Ophthalmological Studies Research Articles

Нові, генетично детерміновані, фактори ризику діабетичної ретинопатії при цукровому діабеті 2-го типу: заключне повідомлення

Актуальність. За прогнозами Міжнародної федерації діабету (IDF), до 2030 року кількість хворих на цукровий діабет (ЦД) зросте з 366 до 552 мільйонів. В Україні зареєстровано понад 1,5 мільйона хворих на цукровий діабет, із яких 84–95 % — хворі на діабет 2-го типу (ЦД2). Одним із важливих ускладнень цукрового діабету є діабетична ретинопатія (ДР), що залишається однією з причин сліпоти і слабкозорості, в тому числі в осіб працездатного віку. В патогенезі ДР важлива роль належить метаболічним порушенням, в тому числі активації поліолового шляху утилізації глюкози, ключову роль у чому відіграє альдозоредуктаза, активність якої пов’язують з поліморфізмом її гена — AKR1B1. Вивчення нових метаболічних і генетичних механізмів розвитку і прогресування ДР при ЦД2 у пацієнтів української популяції є актуальним завданням сучасної офтальмології. Мета: дослідити та узагальнити нові дані про генетично детерміновані фактори ризику діабетичної ретинопатії при цукровому діабеті 2-го типу. Матеріали та методи. У дослідження було залучено 409 осіб, які були розподілені на чотири групи: 1-ша — пацієнти когорти порівняння (98 осіб без ЦД2); 2-га — 76 пацієнтів (I стадія ДР, без змін на очному дні); 3-тя — 64 пацієнти (непроліферативна ДР (НПДР)); 4-та — 64 пацієнти (проліферативна ДР); контрольну групу для генетичних досліджень становили 107 офтальмологічно здорових обстежених пацієнтів. Всім пацієнтам виконували забір крові для молекулярно-генетичних досліджень шляхом пункції ліктьової вени і забору 2,5 мл крові через одноразовий шприц (Hemoplast, Etalon+, Україна) об’ємом 5,0 мл із голкою діаметром 23G з подальшим випусканням до контейнера (Vacuette K3E K3EDTA, Greiner bio-one, Австрія) об’ємом 3,0 мл. Досліджували розподіл поліморфних алелей і генотипів rs759853 та rs9640883 гена AKR1B1 у пацієнтів з НПДР та ПДР і ЦД2 та в контрольній групі та їх асоціацію з захворюванням і впливом на виникнення, механізми розвитку і прогресування ДР. На підставі проведених досліджень було розроблено модель прогнозування розвитку ДР шляхом побудови множинної регресії з достатньою надійністю ступеня впливу незалежних змінних на розрахунковий показник. Результати. В результаті проведених нами досліджень були встановлені нові, генетично детерміновані, фактори ризику розвитку та прогресування різних стадій ДР у пацієнтів із ЦД2, а саме роль поліморфних алелей і генотипів rs759853 та rs9640883 гена AKR1B1. Розроблені логістичні моделі регресії встановили, що ризик розвитку ДР у п’ять разів менший у носіїв генотипів G/G і G/A порівняно з носіями генотипу A/A поліморфізму rs759853 (p < 0,001). Встановлено, що ризик у два рази більший (p = 0,01) у носіїв генотипу G/G rs9640883 порівняно з генотипами A/A + G/A. Ризик розвитку ПДР у 3,3 раза менший у носіїв генотипу G/G та в 2,5 раза — у носіїв генотипу G/A порівняно з носіями генотипу А/А rs759853. Висновки. Отже, на підставі проведених нами клінічних, офтальмологічних і молекулярно-генетичних та статистичних досліджень були встановлені нові фактори ризику розвитку та прогресування різних стадій ДР у пацієнтів із ЦД2. Були побудовані математичні моделі розвитку та прогресування різних стадій ДР у пацієнтів із ЦД2.

