Ophthalmology Reports

BACKGROUND: Published data show that one third of patients who underwent urgent keratoplasty experience graft melting, resulting in repeated corneal transplantation. However, no dedicated studies have been conducted to determine causes of keratolysis and ways to address them in patients with urgent corneal disorder.

AIM: The study aimed to evaluate the effectiveness of platelet-rich plasma lysate in urgent corneal transplantation in patients with keratolysis based on the data of a comprehensive clinical immunoassay.

METHODS: A comparative cohort study was conducted. A total of 50 patients with lysis of the cornea and corneal graft were examined. All patients underwent urgent keratoplasty. Patients were divided into two groups based on postoperative therapy. The first group included 30 patients receiving standard post-transplant therapy. The second group included 20 patients who additionally received subconjunctival injections and instillations of platelet-rich plasma lysate until the graft was completely epithelized. Whole blood samples were used for immunoassay. Phenotyping was performed by flow cytometry.

RESULTS: Prior to keratoplasty, the following common characteristic changes were found in lymphocytes of patients with lysis of the cornea and corneal graft: an increase in absolute total CD3⁺ lymphocyte count; main regulatory T cell subpopulations, T helpers (CD3⁺CD4⁺); cytotoxic cells (CD3⁺CD8⁺), a minor subpopulation of double-positive T cells (CD3⁺CD4⁺CD8⁺), B lymphocytes (CD19⁺), and natural killer cells (CD16⁺CD56⁺) (p < 0.05). Postoperatively, patients with poor keratoplasty outcome demonstrated a further increase in absolute lymphocyte and total T and B cell count and unchanged high count of natural killer cells. Favorable keratoplasty outcomes are explained by positive changes in the T cell subpopulations, which were most pronounced in the platelet-rich plasma group with a decrease in lymphocyte count (CD45⁺), including total CD3⁺ lymphocyte, T helper cell, and double-positive T lymphocyte count.

CONCLUSION: Clinical observations suggest that addition of platelet-rich plasma lysate to therapy in patients after primary and repeat urgent transplantation was more effective than standard postoperative therapy. This is confirmed by corneal engraftment in all patients in the platelet-rich plasma lysate group compared with the standard therapy group, where a favorable outcome was reported in only one third of cases.

BACKGROUND: Thyroid eye disease is an independent progressive autoimmune eye condition involving the thyroid gland. Thyroid eye disease requires researches because of the high risk of visual impairment, and permanent vision loss develops with delayed treatment or therapy not based on activity and severity. The disease progresses to more severe forms in up to 15% of cases, leading to a decrease in visual function up to its complete loss. The article describes first combined medication therapy and assesses its effectiveness.

AIM: The study aimed to assess the effectiveness of combined medication therapy, including glucocorticoid pulse therapy for active thyroid eye disease.

METHODS: A total of 84 patients with active thyroid eye disease aged 26 to 75 years were treated and underwent comprehensive clinical ophthalmological examination and imagining before and after treatment. All patients received combined medication therapy, including high-dose glucocorticoid therapy, cyclophosphamide, and symptomatic and topical therapy. The mean follow-up was 86.2 ± 8.7 months.

RESULTS: The treatment course effectiveness, including cyclophosphamide injections, was 94.6% with no clinically significant side effects. There were three cases of reactivation of thyroid eye disease caused by a recurrence of thyroid disease after 6 months

CONCLUSION: Additional immunosuppressive agents and symptomatic therapy in the treatment strategy, along with high-dose glucocorticoids, increase the treatment effectiveness up to 96.4%, restore visual function, and provide sustained remission.

BACKGROUND: Antibiotic resistance remains a common challenge in treatment of infectious diseases, including ocular ones. Resistance of ocular pathogens can hinder choosing an antimicrobial agent and reduce the effectiveness of prescribed antibacterial therapy. Therefore, constant monitoring of pathogen susceptibility is an important step in tackling increasing antibiotic resistance.

AIM: This study aimed to identify causative agents of bacterial infections of the eyelid and conjunctiva and analyze their susceptibility to antibacterial agents in patients aged over 3 years.

METHODS: We analyzed the data of 20,607 conjunctival microbiome tests in patients with bacterial infections of the eyelid and conjunctiva who visited an outpatient department of the St. Petersburg Diagnostic Center No. 7 in 2018–2024. Conjunctival swabs were taken from all patients to identify pathogens and determine their antimicrobial susceptibility. Microorganisms were isolated and identified by microscopic, cultural, and biochemical methods.

RESULTS: Bacterial infections of the anterior segment were caused by Gram-positive microorganisms in 46% of cases, mainly by Staphylococcus epidermidis with a detection rate of 32.5%–37.9%, followed by Gram-negative microorganisms identified in 34% of cases, of which Klebsiella pneumoniae was the most common with a detection rate of 16%–23.5%. Mixed Gram-positive and Gram-negative flora was identified in the remaining 20% of cases. Data analysis revealed high resistance of all pathogens to azithromycin, with S. epidermidis resistance of up to 64%. All isolated pathogens were most susceptible (up to 99%) to fourth-generation fluoroquinolones, namely to moxifloxacin.

CONCLUSION: Based on the data obtained, moxifloxacin products may be recommended for ophthalmological use as an agent of choice for the treatment of bacterial infections of the eyelids and conjunctiva.

