence, the idea of BBG dye injection into the subretinal space with a 41G subretinal needle was thought of. PFCL would be placed over the posterior pole, which would displace the dye to the periphery, and this would disperse out into the vitreous cavity into a blue plume via the break, thereby leading to its identification. Subretinal dye injection is useful for occult retinal break detection as it provides a color contrast. A posterior draining retinotomy can be avoided. It is also useful in recurrent retinal detachments. We describe the use of BBG, which is the least toxic dye available, and report the use of this technique in Indian eyes. https://youtu.be/JGXQjNV9asw.

Sub-Tenon's anesthesia in equine cataract surgery and vitrectomy: a retrospective case series (2018-2022).

A retrospective data analysis was performed on 17 eyes from 13 horses which underwent a sub-Tenon's injection to facilitate phacoemulsification or pars plana vitrectomy under general anesthesia between 2018 and 2022. All procedures were performed by the same veterinary ophthalmologist. Seven eyes received a sub-Tenon's dose of 7 ml lidocaine (XylocainÒ, 2 % lidocaine hydrochloride, Germany, Aspen Germany GmbH), and 10 eyes received 7 ml mepivacaine (MepinaestÒ purum 2 %, mepivacaine hydrochloride, Switzerland, Gebro Pharma GmbH). Statistical analysis compared onset and duration of globe centralization and pupil mydriasis between the two groups. Intraoperative and postoperative complications were also assessed. Mepivacaine had a significantly later onset of action regarding globe centration and mydriasis (8,9 minutes vs. 6 minutes), but also a significantly longer duration of globe centration than lidocaine (31,5 minutes vs. 15,6 minutes). There were no statistically relevant differences between solutions regarding duration of pupil dilation (40,4 minutes for 2 % lidocaine vs. 69,2 minutes for 2 % mepivacaine). Chemosis occurred in all 17 eyes. Surgical complications included corneal epithelial defects (5), retinal detachment (5), lens opacification (5), temporary blindness during recovery (3) and glaucoma (2). Sub-Tenon's anesthesia is a feasible alternative to systemic neuromuscular blockade and retrobulbar block anesthesia for surgical procedures on the equine globe. A controlled prospective in vivo study is needed to further evaluate effects and risks.

Frequency, Causes and Medico-Legal Aspects of Grievous Injury to the Eye after Physical Assault

Aims: A medicolegal report is prepared by the medicolegal officer in conjunction with an ophthalmologist in cases of physical assault claiming vision loss. The objective was to report the frequency and cause of grievous injury to the eye after a physical assault. Methods: This was a descriptive cross-sectional study, conducted in the Department of Ophthalmology of a tertiary care hospital in Pakistan from October 2019 to August 2022. A total of 378 medicolegal cases were reported in the ophthalmology outpatient. Among them, 285 patients of physical assault were included with consecutive sampling technique. Results: The mean age of the patients was 33.93±12.96 years. The mean reporting time to an ophthalmologist was 4.1±8.2 days. Simple and grievous injuries were found in 278 (97.5%) and 7 (2.4%) cases, respectively. Among the grievous injuries, 4 (57.2%) were close globe injuries and 3 (42.8%) were open globe injuries. Thirteen (4.5%) were malingers. Domestic violence was observed in 82 (28.8%) study subjects. Conclusion: The frequency of grievous injury to the eye is very low (2.4%) in patients with physical assault. The patients of assault-related grievous injury were mostly males, young age, low level of education, and doing manual jobs. Vitrolage with corneal melting, and firearm injury caused the grievous injury in open globe patterns. Vitreous hemorrhage, retinal detachment, macular hole, and secondary glaucoma were seen among close globe patterns. J Bangladesh Coll Phys Surg 2024; 42: 336-341

Ultrastructural investigation of the posterior hyaloid membrane in posterior vitreous detachment.