Compliance with Medical Treatment in Primary Open-Angle Glaucoma (POAG) at the Centre for the Application of the Diploma of Specialized Studies in Ophthalmology (CADES/O)

Introduction: Primary open-angle glaucoma, a chronic, potentially blinding disease, requires lifelong medical treatment that demands full patient compliance. The objective was to determine the rate of compliance and to study the determinants of compliance in glaucoma patients followed at CADES/O. Patients and Methods: This was an observational study, which included old and new glaucoma patients. Compliance was assessed on the availability of medication, regularity of dosing schedules, compliance with prescribed doses, and regularity at check-ups. Compliance was judged to be good when at least four (4) of these criteria were met, fair when only three (3) of these criteria were met and poor when only two (2) of these criteria were met. Results: Compliance was considered good in 38.4% of cases, fair in 48.2% of cases and poor in 13.4% of cases with an overall compliance rate of 86.6%. The correlation was not statistically significant for age, sex, origin, length of illness, route of administration, instiller, or therapeutic regime. On the other hand, profession, level of education, presence of systemic arterial hypertension, compliance with instillation schedules, prescribed dosage, regularity of treatment, compliance with control visits and the climate of trust between patient and treating physician were the determining factors with the greatest statistical influence on compliance with treatment. Conclusion: Compliance with glaucoma treatment is linked to the patient factor but especially to the doctor factor. Doctors should take their time to explain to patients their disease, its evolution with or without treatment and above all the necessity of a good therapeutic compliance.

Hypertensive Retinopathy in Guinean Hypertensive Women: Epidemiological, Clinical and Therapeutic Aspects

Introduction: Hypertensive retinopathy is the set of retinal and papillary manifestations secondary to acute or chronic acute or chronic high blood pressure. Its frequency increases with age in women, its treatment requires the balance of blood pressure figures. Purpose: To study in women the epidemiological, clinical and therapeutic aspects of Hypertensive retinopathy at the application center of the Diploma of Specialized Studies in Ophthalmology (CADES/O). Patients and Methods: Prospective study conducted on 92 women who met the inclusion criteria over a period of six (6) months, from October 1, 2021 to March 31, 2022 in whom the diagnosis of Hypertensive Retinopathy was retained according to the Kirkendall classification. Results: We collected 92 patients with an average age of 57.88 years. The hypertensive Retinopathy was present at 61.75%. The age group of 60 - 69 years was the most represented at 40.22%. The socio-professional stratum most affected was housewives. The duration of the evolution of high blood pressure was from 2 - 5 years representing 57.61% of our study cases; the most common grade of high blood pressure was Grade II at 60.87%. Treatment of hypertension was irregularly followed in 73.91%. Stage II according to Kirkendall’s classification was 58.70% common; the recurrent sign was retinal hemorrhage at 30.43%. Blood pressure balance was the treatment recommended to our patients at 80.48%. Conclusion: Hypertensive retinopathy is common in women and its management remains the balance of blood pressure figures with periodic and multidisciplinary monitoring.

Pediatric Eye Trauma: Epidemiological, Clinical and Therapeutic Aspects at CADESSO in Donka, Guinea

