Ophthalmology Reports

BACKGROUND: Despite the proven effectiveness of intravitreal administration of medications that inhibit vascular endothelial growth factor, the mechanisms through which these agents affect choroidal microcirculation, particularly the perfusion characteristics of the choriocapillaris in the early period after treatment initiation, require further investigation. This study was undertaken to provide a detailed description of the temporal dynamics of choriocapillaris perfusion using a high-frequency monitoring protocol based on optical coherence tomography angiography and an improved image-analysis method aimed at minimizing visualization artifacts.

AIM: To perform a quantitative topographical analysis of changes in choriocapillaris perfusion following antiangiogenic therapy with aflibercept in patients with neovascular age-related macular degeneration.

METHODS: A prospective, single-center cohort study involved patients with newly diagnosed active type 1 macular neovascularization, who were treatment-naïve, including antiangiogenic therapy–naïve ones. Exclusion criteria were type 2 or 3 macular neovascularization; moderate-to-high myopia or hyperopia; significant ocular media opacities; concomitant systemic or ocular conditions associated with shadowing artifacts; and retinal pigment epithelium detachment height > 250 µm. All participants received three intravitreal injections of aflibercept (2.0 mg) at monthly intervals. Choriocapillaris perfusion changes were assessed using a high-frequency monitoring protocol with biweekly examinations over 12 weeks. We applied an enhanced choriocapillaris image-analysis method that reduced projection artifacts and compensated for signal attenuation. Statistical analysis included repeated-measures analysis of variance and paired t-tests.

RESULTS: The mean patient age was 70.8 ± 7.1 years; women accounted for 63.0%. All 29 participants completed follow-up. By week 12, a significant reduction in the FD% was observed in all regions (ANOVA: p < 0.001; paired comparisons between baseline and week 12: p < 0.001); the mean relative reduction was 9.8%, with the largest changes in peripheral zones R3–R5. No treatment-related adverse events were recorded.

CONCLUSION: High-frequency monitoring using an enhanced optical coherence tomography angiography protocol confirmed a significant improvement in choriocapillaris perfusion surrounding the macular neovascularization and the associated "dark halo" in patients with neovascular age-related macular degeneration treated with aflibercept. These findings improve the understanding of the microcirculatory effects of antiangiogenic therapy and support the potential value of this approach for treatment response assessment in routine clinical practice.

BACKGROUND: Effective ocular prosthetics is a crucial factor in the successful rehabilitation of patients with anophthalmos.

AIM: To develop an original concept of ocular prosthetics based on an in-depth analysis of the state of the anophthalmic conjunctival cavity and eyelids.

METHODS: A prospective observational study was conducted. The study included patients with unilateral anophthalmos after ocular trauma, inflammatory diseases, absolute painful glaucoma, with an orbital polytetrafluoroethylene implant, an intact anophthalmic socket, and sufficient conjunctival fornix depth to retain the ocular prosthesis. Examination methods included medical history taking, assessment of the anophthalmic socket (ocular fissure dimensions, conjunctival fornix depth, supporting-motor stump parameters, and ocular prosthesis position), as well as recording the time from surgery to the first prosthetic fitting. We placed a conformer, a standard, or an individual plastic ocular prosthesis.

RESULTS: The study included 80 patients aged 20–55 years after enucleation or evisceration. At 12 months after surgery, the best cosmetic results were obtained in the subgroups with individual ocular prosthetics (1B and 2B), as evidenced by less ocular fissure asymmetry, less prosthesis enophthalmos, and greater mobility compared with the combined prosthetics subgroups (1A and 2A). The total mobility of the ocular prosthesis reached 146 ± 2.50° in subgroup 2B compared with 124.8 ± 2.43° in subgroup 2A; in subgroup 1B, it was 115.65 ± 2.91° compared with 96.27 ± 3.26° in subgroup 1A. It was found that subsequent individual prosthetics at 6 and 12 months could not fully compensate for the deficiencies in anophthalmic socket formation that arose from the initial use of a standard prosthesis. The depth of the prosthesis relative to the fellow eye, its position in the frontal plane, and the mobility of the supporting-motor stump were significantly higher in subgroups 1B and 2B with individual prosthetics, which took into account all features of the conjunctival cavity and eyelids.