Separation of the posterior hyaloid membrane (PHM) from the retina in posterior vitreous detachment (PVD) is a fundamental, but poorly understood, process underlying vitreoretinal disorders including retinal detachment and macular hole. We performed electron microscopy studies of the PHM after PVD to investigate its ultrastructure, associated cellular structures and relationship to the internal limiting membrane (ILM). Post-mortem human eyes were collected from recently deceased patients over 70 years of age. A posterior scleral button was trephined to identify PVD status, and the PHM and vitreous prepared for analysis with transmission and scanning electron microscopy. Twelve eyes from six patients were collected. Seven eyes had PVD; five eyes had attached vitreous. PHM was isolated from seven of seven eyes with PVD. The PHM in eyes with PVD is a laminar lacy sheet, distinct from the disorganised fibres of vitreous gel. Eyes without PVD had vitreous encased in internal limiting membrane which had separated en bloc from the retina. Cells embedded in the PHM (laminocytes) were identified in five of seven eyes with PVD, with strands stretching into the membrane. PHM isolated from eyes with PVD is distinct from artefactual separation of the ILM from the retina during dissection. PHM is ultrastructurally distinct from vitreous gel and is a separate entity. The en face appearance of PHM is similar to that of ILM, suggesting that in PVD, PHM forms from separation of an inner layer of ILM. Laminocytes may play a role in the pathogenesis of vitreoretinal disease.

Human Amniotic Membrane: A Seal for Complex Retinal Detachments.

To evaluate the efficacy of human amniotic membrane (hAM) transplantation for complex retinal detachments (RD). A retrospective analysis of consecutive patients who underwent vitreoretinal surgery with hAM transplantation for complex RD was conducted. The indications included high myopic macular hole (MH)-associated RD (n=5), traumatic large macular tears (n=4), combined RD with MH due to cicatricial retinopathy of prematurity (n=2) and severe retinitis (n=1), and morning glory syndrome (n=1). Surgical procedures, anatomical and functional results, and complications were noted. Thirteen eyes of 13 patients with a median age of 7 years (range, 0-65 years) were included. The follow-up was 15 months (range, 6-30 months). All eyes achieved MH sealing. Sealing occurred after a single surgery in 75% of eyes, while 25% required a second surgery due to hAM contraction/dislocation. The retina was attached and silicone oil could be removed in 92% of eyes during follow-up. The mean logarithm of the minimum angle of resolution visual acuity increased from 2.08±0.49 to 1.78±0.70 (p=0.07). Optical coherence tomography showed good integration of the hAM grafts with the retina, albeit without discernible retinal layer differentiation in any case. Amniotic membrane grafting appears to be promising for anatomical sealing of MHs and posterior retinal tears in complex RDs such as those associated with degenerative myopia, severe trauma, tractional membranes, and retinal shortening, where conventional surgical techniques are likely to fail. Further research is needed to clarify the regenerative potential and functional capacity of hAM grafts in severe retinal pathologies.

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Chronic rhinosinusitis with osteomyelitis in a geriatric snow leopard (Panthera uncia)

AbstractA geriatric, 16‐year‐9‐month‐old, male snow leopard (Panthera uncia) under human care was necropsied after euthanasia over concerns for worsening chronic kidney disease and bilateral blindness. Gross and histological examinations revealed necrotising frontal sinusitis and osteomyelitis with mixed‐cellular rhinotracheitis, affecting the right frontal sinus, right nasal cavity and trachea, respectively, with intralesional and cilia‐associated Gram‐negative bacilli detected. Microbiological cultures were inconclusive, although Bordetella bronchiseptica and feline herpesvirus 1 were positive on PCR analysis. Immunohistochemistry, however, refuted active feline herpesvirus 1 involvement. Marked, chronic, bilateral, renal degeneration and fibrosis (chronic kidney disease), mild hepatic cirrhosis, bilateral chronic degenerative stifle joint disease and testicular intratubular seminoma were also detected on postmortem examination. No gross ocular or optic nerve lesions were identified; however, histology indicated bilateral diffuse outer retinal atrophy and retinal detachment, supportive of clinical blindness at time of death. This case represents the first report of chronic rhinosinusitis and osteomyelitis in a snow leopard.

Surgical outcomes of inverted internal limiting membrane flap technique for primary rhegmatogenous retinal detachment coexisting with a macular hole.

This retrospective study aimed to evaluate the visual outcomes and foveal restoration in eyes with rhegmatogenous retinal detachment (RRD) and macular hole (MH) following surgery using the inverted internal limiting membrane (ILM) flap technique. We collected data on eyes with coexisting RRD and MH that underwent surgery using the inverted ILM flap technique between January 2016 and December 2018. The primary outcome measures were visual acuity (VA) and optical coherence tomography findings. Of 308 eyes with MH originating from various causes, 8 (2.6%) eyes diagnosed with coexisting RRD and MH treated using the inverted ILM flap technique were included. The average patient age and axial length were 65.00 ± 12.01 years and 23.66 ± 0.77 mm, respectively. The mean preoperative best-corrected VA (BCVA) was 1.84 (spherical equivalent [SE], counting finger) ± 0.32 logMAR and the mean final BCVA had improved significantly to 1.05 (SE, 20/223) ± 0.67 logMAR (P = .017). The primary retinal reattachment, MH closure, and secondary retinal attachment rates were 75% (6/8), 87.5% (7/8), and 100% (7/7), respectively. The inverted ILM flap technique led to significant improvements in anatomical and visual outcomes in patients with coexisting RRD and MH.