Introduction: Eye trauma represents all morbid lesions on the eyeball due to external violence. In children, they are an important cause of morbidity and the leading cause of monocular blindness. The aim of this study was to determine the sociodemographic, clinical and therapeutic characteristics of eye trauma in children aged 0 to 16 at the Application Centre for the Diploma of Specialized Higher Studies in Ophthalmology (CADESSO) in Donka, Guinea. Patients and Method: This was a prospective longitudinal study with descriptive purposes from January 1 to December 31, 2019 involving 205 children victims of eye trauma. Variables related to sociodemographic, clinical and therapeutic characteristics were studied. Informed consent from patients and/or their parents was sought and obtained. The confidentiality of the files was guaranteed. The data entry was done on EPI-Info version 7 and the analysis using the Stata software. The tables were made in Excel 2010. Pearson’s Chi2 test was used for the comparison of proportions. Results: Pediatric eye trauma accounted for 9.31% of pediatric visits and 30.92% of all eye trauma cases. There was a male predominance with a sex ratio of 1.59. Age groups from 0 - 4 years; 5 - 8 years and 9 - 12 were the most affected with 26.8%, 28.8% and 27.3% respectively and a decrease in the number of cases in the 13 - 16 age group (17.1%). Gambling and sports accidents accounted for 33.2%, followed by domestic accidents for 16.6% and physical injury for 8.2%. Eye contusion was the most represented at 66.3% followed by wounds of the globe 23.9% and burns at 5.9%. One hundred and twenty-six patients had received a determination of visual acuity (VA) at admission; 99 were assessed at discharge and 27 were lost to follow-up. The VA ≥ 5/10th increased from 43.4% at admission to 79.8% after treatment. We had found 67% of vision ≥ 5/10 in eye bruises against 5% in eyeball wounds. Anti-inflammatories (99.5%)) were almost used. The sequelae were dominated by corneal opacities (71.9%). Conclusion: Child eye trauma is a public health problem in Guinea. The best means of care remains prevention, which must be of interest to the child and his environment.

Epidemiological Aspects of Diabetic Retinopathy at the Center of the Application of the Diploma of Specialised Studies in Ophthalmology (Cadeso)/Donka-Conakry

Purpose: The authors analyzed the epidemiological and clinical aspects of diabetic retinopathy at the Center for the Application of the Specialized Studies Diploma in Ophthalmology, Gamal Abdel Nasser University (CHU/ Donka) Conakry. Diabetic retinopathy (eye damage: eye and retina) is a serious complication of diabetes that affects 50% of type 2 diabetic patients. The eyes are particularly sensitive to damage to a small vessel. Diabetic retinopathy (DR) is the retinal localization of diabetic micro angiopathy resulting in impaired blood flow in the affected territories, the consequences of which will determine the clinical manifestations of the disease. DR is the leading cause of vision loss in adults of working age. Patients and Methods: This is a longitudinal prospective study carried out at CADES/O concerning 198 diabetic patients. The selection criteria were that the media be transparent and the fundus accessible over a period of six months from February to July 2018. Results: A total of 73 patients (37%) presented with diabetic retinopathy with an average age of 49.5 +/− 9 years. The sex ratio (M/F) was 0.6 with a female predominance of 59%. Liberal profession patients were the most numerous 47.5%. Type 2 diabetes was the most common (85.86%). Diabetes fundus assessment was the most common reason for consultation (52%). Arterial hypertension was the most incriminated risk factor (45.45%) followed by the poor balance of diabetes (40.90%), and the age of diabetes (28.28%). 9.5% had diabetic retinopathy complicated by rubella iris, neovascular glaucoma and retinal detachment. Conclusion: Diabetic retinopathy is a common condition for which early detection and regular monitoring must be the rule to prevent, slow down or avoids irreversible blindness if possible, induced by this pathology by a good balance of diabetes and good control of associated risk factors.

Sclerochoroidal calcification associated to breast cancer and parathyroid adenoma