CONCLUSION: An original concept of ocular prosthetics was developed, including the following key components: surgical technique, evidence-based selection of orbital implant shape and volume, application of a pressure dressing to the surgical area for at least 4 days after surgery, early placement of an individual ocular conformer, and step-by-step fabrication of an individual ocular prosthesis. Comprehensive implementation of these measures is aimed at creating optimal conditions for the formation of the anophthalmic socket and achieving high functional and aesthetic results of ocular prosthetics.

BACKGROUND: Among infectious diseases of the cornea, fungal keratitis is characterized by a particularly severe and treatment-resistant course. Since the 1950s, and especially in recent decades, an increase in the number of cases has been observed. In contrast to bacterial and viral keratitis, for which specific topical agents are available, the management of fungal keratitis is complicated by the limited availability of approved topical antifungal agents in most countries, including Russia. Consequently, ophthalmologists are frequently required to use antifungal medications off-label, which is associated with limitations and is often accompanied by insufficient therapeutic efficacy. Furthermore, in this context, timely identification of fungal keratitis and rational selection of topical antifungal therapy are critically important.

AIM: To compare the efficacy of different topical antifungal agents in the treatment of fungal keratitis under experimental conditions.

METHODS: An experimental study was conducted in Chinchilla rabbits using a stromal fungal keratitis model induced by Fusarium solani. Treatment efficacy was assessed based on a combination of clinical (biomicroscopy), instrumental (optical coherence tomography), and morphological (histological) criteria. Animals were divided into four treatment groups: 1% voriconazole; 0.2% chlorhexidine bigluconate solution; 0.15% amphotericin B; and combination therapy with 1% voriconazole and 0.02% chlorhexidine bigluconate solution.

RESULTS: The most pronounced restoration of physiological stromal architecture, as assessed by optical coherence tomography and histological examination, was observed in group 4. Combination therapy with 1% voriconazole and 0.02% chlorhexidine bigluconate solution was accompanied by an optical coherence tomography pattern closest to physiological, as well as more pronounced restoration of the corneal epithelial layers and reduced stromal infiltration. Monotherapy with amphotericin B or chlorhexidine bigluconate at higher concentrations demonstrated significantly lower efficacy.

CONCLUSION: Combination therapy with 1% voriconazole and 0.02% chlorhexidine bigluconate in an experimental model of fungal keratitis demonstrated the greatest efficacy in restoring corneal structure and reducing signs of infectious inflammation, which suggests that this regimen is promising for use in clinical practice.

The article presents a case of successful visual rehabilitation of a 6-year-old child after a penetrating corneal injury. Primary surgical treatment was performed at the local hospital: the corneal wound was sutured and aspiration of the native lens was performed simultaneously due to damage to the anterior capsule. Upon admission to our clinic, based on clinical data and instrumental examination results, the child was diagnosed with membranous cataract, traumatic iris coloboma, and corneal scar of the right eye. The patient underwent anterior segment reconstruction, including removal of the fibrous pupillary membrane, implantation of a posterior chamber intraocular lens into the native capsular bag, and iris plasty for the traumatic coloboma with pupil formation. At the first stage, after preliminary conjunctival dissection in the upper quadrant, a 3.0-mm corneoscleral tunnel incision was made. A 1.0-mm corneal paracentesis was performed at the 3 o’clock position. Through the paracentesis, anterior synechiae were separated from the corneal scar zone using a blunt spatula, after which the anterior lens capsule was opened with a 30G injection needle. These steps were performed without damaging the posterior capsule, which allowed implantation of a posterior chamber intraocular lens (AcrySof IQ Natural) into the capsular bag. At the final stage of the surgery, pupil formation was performed with a 10-0 nylon suture. In the postoperative period, the patient received topical antibacterial and anti-inflammatory therapy. On the first day after surgery, uncorrected visual acuity in the right eye was 0.1. The anterior segment was nearly quiet, with single folds of the Descemet membrane in the optical zone. The anterior chamber was deep and uniform, with a 0–I degree Tyndall phenomenon; the intraocular lens was centered. The fundus reflex was pink. Ophthalmoscopy revealed no pathology of the fundus structures. At 1 month, uncorrected visual acuity in the right eye reached 0.6. The anterior segment was quiet; the optical center of the cornea was clear, and the corneal scar was competent. The anterior chamber was deep and uniform, and the intraocular lens was centered. The treatment achieved high visual function in the postoperative period and complete visual rehabilitation of the patient after severe ocular trauma.