Risk factors for receiving both scleral buckle and glaucoma drainage device in children

We conducted a retrospective review of patients (< 18 years) between 2013 and 2021 to determine risk factors of pediatric patients receiving a glaucoma drainage device (GDD) needing a scleral buckle (SB) and vice versa. The first population underwent an SB placement with no prior GDD. The second underwent a GDD implantation with no prior SB. We analyzed 133 eyes in the SB-first group. The common indications were retinal detachment associated with a syndrome/disease (41.2%), blunt trauma (21%), and non-syndromic pathologic myopia (11%). Twelve eyes (9%) required subsequent GDD implantation with a mean time to reoperation of 19.73 months (median 2.3 months). Eyes with trauma had a 5-fold risk (hazard ratio [HR] 4.81, p = 0.0069) of requiring a subsequent GDD. Each additional glaucoma medication before initial SB surgery increased the risk by 1.81 (p = 0.0096). 135 eyes were in the GDD-first group. Four eyes (3%) required a subsequent SB. The mean time to reoperation was 17 months (median 9.2 months). There was a statistically significant association with trauma (HR 12.3, p = 0.0341) only. Pediatric eyes with a history of trauma and/or multiple glaucoma medications before intervention have a high risk of requiring both an SB and GDD.

Lyophilised amniotic membrane patches are a safe and effective treatment for rhegmatogenous lesions in combined tractional and rhegmatogenous retinal detachment: a prospective interventional study.

This study was performed to evaluate the safety and effectiveness of a lyophilised amniotic membrane (LAM) as a patch for the treatment of retinal breaks and to describe the structural changes at the implantation site. Prospective, interventional case series study. Patients with diabetic retinopathy and combined tractional and rhegmatogenous retinal detachment. Patients were organised into 3 groups according to the number of rhegmatogenous lesions: those in group A had a single break, those in group B had two breaks, and those in group C had three or more breaks. The location of the break was also evaluated as either superior or inferior. Structural outcomes were assessed using SD-OCT during a 3-month follow-up period. Of a total of 23 eyes of 23 patients, 22 (95.6%) achieved retinal repair without associated complications. Patients with 2 or fewer rhegmatogenous lesions located in the superior sector had a better anatomical result as they achieved 100% surgical success. The structural changes observed by SD-OCT over the follow-up period showed adequate adaptation of the lyophilised patch and complete closure of the rhegmatogenous lesion with no alterations in the adjacent tissue. The LAM patch seems to be safe and effective, as it promotes therapeutic closure of rhegmatogenous lesions without damaging the retinal architecture adjacent to the implantation site.

Advances in the Study of the Pathogenesis of Vogt-Koyanagi-Harada Syndrome.

Vogt-Koyanagi-Harada syndrome (VKHS) is a common type of uveitis characterized by the invasion of melanocyte-rich tissues. In recent years, the incidence of VKHS has been increasing yearly, and its specific pathogenesis has not yet been elucidated. However, its pathogenesis has been a hot topic of research. The clinical course of VKHS is characterized by the early involvement of the posterior segment of the eye, including exudative retinal detachment, optic papillitis, bilateral diffuse chorioretinitis, etc. If treated improperly or with delayed treatment, the inflammation may gradually spread to the anterior segment of the eye, leading to vision loss or even vision. This study examines the pathogenesis of VKHS. It reviews the progress of research on the pathogenesis of VKHS, which will help to improve the understanding of VKHS and provide a reference for subsequent studies.

Analysis of Choroidal Thickness Changes in Recurrent Rhegmatogenous Retinal Detachment.

