Vol 18, No 3 (2025)

BACKGROUND: Blepharoptosis is the most common congenital disorder of the upper lid position manifested as drooping. Treatment of this condition is surgical. However, despite the development of many preoperative diagnostic criteria for choosing surgical strategy, to date, no single set of pre-, intra-, and postoperative diagnostic criteria has been developed to achieve sustained, intended, functional, and esthetic outcomes.

AIM: The study aimed to evaluate the effect of preoperative diagnostic criteria on selection of surgical strategy and to analyze surgical outcomes.

METHODS: The study was conducted from 2019 to 2024 and included 116 naive children diagnosed with congenital blepharoptosis. The patients were divided into two treatment groups, and different sets of diagnostic preoperative criteria for choosing surgical strategy were used in both of them. Surgical procedures included resection of the upper lid levator or superior tarsal muscle. Intraoperative diagnostic criteria were additionally applied in group 2. Postoperatively, patients were followed-up on days 1, 3, and 7 and at months 1, 3, and 6 to evaluate the surgical outcomes.

RESULTS: Undercorrection in 13 (33.33%) patients required re-intervention in group 1 (n = 39), where the diagnostic preoperative examination included 5 criteria. In the late postoperative period (over 6 months), persistent mild lagophthalmos was observed in 7 (17.95%) patients. For group 2 (n = 77), the preoperative diagnostic examination included 12 criteria, and intraoperative diagnostic criteria were also applied. A total of 16 (20.78%) patients required re-intervention, and postoperative persistent mild lagophthalmos was reported in 1 (1.3%) patient. The study demonstrated 12.55% decrease in re-interventions and 16.65% decrease in a postoperative complication of persistent lagophthalmos.

CONCLUSION: Additional criteria for preoperative examination allowed considering the anatomical and physiological characteristics of children with congenital blepharoptosis to choose surgical strategy, and intraoperative diagnostic criteria provided intended, sustained, functional, and esthetic outcomes.

BACKGROUND: Glaucoma affects 64 million people worldwide. It is the leading cause of visual disability in the Russian Federation, therefore treatment continues to present a challenge. For patients with glaucoma uncontrolled by drug or laser hypotensive therapy, drainage device implantation is the most definitive and effective surgery.

AIM: The study aimed to evaluate the hypotensive effectiveness and safety of collagen drainage device implantation during trabeculectomy to treat primary open-angle glaucoma.

METHODS: We analyzed medical records of 162 patients (162 eyes) with primary open-angle glaucoma who underwent hypotensive penetrating surgery, trabeculectomy with (group 1) and without (group 2) Xenoplast collagen drainage device implantation. The results were evaluated for up to 36 months.

RESULTS: The positive surgical effect, including absolute and relative success, was achieved in 98% of patients in group 1 at discharge, then gradually decreased and reached 73% of cases after 36 months. In group 2, the positive effect was achieved in 91% and subsequently decreased to 48% within the same follow-up period. In the early postoperative period, patients in both groups (33.8% and 40.2%) experienced complications, typical for penetrating hypotensive surgery and comparable with published data.

CONCLUSION: An analysis of the surgical outcomes indicates superiority of trabeculectomy with Xenoplast drainage device implantation.

BACKGROUND: Currently, endonasal endoscopic dacryocystorhinostomy is considered the most effective and safe surgical procedure for narrowing or obstruction of the lacrimal duct. There is now extensive clinical experience of this condition management, both diagnostic and postoperative. Nevertheless, relapses occurring in 10% of cases reduce the treatment effectiveness. They may be caused by granulomas at rhinostomy opening and intranasal synechiae. The outcome of endonasal endoscopic dacryocystorhinostomy largely depends on proper postoperative management. Today, hyperosmolar solutions are used postoperatively to improve outcomes of ocular surgery. However, there is few data on using these agents in nasolacrimal duct surgery.

AIM: The study aimed to evaluate the clinical effectiveness of hyperosmolar solutions in patients with postoperative edema of the conjunctiva and nasal mucosa after endonasal endoscopic dacryocystorhinostomy.

METHODS: The study was conducted at the Ophthalmology and Otorhinolaryngology Departments of Pavlov First Saint Petersburg State Medical University. Patients who underwent primary endonasal endoscopic dacryocystorhinostomy were enrolled. The control group received a combination medicinal product with antibacterial and anti-inflammatory effects, moisturizer, and topical nasal glucocorticosteroids for 1 month. The study group received 3% NaCl for irrigation of the conjunctival sac and a 21 g/L hypertonic saline intranasally in addition to the agents mentioned above. The effectiveness was assessed based on complaints of lacrimation and nasal breathing difficulties, biomicroscopy of the anterior segment, Norn test, endoscopy of the nasal cavity, and the results of lacrimal duct irrigation.

