Vol 17, No 2 (2024)

BACKGROUND: The new coronavirus infection (COVID-19) gained the pandemic status in 2020, and despite the fact that since then the virus has become less pathogenic, its virulence has increased by 2023. Well-vascularized organs and tissues, including the retina, represent the target for coronavirus. The etiopathogenesis of COVID-associated retinopathy, first described in 2021, still remains poorly understood, and its forms and occurrence frequency during different periods of the infectious process vary greatly.

AIM: To identify the main characteristics of the COVID-associated retinopathy in patients with moderate and severe COVID-19 course during the acute period of the disease.

MATERIALS AND METHODS: The study, conducted in 2021 (group 1) and 2023 (group 2), included patients with confirmed COVID-19 of moderate to severe course during the first 7 days from the onset of symptoms. Group 1 included 46 people, mean age 65.5 years, and group 2 included 55 people, mean age 69.3 years. The ophthalmologic examination was carried out in the “red zone” and intensive care unit, and included examination of the anterior segment of the eye, indirect ophthalmoscopy, and fundus photography using a portable hand-held digital fundus camera (Smartscope M5, Optomed, Finland). Hypertension, diabetes mellitus, volume of lung damage, invasive mechanical ventilation, and anticoagulant therapy were considered as conditions affecting retinal microcirculation.

RESULTS: The observation groups were homogeneous in terms of gender, age, and concomitant diseases. The incidence of ophthalmoscopic findings in group 1 was 17.3%, and in group 2 — 12.7%. Most often, during the first 7 days of the disease, signs of angiopathy were observed: dilatation of blood vessels, irregularity of their diameter and tortuosity. Among focal changes, there were multiple retinal hemorrhages (6.5% and 3.6%) and cotton wool spots (4.3% and 5.4%). In patients with fundus changes, diabetes mellitus was significantly less common (in group 1, 25% vs. 39%, p < 0.001; in group 2, 28% vs. 44%, p < 0.001), as well as arterial hypertension (in group 1, 55% vs. 66%, p = 0.003; in group 2 28% vs. 83%, p < 0.001). In group 1, there was a higher proportion of patients treated in intensive care unit, as in group 2 (37% vs. 17%, p < 0.001), but in group 2, patients with identified retinal changes were more likely to receive therapeutic doses of anticoagulants (33% vs. 12%, p < 0.001).

CONCLUSION: The main characteristics of COVID-associated retinopathy in patients with moderate to severe COVID-19 during the acute period of the disease are dilatation and pathological tortuosity of the retinal arteries and veins, intraretinal hemorrhages and cotton wool spots. The connection between COVID-associated retinopathy and concomitant to the infectious process cardiovascular conditions has not been established. Retinopathy associated with coronavirus infection, with absolute similarity of clinical manifestations, was significantly more common in 2021 than in 2023.

BACKGROUND: The uveitis–glaucoma–hyphema (UGH) syndrome was first described in 1978 as a complication of anterior chamber polymethyl methacrylate intraocular lenses implantation. Introduction into practice of foldable intraocular lenses with intracapsular fixation has reduced the incidence of UGH. However, this complication still occurs today, especially with extracapsular intraocular lens fixation.

AIM: The aim of this study is to describe “uveitis–glaucoma–hyphema” syndrome pathogenesis, clinical features, and diagnosis.

MATERIAL AND METHODS: A retrospective analysis of medical data for 2017–2021 identified 100 patients (101 eyes) diagnosed with UGH syndrome, they made up the study group. Complaints, medical history, biomicroscopy, visual acuity and intraocular pressure were assessed. 37 patients underwent anterior segment ultrasound biomicroscopy using the Accutome UBM Plus (USA).

RESULTS: The occurrence of UGH syndrome is at least 0.19%. The leading UGH syndrome risk factor was intraocular lens material. In 49% of cases these were AcrySof hydrophobic intraocular lenses. The second UGH risk factor was extracapsular (mixed and sulcus) intraocular lens fixation, occurring, according to ultrasound biomicroscopy, in 54 and 19% of cases, respectively. The most significant diagnostic UGH sign was hyphema (93%). Ocular hypertension was detected in 66%, and uveitis in 57% of cases.

CONCLUSIONS: The main UGH syndrome manifestations are hyphema and iris transillumination after phacoemulsification complicated by posterior capsule rupture with extracapsular hydrophobic intraocular lens fixation. The most informative instrumental method to assess intraocular lens position is ultrasound biomicroscopy.

BACKGROUND: One of the socially significant ophthalmic diseases is the dry form of the age-related macular degeneration, the key feature of which consists in a slowly progressing damage to the pigment epithelium and the formation of drusen. However, the basic mechanisms of pathogenesis are still not completely clear nowadays.

AIM: The aim is, using the data of OCT, OCT-angiography and visometry, to study the dynamics of structural and functional parameters of the macular area, as well as the dynamics of rheological and biochemical blood parameters in patients with an intermediate stage of the dry form of age-related macular degeneration before and after the use of serum cascade filtration.