To analyze changes in choroidal thickness in patients with recurrent rhegmatogenous retinal detachment (RRD) before and after surgical intervention and to identify factors that influence changes in choroidal thickness. A retrospective observational study was conducted on patients who underwent surgery for recurrent RRD from November 2019 to March 2023. Choroidal thickness was measured using optical coherence tomography (OCT) at baseline, and then at 2 and 6 months postoperatively. The study analyzed the impact of various factors on choroidal thickness changes. The study included 33 patients, demonstrating a significant decrease in choroidal thickness in the surgical eye compared to the fellow eye over a 6-month period. In the univariate analysis, changes in choroidal thickness were significantly correlated with changes in central retinal thickness (p=0.048) between 0-2 months, and with proliferative vitreoretinopathy (PVR) grade between 2-6 months (p=0.009) and 0-6 months(p=0.02). In the multivariate analysis, an association was found between changes in choroidal thickness from 2 to 6 months and PVR grade(p=0.030). The findings indicate that surgical reattachment in eyes with recurrent RRD leads to a significant reduction in choroidal thickness. The extent of this reduction is influenced by the severity of PVR, highlighting the importance of considering PVR severity when evaluating surgical outcomes in patients with recurrent RRD.

Epidemiology and characteristics of unintentional self-inflicted penetrating ocular injuries in children less than 6 years-old

IntroductionPediatric ocular injuries, notably unintentional self-inflicted penetrating ocular injuries in children under 6, pose a substantial public health concern, leading to visual impairment and psychological distress. With global prevalence indicating severe visual impairment or blindness in 2–14% of affected children, these injuries necessitate multiple surgeries and extended monitoring. Our study aims to analyze the epidemiology and characteristics of such injuries, emphasizing preventive measures, parental supervision, and timely medical intervention to mitigate their impact on young lives.MethodConducted at Khalili Hospital in Shiraz, Iran, our retrospective study included 141 cases admitted between April 2018 and April 2023. Ethical principles guided data collection from medical records, encompassing demographic details, causative objects, ocular laceration specifics, surgical procedures, complications, and visual acuity assessments.ResultsThe mean age of the participants in this study was 47.18 ± 16.48 months (ranging from 10 to 71 months), and the male to female ratio was 1.76:1 (90 vs. 51). Objects of injury mostly included knives (34.8%), wood (12.1%), and glass (10.6%), and the most common initial manifestation of injury was iris prolapse (56.7%), followed by traumatic cataract (46.8%) and limbus laceration (34.0%). Fifteen (10.6%) patients had a visual acuity better than LogMAR 0.5, 24 (17.1%) had finger count vision, 37 (26.2%) had hand motion, 7 (0.5%) had light perception, and 58 (41.1%) were uncooperative. Type of laceration and season of injury were associated with retinal detachment, and a longer time-to-visit was correlated with a higher risk of developing retinal detachment or endophthalmitis.ConclusionOur study highlights the significant burden of unintentional self-inflicted penetrating ocular injuries in children under 6. Emphasizing preventive measures, parental supervision, and timely medical intervention, our findings underscore the potential psychological and visual consequences. This research advocates for parental education and safety measures to reduce the occurrence and severity of such injuries in this vulnerable population, promoting a healthier and safer environment for children.

The difference in clinical characteristics between patients with rhegmatogenous retinal detachment during partial and complete lock-down periods related to COVID-19 pandemics 2-year long follow-up results

BackgroundWe aimed to compare results of clinical presentation of rhegmatogenous retinal detachment (RRD), and the surgical approach during partial or complete lock-down periods (LP), and non-COVID periods in a tertiary ophthalmology clinic.MethodsThe medical data of the patients who were diagnosed with RRD in a tertiary hospital. The demographic data of patients, the duration from the beginning of the visual symptoms to hospital admission, the status of lens, the anatomical quadrant of retinal break, best-corrected visual acuity (BCVA) at presentation, the type of intraocular tamponade, and final BCVA were recorded. The exclusion criteria were RD other than rhegmatogenous (tractional or exudative), and incomplete follow-up until 2nd-year.ResultsThe study included 20 eyes of 20 RRD cases in partial LP, 20 eyes of 20 RRD cases in complete LP, and 23 eyes of 23 RRD cases in non-COVID period. The ratio of perfluoropropane (C3F8) gas to silicone oil which was applied as intraocular tamponade at the end of the surgery for RRD was 15/8 in non-COVID period, 11/9 in partial LP, and 11/9 in complete LP (p = 0.730). In final visit at postoperative 2nd-year, the BCVA was logMAR 0.613 ± 0.425 in non-COVID period, logMAR 0.668 ± 0.348 in partial LP, and logMAR 0.730 ± 0.368 in complete LP (p = 0.612). In both inferior and superior quadrant RD, there was significant difference between baseline and final BCVA after surgery. (Baseline and final BCVA in inferior RD: logMAR 1.71 ± 0.40, and logMAR 0.950 ± 0.30 (p = 0.011) and, in superior RD: logMAR 1.35 ± 0.59, and logMAR 0.505 ± 0.321 (p = 0.0001), respectively.)ConclusionsAs a result, it seems that both partial and complete LP did not modify the typology of RRD surgeries.Trial registrationRetrospectively registered. The study followed the tenets of the Declaration of Helsinki, and it was approved by the local ethical committee (2023-088).

