2022, volume 18

Abstract. Objective: to analyze the data available in the literature on the possibilities of using molecular biomarkers of glaucoma for early detection of the mechanisms involved in neuronal damage to retinal ganglion cells. The review material was 30 foreign and 10 Russian sources from the medical international databases PubMed, Cochrane and the e-Library electronic library, the electronic search period is 2018-2022. Despite the fact that the diagnosis of glaucoma is based on the clinical picture, the identification of molecular biomarkers of glaucoma may contribute to its earlier diagnosis and the development of new approaches to monitoring and drug therapy.

Abstract. Objective: to analyze the results of implantation of toric posterior chamber phakic intraocular lenses (FIOL) in patients with high-grade myopia with astigmatism and high-grade refractive amblyopia. Material and methods. A toric posterior chamber FIOL was implanted in 52 eyes with a high degree of myopic astigmatism. Of these, 10 are with refractive amblyopia of a high degree. Results. Visual acuity on the first day after surgery was 0.93±0.06, in 7 days, 1 and 6 months — 0.97±0.05. The relative accommodation reserve after surgery in 1 month increased to 5.42±0.62D. The visual acuity of the amblyopic eye on the first day after surgery was 0.46±0.05, in 7 days — 0.52±0.07, in 1 month — 0.75±0.07 and in 6-12 months 0.78±0.07. The absolute accommodation reserve of the amblyopic eye at 6 months was 5.15±0.64D. Unstable binocular vision was revealed in 10 patients with amblyopia. Analysis of postoperative refraction after 12 months showed that emmetropic refraction was achieved in 45 eyes, myopic in (-) 0.25D — in 5, myopic in (-) 0.5D — in 2 eyes. Conclusion. Implantation of toric posterior chamber FIOL in patients with high-grade myopia and astigmatism, refractive amblyopia is justified: visual acuity improves, accommodation is preserved, binocular vision is restored, refractive effect is stable and a short rehabilitation period.

Abstract. Objective: to present current data regarding the epidemiological, pathogenetic, diagnostic and surgical aspects of proliferative diabetic retinopathy (PDR). The review was performed using the Russian database RSCI and the international database PubMed, while the search keywords were "diabetic retinopathy", "proliferative diabetic retinopathy", "vitrectomy". A total of 478 sources were identified with further use of systematic review filters and authors' knowledge of the topic (43 sources were selected for review). The duration of the search was 10 years (2013-2022). Conclusion. A significant increase in the incidence of diabetes mellitus is accompanied by an increase in the incidence (up to 4% among people with diabetes) of PDR, which is one of the main causes of blindness and low vision in working age. The leading factors that determine the occurrence and pathogenesis of PDR are hyperglycemia, chronic inflammation, and changes in retinal blood flow. In the diagnostic plan, the value of optical coherence tomographic angiogra-phy is noted. The main directions of vitrectomy in PDR (optimization of surgical equipment, visualization of vitreoretinal structures, the use of drugs, the development of new technologies for surgical intervention) provide an increase in the clinical effectiveness of the treatment. The presented modern data should be taken into account when counseling patients about the tactics and duration of treatment for patients with PDR.

Abstract. Objective: to analyze the efficacy, safety and tolerability of Panavir® (eye drops 0.004%) in the treatment of keratoconjunctivitis of adenovirus etiology. Material and methods. 216 patients with acute keratoconjunctivitis of adenovirus etiology participated. Group 1 patients received Panavir® 0.004%, group 2 patients received Ophthalmoferon® (interferon alfa-2b). The study included 5 visits. Results. There was a significant decrease in the number of patients with the studied symptoms (conjunctival follicles and hemorrhages, conjunctival edema and hyperemia, subepithelial infiltrates, itching, foreign body sensation, lacrimation and eyelid edema) by day 10 in both groups (p<0.001 when compared with the initial value of the indicator), while in group 1 there was a more pronounced dynamics on the 10th and 15th day of observation when compared with the value of the indicator in patients from group 2 on each day. In group 1, there was an earlier significant disappearance of hemorrhages and conjunctival follicles (by 13.2±1.3 days, in group 2 by 17.0±1.7 days, p<0.001), edema and hyperemia of the conjunctiva (by 13.2±1.3 days, in group 2 — by 18.7±2.5 days, p<0.001), itching in the eyes (by 8.2±1.6 days, in group 2 —by 13.6±3.2 days, p<0.001)and sensation of a foreign body (by 8.0±1.6 days, in group 2 — by 11.2±3.2 days, p=0.035). Conclusion. The conducted clinical study showed the efficacy, safety and good tolerability of Panavir® in comparison with interferon in the treatment of adenovirus keratoconjunctivitis.