MATERIALS AND METHODS: The study included 63 patients (94 eyes) with an intermediate stage of the dry form of age-related macular degeneration. Patients were randomly separated into two groups. The first (main) group consisted of 34 patients (52 eyes), in whom serum cascade filtration was performed; the second group (control) group included 29 patients (42 eyes) who did not receive any specific treatment. In patients of the main group, before and after the serum cascade filtration course (1 month after the start of follow-up), in 6 and 12 months, in addition to standard ophthalmological examination, as an indicator of the efficacy of performed serum cascade filtration, the ultrasound triplex scanning in color Doppler mapping mode with an assessment of blood flow velocity in the posterior short ciliary arteries, Fourier IR spectroscopy, and the testing of the serum and blood viscosity were performed. Patients in the control group also underwent a similar examination at 1, 6, 12 months after the start of follow-up.

RESULTS: According to optical coherence tomography, optical coherence tomography-angiography and visometry data, we found a positive dynamics of structural and functional parameters of the macular retina and an improvement in blood rheological parameters with an increase in microcirculation indices against the background of the serum cascade filtration use in treatment of patients with an intermediate stage of the dry form of age-related macular degeneration. At the same time, a statistically significant difference between the two groups begins at 1 month and persists for 12 months of follow-up, being an evidence of the stabilization of the pathological process.

CONCLUSIONS: This study showed that after the serum cascade filtration in patients with an intermediate stage of the dry form of age-related macular degeneration, against the background of an improvement in blood rheological and biochemical parameters, there was an improvement in structural and functional parameters of the macular area, which consisted in a decrease of the volume of the drusenoid retinal pigment epithelium detachment and in a visual acuity amelioration.

BACKGROUND: An increase was noted in the number of gunshot eyeball injuries, which are accompanied by low functional outcomes. Reproduction and experimental study of this type of eye injury would help improving the functional and cosmetic treatment results in patients.

AIM: The aim of the study is to investigate gunshot open globe injury type B (penetrating wound without intraocular foreign body) on a standardized experimental model.

MATERIALS AND METHODS: A complete investigation of the standardized model of gunshot open globe injury type B (penetrating wound without intraocular foreign body) simulated on the ballistic test facility was carried out. The experiment was accomplished at the ophthalmology chair on 36 rabbits (71 eyes). The injury was inflicted in the projection of the ciliary body — zone II (Birmingham Eye Trauma Terminology). The examination in the control period included ophthalmologic (ophthalmoscopy, full field electroretinography, optical coherence tomography), biochemical (testing of vitreous fibronectin level), histological and radiological (magnetic resonance imaging, ultrasound examination) methods. Statistical non-parametric methods of data analysis were used.

RESULTS: The analysis of gunshot open globe injury type B model demonstrated the rate and multiple foci of abnormalities practically of all eyeball structures.

CONCLUSIONS: For the first time ever, the characteristics of gunshot open globe injury type B model were studied using a new complex of methods, their high reproducibility (91.5–100%) was demonstrated. Based on recorded abnormalities in all ocular structures, including proliferative vitreoretinopathy, the multifocal character of damage in this type of injury is validated.

The prognosis for the life of patients with genetic pathology depends on the interaction between specialists from different areas of medicine for timely detection and selection of treatment tactics. Pseudoxanthoma elasticum (Grenblad–Strandberg syndrome) is a hereditary disease in which elastic fibers of the skin, the cardiovascular system and the retina are affected. Clinical manifestations: skin changes in Grenblad–Strandberg syndrome are represented by flat xanthomatous nodules of yellowish color. Cardiovascular manifestations of pseudoxanthoma elasticum are angina pectoris, decreased pulse amplitude, cardiomyopathy, sudden heart failure, often leading to death. Eye disorders occur in stages. For the early stages, the appearance of angioid streaks is typical, which appear as a result of calcification of elastic fibers of capillaries. The progression of the process leads to neovascularization and hemorrhages from the choriocapillaries, the formation of a subretinal neovascular membrane of foveolar localization, causing a decrease in vision. The late stages are characterized by scarring. Therapy depends on the stage and rate of progression of the disease and is effective at stages I–II (according to Vivaldi). Own clinical observation: Male patient, 71 years old, referred for cataract surgery with the diagnosis “Both eyes: Senile cataract, open-angle glaucoma, (stage I a, under beta-blocker therapy), Grenblad–Strandberg syndrome”. Attention is drawn to the long observation period — 34 years, with documented data from the first examinations in 1989 and all subsequent ones. Of particular interest is the availability of preserved patient documentation for all years of follow-up, including diagnosis and treatment.

Inflammatory diseases of the uvea demonstrate a high incidence and a significant prevalence among people of working age. Uveitis complications often lead to blindness and low vision in patients of various age groups. Diagnostics and monitoring the efficacy of uveitis therapy requires the use of quantitative criteria to assess the degree of inflammatory reaction. The aim of this review is to analyze the informative value and accuracy of various clinical methods for subjective and objective assessment of the inflammatory reaction in the anterior and posterior segments of the eye in uveitis. To assess the inflammatory reaction in uveitis in everyday clinical practice, biomicroscopy is most often used, which is characterized by subjectivity associated with the level of qualification of the ophthalmologist. Other clinical methods, such as fluorescein angiography, optical coherence tomography-angiography, have high sensitivity and informative value along with independence from the subjective impression of the examiner. However, the first of them is invasive, and the second is still not available to a wide range of practicing ophthalmologists today, especially in the “angio” mode. Laser flare photometry is of special importance in the diagnosis of uveitis. It is both a non-invasive and sensitive method that makes it possible to obtain quantitative indicators characterizing the activity of uveal inflammation. The prospects for the application and development of this method are important both for clinical practice and for research purposes.