AbstractPurposeSclerochoroidal calcification (SCC) is an unusual and poorly recognized ocular condition which is usually presented as an incidental finding in asymptomatic individuals. An exhaustive diagnosis is required as it may be commonly misdiagnosed such as choroidal osteoma, choroidal metastasis, amelanotic choroidal nevus, or lymphoma. It is commonly idiopathic but ophthalmologists should be aware of the possible association with severe ocular trauma and chronic intraocular inflammation, or with abnormal calcium‐phosphorus metabolismMethodsWe report the case of a 78‐year‐old woman with a medical history of breast cancer treated with quadrantectomy followed by adjuvant chemotherapy and radiotherapy, and Letrozole (aromatase inhibitors) for 3 years, which was discontinued when a hypercalcaemia and primary hyperparathyroidism (PHPT) related to a parathyroid adenoma. Oncological follow‐up was negative until during a routine examination prior to a right eye cataract intervention, dilated fundus examination revealed bilateral multiple asymptomatic yellow placoid lesionsResultsThe patient's best‐corrected visual acuity (BCVA) was 20/20 in the right and left eye. Tomography–computed tomography (OCT‐scan), Magnetic resonance imaging (MRI) and Positron emission tomography–computed tomography (18‐FDG PET‐TC) revealed diffuse calcification in the choroid plexus bilaterally as well as calcification in the posterior aspect of both globes with no changes in metabolism at these levels. A SCC secondary to hypercalcaemia and PHPT related to a parathyroid adenoma was diagnosed. She was referred to endocrinology specialist to rule out systemic conditions. As the patient stills refusing surgery, she was treated with Cinacalcet (a calcimimetic) with regular follow‐up in the endocrinology clinic. Dilated fundus examination and OCT are performed periodically. For the time being, the patient remains asymptomatic and the lesion stays stable.ConclusionsAll patients with SCC should be tested for underlying systemic disorders involving abnormal calcium‐phosphorus metabolism to avoid complication or unwarranted intervention resulting from the misdiagnosed as a malignant tumor. Periodic ophthalmology studies are required as well to rule out possible complications.

Clinical and Functional Characteristics of Secondary Geographic Atrophy Against the Background of Exudative Age-Related Macular Degeneration

Background.Studies demonstrate the need for long-term follow-up of patients with wet age-related macular degeneration (AMD) treated with inhibitors of angiogenesis to monitor long-term vision outcomes and assess the safety of antiangiogenic therapy in relation to the risk of secondary geographic atrophy.
 Aims to determine the characteristic clinical and functional signs of secondary GA that developed against the background of wet AMD.
 Methods.In 22 patients (25 eyes) with wet AMD and 18 healthy subjects comparable in age and sex standard ophthalmological and instrumental studies were performed and photopic electroretinograms (ERGs) were recorded according to ISCEV standards, flicker-ERGs, multifocal ERGs and electrooculogram.
 Results.The appearance of the area of secondary atrophy against the background of wet AMD in eyes treated with inhibitors of angiogenesis is clinically indistinguishable from areas of geographic atrophy that developed as an outcome of dry AMD. The ERG-signs of secondary atrophy are described, which are similar to the biomarkers of primary atrophy and specifically differ from them. Secondary atrophy is characterized by the dependence of the increase in the b/a ratio on the atrophic area, reducing of the 8.3 Hz-flicker-ERG amplitude in the absence of 24 Hz-flicker ERG changes. In eyes with secondary atrophy, a significant decrease in the density of the multifocal ERG P1-peak was shown not only in the first hexagon but also in the parafoveal zone. The electrooculography results showed a sharper dark troughs decrease in with an increase in Ardens ratio in patients with secondary atrophya on the background of wet AMD, in contrast to the previously described changes in primary geographic atrophy.
 Conclusion.Comparison of the change in the b/a ratio with secondary atrophy area in patients with wet AMD may have clinical implications for assessing retinal dysfunction and predicting visual function. Secondary atrophy is associated with a pronounced inhibition of photoreceptor activity with better preservation of cone bipolar cells. The ERG and electrooculography data taking together indicate a more significant dysfunction of the retinal pigment epithelium in GA against the background of wet AMD and the associated deterioration of photoreceptor function than the changes characterizing primary geographic atrophy.

Application of Mendelian randomization in ophthalmology and other medical fields

In recent years, the application of Mendelian randomization has become more and more widely in the world. By taking genes as instrumental variables, it can eliminate the interference of confounding factors and reverse causality in the system, and effectively judge the causal correlation between exposure factors and outcomes, which has a unique advantage for etiological exploration in the medical field. This article reviews the application of Mendelian randomization in ophthalmology and provides new ideas for the development of correlational and causal studies in Ophthalmology. (Chin J Ophthalmol, 2021, 57: 791-795).