The Effect of Glucagon-like-Peptide-1 Receptor Agonists on Diabetic Retinopathy Progression, Central Subfield Thickness, and Response to Intravitreal Injections.

Objectives: To examine the effects of glucagon-like-peptide-1 receptor agonists (GLP1-RAs) on diabetic retinopathy (DR) progression, visual acuity (VA), central subfield thickness (CST), and response to intravitreal injections (IVIs) in the Hadassah ophthalmological cohort. Methods: Of 4500 Hadassah patients with DR, 146 had a documented first course of GLP1-RA treatment lasting at least a year along with ophthalmological follow-up. Of these, 35 underwent at least two optical coherence tomography (OCT) exams with a one-year interval. These 35 GLP1-RA-naïve patients were compared to a control group of 31 patients with DR who did not receive GLP1-RA treatment. We compared demographics, medical records, ocular data, and OCT characteristics between the two study groups. Results: At baseline, patients who received GLP1-RA treatment had a significantly higher prevalence of retinal detachment and vitreous hemorrhage, as well as a higher (though not statistically significant) prevalence of cardiovascular comorbidities compared to the control group. At the end of the follow-up period, the GLP1-RA group had a higher prevalence of DR progression compared to controls (3/19 vs. 0/20, respectively; p = 0.106, Fisher's exact test), but also showed a better response to IVIs (27/35 vs. 17/31, respectively; unadjusted OR: 2.78, p = 0.058; 95% CI: [0.963, 8.020], Pearson's chi-square test). However, vitreous hemorrhage and hyperreflective retinal foci were confounding factors (adjusted IVI response OR: 1.76, p = 0.229, 95% CI: [0.553, 5.650], logistic regression). No significant differences were observed between the two groups in terms of change in visual acuity (-0.135 vs. -0.063 logMAR, respectively; p = 0.664, Student's t-test) or CST (-13.49 vs. -30.13 μm; p = 0.464, Student's t-test). Conclusions: This study presents preliminary findings showing no significant differences in DR progression, visual acuity, and CST between patients treated with GLP1-RA and control patients. Moreover, GLP1-RA therapy was not significantly associated with improved IVI response, with ocular parameters acting as confounding factors.

Evaluation of vitrectomy with or without internal limiting membrane peeling in management of macula off rhegmatogenous retinal detachment

Evaluation of vitrectomy with or without internal limiting membrane peeling in management of macula off rhegmatogenous retinal detachment

Retinal detachment and mortality in patients with cytomegalovirus retinitis: A multicenter study in taiwan.

To characterize patients with cytomegalovirus (CMV) retinitis and identify risk factors for retinal detachment (RD) and mortality in this Taiwanese patient population. This retrospective study included patients diagnosed with CMV retinitis between 2007 and 2019. The diagnosis was confirmed through aqueous polymerase chain reaction (PCR). Relevant data were collected from the Chang Gung Research Database. Univariate Cox regression was performed to identify the associations of RD and mortality risks with various patient characteristics, including demographic features, comorbidities, laboratory results, and medication use patterns. In total, 32 patients with CMV retinitis were included. Among these patients, 78.1% had an immunocompromised status, including 56.3% with high-dose systemic steroid use, 21.9% with HIV infection, 12.5% with hematologic malignancy, and 9.4% with renal transplantation. Approximately 21.9% of patients had RD 2.4 ± 2.1 months after CMV retinitis diagnosis, and 34.4% died within 6.2 [4.2, 38.2] months after diagnosis. Patients with RD had a statistically significant, but likely not clinically significant, later initiation of anti-CMV medications compared to their non-RD counterparts (8 [5, 23] days vs. 2 [1,11] days, p = 0.039). Mortality was significantly associated with older age (hazard ratio [HR]: 1.06; 95% confidence interval [CI]: 1.02-1.10), hematologic malignancy (HR: 5.92; 95% CI: 1.44-24.37), and positivity for CMV on blood PCR (HR: 4.93; 95% CI: 1.49-16.35). Our study suggests that older age, hematologic malignancy, and positivity for CMV on blood PCR are risk factors for mortality in patients with CMV retinitis. What is known Cytomegalovirus (CMV) retinitis is the predominant sight-threatening opportunistic ocular infection in patients with acquired immunodeficiency syndrome (AIDS). What is new In the era of highly active antiretroviral therapy for AIDS, the majority of CMV retinitis patients are those receiving immunomodulatory therapy for underlying diseases. Older age, hematologic malignancy, and positive blood polymerase chain reaction for CMV are potential risk factors for mortality in patients with CMV retinitis.