Abstract. Objective: to analyze the efficacy, safety and tolerability of Panavir® (eye drops 0.004%) in the complex therapy of post-primary herpetic keratitis. Material and methods. 106 patients with post-primary herpetic keratitis participated. Patients in group 1 received Panavir® in combination with acyclovir (eye ointment 3%), patients in group 2 — placebo and acyclovir (eye ointment 3%). The study included 6 visits. Results. Complete epithelialization of the cornea at visits 3 and 4 was registered in significantly (p<0.001) more patients from group 1, the average value of the epithelial defect size was also statistically significantly (p<0.001) less in patients of group 1 at visits 3 and 4. In the group 1 registered a statistically significant greater number of patients with non-hyperemic conjunctiva than in the monotherapy group (p<0.001) at visit 4. The severity of corneal syndrome was statistically significantly less in patients from group 1 than in patients from group 2 at visits 3 (p=0.003) and 4 (p<0.001). Conclusion. The conducted clinical study showed the efficacy, safety and good tolerability of Panavir® in combination with acyclovir in the treatment of herpetic keratitis.

Abstract. The article describes cases of penetrating wounds with double (inlet and outlet) perforating eyeball injuries. The clarifying methods of X-ray localization of foreign bodies, the surgical method of treating such patients and the results of treatment are described in detail. The authors concluded that the early treatment of patients, the use of clarifying techniques, timely surgical treatment in combination with the use of vitreoretinal surgery allows saving the eyeball and obtaining functional results.

Abstract. Objective: comparative assessment of quality of life (QoL) after various vitrectomy techniques in patients with proliferative diabetic retinopathy on hemodialysis. Material and methods. 72 patients (mean age 57.4±2.2 years) requiring regular hemodialysis sessions were under observation. Patients were divided into two groups (36 patients, 36 eyes) equal in age, gender and severity of proliferative diabetic retinopathy: the main group included underwent vitrectomy following the developed technique and the control group included underwent the traditional surgery. QoL investigation was performed according to a special (Assessment of Quality of Life in Patients with Vitreoretinal Pathology, QoL-20) and general (Visual Function Questionnaire 25, VFQ-25) questionnaires before and one month after surgery. Results. QoL after vitrectomy was significantly increased by both questionnaires. Comparatively, the greatest positive dynamics was revealed in the main group patients compared to the control group on the VFQ-25 questionnaire (by 20.0%, p=0.013) and the QoL-20 questionnaire (by 47.5%, p=0.008). Conclusion. The developed technique of vitrectomy in patients with proliferative diabetic retinopathy undergoing hemodialysis was characterized by higher clinical effectiveness as shown by a comparative dynamics of QoL indicator, especially according to a special questionnaire QoL-20 designed for vitreoretinal pathology.

Abstract. Objective: evaluate the time of occurrence of macular holes and the results of surgical treatment in patients with myopia of varying degrees. Material and methods. 47 patients, 47 eyes with stage 3 and 4 macular holes were examined. Group 1 included 18 eyes with high myopia and eye length from 27.0 mm or more, group 2 included 17 patients with moderate myopia and eye length from 25.0 to 26.99 mm, group 3 (comparison) included 12 patients (12 eyes) with macular holes in mild myopia and emmetropia. Visual acuity in group 1 before treatment with maximum correction was 0.05±0.02, in group 2 it was 0.07±0.02, in group 3 it was 0.08±0.04. All patients underwent subtotal vitrectomy with removal of the posterior hyaloid membrane, peeling of the internal limiting membrane, closure of the rupture with platelet mass, and gas tamponade. Results. The average age of onset of macular hole in group 1 was 51 1±3.2 years, in group 2 — 57.1±2.4 years, in group 3 — 65.2±3.8 years. Closure of the gap was noted in 100% in group 1, in group 2 also in 100%, in group 3 in 83.3%. Visual acuity in group 1 after surgery increased to 0.1±0.05, in group 2 — up to 0.4±0.02, in group 3 — 0.5±0.05. Conclusion. Myopic refraction is a risk factor for the formation of a macular hole at an earlier age. Vitrectomy eliminates the traction effect on the macula during epiretinal membrane and closes the macular hole, while there is a stable increase in visual acuity for 6 months. Macular holes in high myopia require immediate surgical treatment as they lead to retinal detachment.

Abstract. Idiopathic macular rupture is a rather rare pathology, occurring to a greater extent among the female population. Based on the above clinical case, the effectiveness of various methods of operative treatment of large and small diameter ruptures, as well as tactics and functional results after reconstitution in case of inefficiency of primary operative treatment of macular rupture are considered. Described is apatient with bilateral idiopathic macular hole in both eyes underwent a standard 3-port 25G vitrectomy with removal of the posterior hyaloid membrane, peeling of the internal limiting membrane and endotamponade with an air-gas mixture. The condition of the right eye after 1 month required the 2nd stage of surgical treatment — revision of the vitreal cavity with a wider removal of the internal border membrane, the introduction of platelet mass and endotamponade of the vitreal cavity with silicone oil. After surgical treatment of the patient, both eyes achieved complete closure of the macular hole and increased visual acuity in both eyes.

The article presents a case of the development of a bullous form of exudative erythema multiforme, which was erroneously diagnosed as Stevens — Johnson syndrome. This observation demonstrates the difficulties encountered in the differential diagnosis of dermatoses having the similar etiopathogenesis and identification of manifestations. The authors presenting a clinical case focus on those symptoms that allow, in the event of a diagnostic examination, to exclude the most severe skin disease — Stevens — Johnson syndrome. The knowledge of the data will prevent practising physicians from medical diagnostic and tactical errors.