Diabetic retinopathy, including its complication diabetic macular edema, is considered a socially significant disease of our time. The pathogenesis of these conditions is complex and remains the subject of investigation. There are two forms of diabetic macular edema — intracellular and extracellular. Diabetic intracellular edema develops as a result of intracellular accumulation of sorbitol, lactate, and phosphates, caused by metabolic disturbances in hyperglycemia. Extracellular edema is associated primarily with damage to the blood–retinal barrier, which is accompanied by increased fluid inflow into the tissue and decreased clearance as diabetes progresses. The loss of the protective function of the inner blood–retinal barrier occurs mainly due to damage to the cells and intercellular junctions comprising it. The outer blood–retinal barrier is affected by damage to the external limiting membrane. Currently, the gold standard for the treatment of diabetic macular edema is the use of angiogenesis inhibitors. At the same time, with the development of vitreoretinal surgery, the effect of this method on diabetic macular edema is being actively studied. In addition, new vitreoretinal surgical techniques are being proposed to correct it. However, the results of surgical treatment vary according to different authors. The preservation of the ellipsoid zone and the external limiting membrane are considered as predictors of its effectiveness.

Neurotrophic keratopathy is a rare degenerative corneal disease caused by impaired corneal innervation and characterized by reduced corneal sensitivity and trophic changes that may lead to the development and persistence of corneal defects. The diversity of etiological factors, the absence of pronounced corneal syndrome, and the similarity of early manifestations to other ocular surface disorders frequently result in delayed diagnosis and complicate treatment selection. Therefore, a comprehensive approach to the examination of patients with neurotrophic keratopathy remains highly relevant, as it allows objective assessment of disease severity and monitoring of pathological changes during treatment. Report the case of a 69-year-old woman with a persistent postherpetic corneal erosion of the right eye lasting for four months and refractory to conservative treatment. The patient complained of decreased vision and a foreign body sensation. Best-corrected visual acuity was 0.08. Slit-lamp examination revealed an epithelial defect involving 7.6% of the corneal surface, accompanied by perifocal and stromal edema. Corneal sensitivity was absent at all nine examined points. Anterior segment optical coherence tomography demonstrated a minimum corneal thickness of 609 μm. In vivo confocal microscopy revealed marked depletion of the subbasal nerve plexus, with a corneal nerve fiber density of 4 fibers/mm², a corneal nerve branch density of 3 branches/mm², and a corneal nerve fiber length of 662 mm/mm². An extended diagnostic algorithm incorporating clinical, functional, and instrumental examinations was used for comprehensive assessment of the ocular surface and subsequent follow-up. Following sublimbal orbital fat transposition (S-LOFT), involving transposition of the inferomedial orbital fat pad beneath a scleral flap to the limbal area, complete corneal epithelialization was achieved, with no recurrence of epithelial defects during the 12-month follow-up post-S-LOFT period. This clinical case demonstrates the practical value of an extended diagnostic algorithm for patients with neurotrophic keratopathy. Comprehensive evaluation of the ocular surface enables timely diagnosis, objective assessment of pathological changes, rational selection of treatment strategy, and monitoring of therapeutic outcomes.