Testing the homogeneity of proportions for combined unilateral and bilateral data

ABSTRACT Measurements are generally collected as unilateral or bilateral data in clinical trials or observational studies. For example, in ophthalmologic studies, statistical tests are often based on one or two eyes of an individual. For the bilateral data, recent literatures have shown some test procedures that take into account the intraclass correlation between paired organs of the same person. Ma et al. investigated three test procedures under Rosner’s model. In this paper, we extend Ma’s work for bilateral data to combined bilateral and unilateral data. The proposed procedures are based on the likelihood estimate algorithm derived from the root of 4th order polynomial equations and the Fisher scoring iterations. Simulation studies are performed to compare the testing procedures under different parameter configurations. The result shows that score test has satisfactory type I error rates and powers. Therefore, we recommend score test for testing the homogeneity of proportions. We illustrate the application of the proposed methods with two real world examples.

A Ophthalmology Study on Eye Glaucoma and Retina Applied in AI and Deep Learning Techniques

Artificial intelligence based on deep learning has huge global interest in current times. Deep Learning has been widely affiliated in image and speech recognition and also natural language processing, but it is beginning of healthcare. In ophthalmology, Deep learning has applied in photographs fundus, optical coherence tomography and vision sectors. Accomplishes safety in classifying the detection performance on diabetic retinopathy, age-related macular degeneration. Deep learning may be used in concurrence with telemedicine as possible to diagnose and monitor major eye diseases for patients in primary care. There are also prospective challenges with Deep learning application in ophthalmology, including clinical and technical challenges, explain ability of the algorithm results, medico legal issues, and physician and patient acceptance of the AI “black-box” algorithms. Deep learning could probably revolutionize how ophthalmology is practiced in the future. Hence this reviewprovides a Deep Learning systems described for ophthalmic conditions, and fundamental functions.

Quantitative Retinal Microvascular Analysis in Schizophrenia With Swept Source Optical Coherence Tomography Angiography

Ophthalmologic studies in schizophrenia have reported changes in retinal arterial/venule diameter and tortuosity. We used optical swept-source coherence tomography angiography (SS-OCTA) to analyze retinal microvasculature in schizophrenia and their correlations to clinical measures.

Ophthalmologic manifestations of adult patients with cystic fibrosis.

Cystic fibrosis (CF) is the most common life-shortening recessive genetic disease in Caucasians, affecting primarily the lungs. The objective of our study was to investigate potential ophthalmologic involvement in adult patients with CF. Fifty adult patients with cystic fibrosis and 60 age- and sex-matched controls underwent complete ophthalmologic examination including tear-film Break-Up Time (BUT), Macular Thickness, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness measurements using Spectral Domain-OCT. CF patients had significantly lower nasal-inferior pRNFL thickness (median 82 IQR 67-102 vs 92.5 IQR 82-107, p = 0.005) and lower percentage of normal tear Break-Up Time (56.0% vs 96.7%, p = 0.001) than healthy controls. All CF patients with BUT <10 s were diagnosed with blepharitis at the time of our assessement. The subgroup of patients homozygous for the most common CF mutation, F508del, had lower nasal-inferior pRNFL thickness (p = 0.014) and lower percentage of normal tear Break-Up Time (p = 0.001) compared to the control group. Additional findings, present in the CF group only, were punctuate retinal hemorrhages (four patients), vessel tortuosity (four patients), snail-track degeneration, and retinal tufts (two patients without refractive error). There were no significant differences in visual acuity, refractive errors, gonioscopic findings, or intraocular pressure between the groups. Our study is, to the best of our knowledge, the largest ophthalmologic study of patients with cystic fibrosis. We found that CF patients had significantly decreased inferior-quadrant peripapillary retinal nerve fiber layer thickness and decreased tear-film break-up time compared to controls. We highlight the importance of careful regular ophthalmologic assessment and follow-up of these patients.