The Editor-in-Chief’s comment on the article by Yakushenko A.R., Potemkin V.V., Astakhov S.Yu., Babaeva Sh.E., Tobilko M.A., titled “First results of tunnel lateral canthoplasty in patients with involutional lower eyelid entropion” (2026;19(1):61–68, doi: https://doi.org/10.17816/OV686371) discusses aspects of ophthalmic plastic and reconstructive surgery—specifically, the fixation of the lateral canthus. The comment provides an evaluation of the manuscript and identifies the patient subgroup for whom the described surgical technique is likely to be most effective.

Hereditary optic neuropathies are a genetically heterogeneous group of disorders leading to degeneration of retinal ganglion cells and the optic nerve. This group includes two main forms: autosomal dominant optic neuropathy and Leber hereditary optic neuropathy. The first one is caused by mutations in nuclear genes (such as OPA1). OPA1 mutations, which disrupt mitochondrial fusion, lead to their fragmentation and reduced energy production. This results in the death of retinal ganglion cells, which have high energy requirements. Their gradual death and degeneration of the optic nerve induce a gradual, symmetrical, and painless loss of vision starting in childhood (6–10 years). The incidence of the disorder is 1 in 35,000, with about 25% of patients maintaining high visual acuity. Leber hereditary optic neuropathy is a maternally inherited mitochondrial genetic disorder with a male predominance and an incidence of 1:27,000 to 1:45,000. The main cause of the disease is mitochondrial DNA mutations (m.3460G>A, m.11778G>A, and m.14484T>C), which disrupt the mitochondrial respiratory chain. The clinical presentation of this disorder is characterized by a subacute onset with rapid, painless bilateral loss of vision. There are asymptomatic, subacute (within 6 months of onset), dynamic (6–12 months), and chronic (greater than 12 months) disease stages. In recent years, recessive forms of hereditary optic neuropathy have been identified, associated with mutations in nuclear genes such as DNAJC30 and MCAT, which challenges the diagnosis. The presented article analyzes two clinical cases of autosomal dominant optic neuropathy and hereditary optic neuropathy. A comparative analysis of clinical and metabolic parameters, in particular blood lactate levels as a marker of mitochondrial dysfunction, revealed both differences and similarities between these disorders. This highlights the importance of a comprehensive approach, including a thorough clinical examination, molecular genetic testing, and assessment of the patient’s metabolic status. This comprehensive assessment is the key to early and accurate diagnosis, which enables personalized patient management and development of optimal treatment and rehabilitation strategies.

The relevance of chlamydia infection is explained by an increase in the global incidence, which is about 129 million new cases of Chlamydia trachomatis infection in patients aged 15–49 years. There is recent evidence of a significant role of this pathogen in vitreoretinal damage. Chronic infection is latent and can present with chorioretinitis and vitreous dystrophy, with a high pathogen detection rate in subretinal fluid in rhegmatogenous retinal detachment (50.8%–71.4%), which suggests that this obligate intracellular pathogen is involved in the development and maintenance of inflammation. Chlamydia infection of the posterior segment is clearly substantially challenging to confirm because of the variety of clinical forms, limited symptoms, and technical difficulties of detecting the pathogen in the eye. Therefore, new approaches are needed for reliable clinical and laboratory diagnosis of this infection, which are based on molecular biology, immunofluorescence, culture, and serological test methods. The reliability of the results is determined by the quality of obtaining biological material during vitrectomy (vitreous humor, subretinal fluid), compliance with transport and sample storage conditions, and technical equipment in laboratories. In clinical practice, a set of diagnostic methods, examination of material taken directly from the posterior segment, and interdisciplinary interaction of ophthalmologists with relative specialists are required. Resolution of this challenge will ensure adequate treatment and improve visual prognosis.

The article is dedicated to the 125th anniversary of the Department of Ophthalmology with the Clinic named after Professor Yu.S. Astakhov (part of the First Pavlov State Medical University of St. Petersburg, originally established as the Saint Petersburg Women’s Medical Institute in 1897). The article presents a brief history of the origins of the Department of Ophthalmology with the clinic, founded in 1900 by Doctor of Medicine, Privat-Docent Nikolai Ivanovich Andogsky. At that time, the ophthalmology clinic was located in one of the wards of the therapeutic department of the Petropavlovsk Hospital for the Poor, which served as the clinical base of the institute. Under such conditions, it was not possible to provide students of the institute with the practical knowledge in ophthalmology required by the curriculum. Visits to the clinic revealed its unsuitability for specialized ophthalmic departments, as well as inconvenience, overcrowding, poor sanitary conditions, and the inability to isolate postoperative patients. An urgent need for the construction of a dedicated building was evident. The establishment of a specialized ophthalmology clinic became the priority of the first Head of the Department, N.I. Andogsky, and his closest assistant, Aleksandr Ivanovich Merts—Doctor of Medicine, State Councillor, senior physician of the Saint Petersburg municipal poorhouses, and Privat-Docent of the Women’s Medical Institute. On November 24, 1907, the clinic was consecrated and opened. The three-story building, constructed in the then-fashionable brick style, was built not only with the active financial support of the Nobel family but also using the same bricks used for the construction of the Ludvig Nobel factory buildings. Despite all the challenges that the department has faced over its 125-year history—together with the institute, the city, and the country—the core traditions established at its founding and the high level of professionalism of its faculty and physicians have been preserved, and they continue to serve the cause with distinction.