Occlusive lesions of retinal vessels: etiological and patogenetic factors

Background. Vascular pathology of the organ of vision is one of the most urgent problems of ophthalmology, as it is the main cause of vision loss and vision loss. Retinal vein occlusion ranks second after diabetic retinopathy in the world among vascular causes of vision loss. In a significant risk group for the occurrence of occlusions of the retinal vessels are patients with cardiovascular diseases. Today, treatment of patients with coronary heart disease and patho­logy of heart valves is impossible without surgical interventions, most of which require the use of artificial circulation (AC). During the operation of the AC due to prolonged hypothermia, hemodilution, prolonged hypotension, anemia, development of ophthalmologic complications in the early postoperative period is possible. The purpose of the study was to investigate etiological and pathogenetic factors of occlusive lesions of retinal vessels. Mate­rials and methods. The search for sources of Ukrainian and foreign literature for the ana­lytical review was conducted keywords using the open medical scientific database PubMed (USA). At the first stage, 211 sources were selected, of which 66 were selected for this article. Results. Occlusion of the central retinal vein (CVO) deve­lops in 214 people per 100,000 population, mainly in people over 65 years of age. The frequency of branh retinal vein occlusions (BRVO) is 67.2%, of which 82.4% is a occlusion of the superior temporal branch. The main risk factors of CVO are age, hypertension, diabetes, atherosclerosis, glaucoma, coronary heart disease. A small number of sources are found in the literature regarding complications from the organ of vision in patients after cardiac surgery with AC such us thromboembolism of retinal vessels, optic ischemic optic neuropathy, retinal ischemia, optic nerve atrophy, retinal detachment, proliferative vitreoretinopathy. The authors' research showed a multiple increase in blood markers of endothelial dysfunction, including vascular endothelial cadherin (VE-cadherin, VE-C) after surgery. Conclusions. Diseases of the organ of vision due to general or local blood circulation disorders account for 10 to 28%, 2.6% of which lead to blindness. There is a relationship between occlusive lesions of retinal veins and cardiovascular diseases. The main reasons for the development of retinal vein occlusion after cardiac surgery with coronary artery disease are acute inflammation occurring during and immediately after surgery and endothelial dysfunction.

ATROPINE FOR MYOPIA CONTROL: EFFICACY, CHALLENGES AND FUTURE DIRECTIONS

Myopia, or near-sightedness, is rapidly emerging as a major global health issue, with projections indicating that by 2050, it will affect nearly 50% of the world’s population. This condition arises from excessive elongation of the eyeball, leading to blurred vision at a distance and increasing the risk of severe ocular complications, such as retinal detachment and glaucoma. Effective management strategies are critical to mitigating the public health impact of this growing epidemic. Atropine, a muscarinic antagonist, has gained attention for its potential in myopia control. By inhibiting muscarinic acetylcholine receptors (mAChRs) in the eye, atropine slows down axial elongation, the anatomical hallmark of myopia. Low-dose atropine (0.01%) has demonstrated efficacy in clinical trials, such as the ATOM2 study, which showed a 50% reduction in myopia progression with minimal side effects, including photophobia and blurred vision. Meanwhile, the LAMP study indicates that slightly higher concentrations (0.05%) may further balance efficacy and tolerability, especially in children at high risk of severe myopia. Despite these promising results, critical knowledge gaps persist, particularly concerning atropine’s long-term safety, optimal dosing, and the rebound effect, where myopia progression may accelerate after stopping treatment. Ethnic and genetic variability also calls for a more diverse research focus. Future studies should explore combining atropine with other interventions, such as orthokeratology or multifocal lenses, to optimize outcomes. As leading pharmacological option for myopia management, atropine holds potential for integration into multifaceted treatment strategies to address this pressing public health concern. KEYWORDS: Atropine, Myopia, Pediatric Populations, Muscarinic Acetylcholine Receptors, LAMP.