Immuno-toxicological evaluation of her1 cancer vaccine in non-human primates: a 6-month subcutaneous study

Purpose: A vaccine composition based on the extracellular domain of the human epidermal growth factor receptor 1 (HER1-ECD) and the combination of VSSP (very small size proteoliposomes) and Montanide ISA 51 adjuvants when used by intramuscular route, demonstrated promising results in preclinical studies. However, in order to avoid potential adverse events due to the use of Montanide, it is proposed to modify the vaccine formulation by using VSSP (very small size proteoliposomes) adjuvant alone, and to evaluate the quality of subcutaneously induced immune response. This study aimed to assess the immunotoxicological effects of HER1 vaccine in Cercopithecus aethiops. Materials and methods: Fifteen monkeys were randomized into four groups: Negative Control (Tris/NaCl, s.c.), Positive Control (200 µg HER1-ECD/VSSP/Montanide ISA-51 VG, i.m), Low Dose (200 µg HER1-ECD/VSSP/Tris NaCl, s.c.) and High Dose (800 µg HER1-ECD/VSSP/Tris NaCl, s.c). All monkeys received 7 doses and were daily inspected for clinical signs. Body weight, rectal temperature, cardiac and respiratory rates were measured during the study, and electrocardiographical and ophthalmological studies were performed. Humoral and cellular immune response and clinical pathology parameters were analyzed. Results: Animal’s survival in the study was 100% (n = 15). Administration site reactions were observed in the Positive Control animals (n = 4). HER1 vaccine administered subcutaneously (High Dose Group) achieved good IgG antibody titers although lower than the Positive Control group, but with higher ability to inhibit HER1 phosphorylation. Conclusions: This suggests that the alternative of eliminating the use of Montanide in the HER1 vaccine preparation and the using subcutaneous route is feasible.

Current status of home monitoring technology for age-related macular degeneration.

Evidence suggests that patients present with exudative age-related macular degeneration (AMD) in a delayed fashion. Increased lesion size associated with this delay directly impacts visual acuity. Upon treatment initiation, patients are monitored largely with optical coherence tomography (OCT) technology to determine the need for treatment. Home-monitoring systems using preferential hyperacuity perimetry (PHP) and OCT may optimize management. Comparison of Age-related Macular Degeneration Treatment Trials study and American Academy of Ophthalmology's Intelligent Research in Sight registry data suggest smaller lesion size and better visual acuity upon choroidal neovascularization (CNV) capture are associated with better final visual acuity with therapy. The HOME study and recent PHP-based ForeseeHome data indicate that this modality leads to earlier detection of CNV. Results of a real-world data analysis demonstrate 82% retention of ≥20/40 vision with median visual acuity of 20/40 at time of CNV detection using PHP home-monitoring. Home OCT data suggests excellent patient useability, with >90% of patients obtaining analyzable images. The Notal OCT Analyzer demonstrates superiority over human interpreters regarding the ability to detect intraretinal and subretinal fluid (82% vs. 47% sensitivity). PHP may improve treatment outcomes for exudative AMD by allowing for earlier detection of lesions. Home OCT platforms could allow for more convenient monitoring of patients undergoing treatment for exudative AMD and better enable true PRN models.

Imaging Motion: A Comprehensive Review of Optical Coherence Tomography Angiography.

Optical coherence tomography (OCT) is a three-dimensional (3-D) optical imaging technology that provides noninvasive, micrometer resolution images of structural interiors within biological samples with an approximately 1~2 mm penetration depth. Over the last decades, advances in OCT have revolutionized biomedical imaging by demonstrating a potential of optical biopsy in preclinical and clinical settings. Recently, functional OCT imaging has shown a promise as angiography to visualize cell-perfused vasculatures in the tissue bed in vivo without requiring any exogenous contrast agents. This new technology termed OCT angiography (OCTA) possesses a unique imaging capability of delineating tissue morphology and blood or lymphatic vessels down to capillaries at real-time acquisition rates. For the past 10years since 2007, OCTA has been proven to be a useful tool to identify disorder or dysfunction in tissue microcirculation from both experimental animal studies and clinical studies in ophthalmology and dermatology. In this section, we overview about OCTA including a basic principle of OCTA explained with simple optical physics, and its scan protocols and post-processing algorithms for acquisition of angiography. Then, potential and challenge of OCTA for clinical settings are shown with outcomes of human studies.