RESULTS: A total of 60 patients (62 eyes). Control group: 30 eyes, study group: 32 eyes were enrolled. In the study group, edema of the conjunctiva and nasal mucosa resolved by postoperative day 7. In the control group, severity of nasal cavity edema was 5% higher by day 7. By day 30, severity of nasal cavity edema was 1% and 5% in the study and control groups, respectively.

CONCLUSION: Postoperative therapy with topical hyperosmolar eye drops and nasal sprays after endonasal endoscopic dacryocystorhinostomy relieves edema of the nasal mucosa and lacrimal duct and prevents recurrent rhinostomy opening scarring.

Astrocytic hamartoma is a quite rare disease secondary to tuberous sclerosis and is challenging to identify at the initial ophthalmological examination. The article presents a case report of retinal astrocytic hamartoma secondary to tuberous sclerosis in a 42-year-old male patient. OD ophthalmoscopy revealed a space-occupying, oblong, subretinal, slightly elevated, light yellow lesion of 1.5 disc diameters, with a bumpy surface (resembling a mulberry) at 4–5 o’clock along the inferior nasal vascular arcade. In the left eye, a space-occupying, subretinal, light yellow lesion of 1.5 disc diameters resembling a mulberry was visualized along the superior vascular arcade. A subretinal, flat, gray lesion of about 1.5 disc diameters was observed along the inferior nasal arcade. Magnetic resonance imaging showed multiple lesions (tubers) of altered magnetic resonance signal intensity in the middle cranial fossa, which were typical for tuberous sclerosis. Age of onset, clinical manifestations, and location of tubers in the presented case report are quite consistent with the published data. The presented case report demonstrated challenges of determining etiology of astrocytic hamartoma diagnosed at initial ophthalmological examination.

The problem of adverse side effects affecting various organs and systems in patients receiving molecular targeted therapy for oncological diseases remains relevant. One group of such drugs are inhibitors of the MEK signaling pathway. These antineoplastic agents inhibit the mitogen-activated protein kinases MEK1 and/or MEK2 and are used, among other indications, in the treatment of cutaneous melanoma. In ophthalmology, ocular toxicity associated with MEK inhibitors has been defined as MEK retinopathy—a characteristic binocular toxic retinal lesion with multifocal foci of neuroepithelial retinal detachment resembling mercury droplets, which reduces visual acuity and often resolves spontaneously or upon discontinuation of targeted therapy. This article presents a clinical case of toxic retinopathy in a female patient receiving targeted therapy with trametinib and dabrafenib for the treatment of cutaneous melanoma. The clinical manifestations and diagnostic criteria of MEK retinopathy are described, differential diagnosis with central serous chorioretinopathy is provided, and the results of empirical therapy for this condition are presented, along with insights into its course and response to different treatment methods.

The article reviews current published data on methods to analyze retinal microvasculature images and the importance of these technologies for diagnosis of retinal conditions in patients with hypertension and atherosclerosis. Formerly popular programs (Retinal Analysis and Integrative Vessel Analysis), used to calculate central retinal artery and vein equivalents, gave way to more sophisticated software such as Singapore I Vessel Assessment and ALTAIR, which also performed geometric analysis of the vasculature (endpoints, bifurcations, branch angles, etc.) in addition to measuring diameters of retinal vessels. Not only hardware detection of the vasculature in the image becomes more complicated, but also microcirculation analysis algorithms. Russian analogs, OphtoRule and N.S. Semenova’s calculation method, showed good reproducibility, but they have a limited sample and set of study variables, including retinal vessel diameters and their ratios. Over 100,000 people have been enrolled in population-based and clinical retinal studies, thus the issue of harmonizing databases of various programs is more urgent than ever. Further evolution of automated programs for analysis of retinal vessels and assessment of the clinical significance of parameters for stratification of risk of cardiovascular events and mortality will allow using software analysis of retinal vessels for scientific researches and to improve treatment of patients with cardiovascular diseases in clinical practice.

Any surgical procedure is accompanied by a risk of infection, the most serious of which is endophthalmitis. One of the causes of this complication is inappropriate preparation of the surgical field, which is currently unregulated. There is a need for a step-by-step description of the algorithm for preparation of the surgical field for all ocular procedures, which could become a prototype of the Russian standard after discussion by the ophthalmology community. Standards ensure safety of surgical procedures and make training and control of compliance possible. Current Russian regulatory documents are contradicting. The effective Sanitary Rules and Regulations 3.3686–21 do not consider the anatomical features of the orbit and the risks of corneal and conjunctival burns caused by alcohol topical antiseptics, especially when scrubbing the eyelids. The relevant algorithm recommendations should also be included in the updated version of the effective Sanitary Rules and Regulations 3.3686–21 to standardize approaches to prepare the surgical field and reduce the incidence of postoperative complications. The article presents an algorithm prepared by a multidisciplinary team of clinic specialists. The procedure stages were determined, antiseptics available on the Russian market and complying with Sanitary Rules and Regulations 3.3686–21 were chosen, formulations and concentrations of solutions, exposure, and application technique were determined based on available worldwide published data.