THE NATURE OF CHANGES IN THE HEMODYNAMICS OF THE EYES OF PATIENTS WITH CHRONIC ANTERIOR IDIOPATHIC UVEITIS COMPLICATED BY OPTIC NEURITIS WITH TRANSITION TO ATROPHY

Aim. To determine the nature and direction of changes in the hemodynamics of the eyes of patients with chronic anterior idiopathic uveitis complicated by optic neuritis with transition to atrophy. Materials and methods. The study involved 18 people with chronic anterior idiopathic uveitis complicated by optic neuritis with transition to atrophy. Ophthalmological (ophthalmoscopy, biomicroscopy, intraocular pressure, perimetry, visual acuity with maximum correction) and electrophysiological (volumetric pulse blood filling, vascular tone of the eye, volumetric blood flow rate) studies were performed before and after treatment for a year. The treatment was carried out according to the protocol: at the first visit — non-steroidal anti-inflammatory drugs, antibiotics, immunosuppressant, corticosteroids and immunomodulatory; with subsequent — metabolic and vitamin therapy, physiotherapy. Statistical analysis was performed using Statistic 12. 0 software. The t-test of Student and Wilcoxon was used. Research results. As a result of treatment, the visual functions of patients are improved: the number of people with higher visual acuity is increasing. In the period up to 6 months after treatment, the number of patients with low visual acuity (0.12–0.5) decreased from 94.4 to 50 %; in 11 of 13 visual acuity increased to 0.3–0.5 (66.7 % of all subjects). A year after the treatment, the visual acuity in the diseased eyes remained the same. The study of eye hemodynamics showed a significant (p&lt;0. 000) increase in all parameters in the diseased eye relative to the healthy one before treatment: volumetric pulse blood filling — by 64.8; the tone of large eye vessels — by 10.1, small — by 17.5; the rate of volumetric pulse blood filling — by 37.8 %. Comparative analysis of the hemodynamic data of sick eyes at different periods after treatment revealed a significant decrease in volumetric pulse blood filling to 66.4 and 52.4 %, the rate of volumetric pulse blood filling to 60. 2 and 44. 4 %. A decrease in the tone of large vessels by 3.1 and 6.4 %, and small — up to 94.6 and 92.7 % at the time of up to six months and up to a year relative to the initial data (p &lt;0.000 in all cases). Conclusions 1. As a result of treatment, the visual functions in the diseased eye improve without deteriorating until a year after treatment. 2. Before treatment, hemodynamic indices are increased (p&lt;0.000) in the diseased eye relative to the healthy one. 3. Six and 12 months after treatment, the volumetric pulse blood filling, the rate of volumetric pulse blood filling, the tone of large and small vessels were significantly reduced relative to the initial data.

Risk factors and prognosis of the development of pseudophakic myopia in children

Recent studies indicate the prevalence of myopic refraction in children with pseudophakia, which significantly reduces the functional results of treatment and may be an indication for replacing the intraocular lens (IOL). Therefore, studies conducted to achieve the target refraction in children with pseudophakia are relevant. Purpose To determine the risk factors for the prognosis of myopic refraction in children after extraction of congenital cataract and IOL implantation. Material and methods The study presents the results of refraction examination in 69 (110 eyes) children aged 1 to 12 years 36 months after extraction of congenital cataract with implantation of soft IOL. Results The obtained data of anamnesis, results of ophthalmological, echobiometric, clinical and laboratory studies were subjected to statistical processing assessing the significance of differences in outcomes depending on the impact of possible risk factors for the development of pseudophakic myopia; a regression logistic model and a ROC-curve were constructed. Conclusion According to the authors, reliable risk factors for the development of pseudophakic myopia in children can be such indicators as axial eye length at the time of IOL implantation exceeding the age norm by more than 0.2 mm; the child from the first pregnancy; the AL/CR ratio of ≥3.0; myopia on the paired eye; strabismus of more than 4 prism diopters; hereditary load; tension of eye's fibrous capsule: pressure of ≤180 mm Hg at the time of IOL implantation. The presented reliable factors, as well as a combination of less significant signs (the child being outside for less than 1 hour per day, intermarriage of the patient's parents, near-sight visual loads of more than 3 hours per day, the blood Ca level of less than 1.8 mmol/L) can be used for prognosis of the development of pseudophakic myopia and to help make adjustments in the management tactics for patients to achieve target refraction.

A novel tool to assess the quality of RWE to guide the management of retinal disease.

Despite the growing importance of real-world evidence (RWE) for guiding clinical decisions in retinal disease, there is currently no widely used guidance available for assessing the quality and relevance of RWE studies in ophthalmology. This paper summarizes the development of a user-friendly tool that facilitates assessment of the quality of available RWE for neovascular age-related macular degeneration (nAMD), diabetic macular oedema (DME) and retinal vein occlusion (RVO). A literature search was conducted to identify tools developed to assess the quality of RWE, in order to identify the most appropriate framework on which to base this tool. The Good Research for Comparative Effectiveness (GRACE) guidelines was chosen for this purpose as it is designed to assess the quality of observational studies and has been extensively validated, including demonstration of strong sensitivity and specificity. The GRACE guidelines were adapted to develop a straightforward tabular tool that allows simple assessment and comparison of the quality of published evidence in retinal disease for researchers and physicians alike, and includes guidance on treatment details, outcome measures, study population, and controlling for bias. The newly developed tool provides a simple method to support assessment of the strength of evidence and certainty of conclusions drawn from RWE in retinal disease, to ensure clinical decision-making is influenced by the highest quality evidence.

Hallazgos neuro-estrabismológicos en una paciente con Síndrome de Kabuki

El síndrome de Kabuki es un trastorno congénito, evolutivo y permanente que posee manifestaciones clínicas características. Se presenta el caso de una niña con diagnóstico de síndrome de Kabuki MLL2 positivo a quien se le realizó tipificación, caracterización clínica, estudio oftalmológico, estrabismoglógico, análisis perceptual visual, optométrico y estudios de neuroimagen. Se identificó facies característica, estrabismo disociado, anisocoria, disminución de habilidades perceptuales, hipocoherencia y asimetría interhemisférica importante para Delta y Theta, disminución del volumen del hipocampo izquierdo y de la arborización de la vía visual en su porción posterior izquierda, disminución de la colina y un incremento del lactato cortical. El estudio reveló alteraciones corticales y de la vía visual.

Early Appearance of Aging Signs in the Retinal Pigment Epithelium in Young Albino Rats

Retinal pigment epithelium (RPE), whose main functions are to participate directly in light perception and ensure the trophic and functioning of the retina, is a traditional subject of numerous studies. A significant part of them is biomedical and is aimed at identifying the causes of aging and degeneration of RPE, which are, in turn, associated with several serious retinal diseases that lead to the loss of the eyesight. Rodents, in particular, the albino Wistar rats, are often used as the object of these studies. The work is aimed at identifying signs of aging in the RPE in young (from 2 weeks up to 2 months) albino rats. Using the methods of fluorescence analysis and Schmorl staining, the accumulation of the “aging pigment” lipofuscin in the isolated layer of RPE, as well as a high content of polyploid binuclear cells to mononuclear cells, were detected in albino rats of an early age. In parallel, the presence of lipofuscin was detected in the isolated vascular layer (choroid) of the retina that underlies RPE. The relationship between the early appearance of signs of aging in the RPE of albino rats and the absence of the melanin pigment in the cells of this tissue is discussed. The obtained data should be taken into account when conducting experimental ophthalmological studies on this animal model object.