Vol 14, No 1 (2021)

AIM: The clinical evaluation of zonules condition in patients with age-related cataracts without weak zonular support signs against the background of connective tissue somatic involutional changes.

MATERIALS AND METHODS: The main group consisted of 70 patients (70 eyes) with connective tissue involutional somatic pathology without concomitant eye pathology, eye injuries, and decompensated systemic diseases; the control group included 60 people (60 eyes) with age-related cataracts without connective tissue involutional pathology. Using ocular echography (Aviso S, Quantel Medical, France) with high resolution (50 MHz) sensor, we estimated the “ciliary processes to lens equator” distance symmetry in 2 main meridians (of 6 and 12 hours). Its equal value in 2 opposite meridians or difference less than 0.3 mm between them was considered as the sign of symmetry; the difference of 0.3 mm and more was a sign of asymmetry.

RESULTS: The presence of “ciliary processes to lens equator” distance asymmetry between the meridians was revealed in 28 eyes in the main group (40%); in 14 of the eyes with asymmetry ranging from 0.4 and more, a 1^st degree lens subluxation was revealed intraoperatively.

CONCLUSIONS: The presence of “ciliary processes to lens equator” distance asymmetry indicates subclinical involutional changes in the lens’ ligament apparatus, which has a prognostic value for choosing a model of an intraocular lens to be implanted.

The issues of endpoints selection for regulatory requirements and real-world clinical practice using the example of anti-VEGF therapy in neovascular age-related macular degeneration (nAMD) are discussed in the article. New technologies (optical coherent tomography) introduction are shown to change clinical practice but not regulatory requirements on the endpoints. In the same time for regulatory purpose clinical trials design is changed from superiority to non-inferiority. The changes in the approach to primary endpoint selection are not anticipated due to regulator’s conservatism but there is a requirement to the comparison with best treatment alternative (i.e. same class comparator in case of anti-VEGF therapy) due to ethical reasons. To satisfy real-world clinicians need, the secondary endpoints are analyzed, but multiple testing problem appears. Statistical methods developed in recent years allow using specified comparison to be made without inflating Type I error. HAWK and HARRIER clinical trials demonstrated an example how superiority of brolucizumab over aflibercet on anatomical endpoints was reliably found.

AIM: To evaluate the results of the effectiveness of cryogenic scleroplasty.

MATERIALS AND METHODS: 184 children (313 eyes) (mean age 11,72 ± 3,76 years) with moderate and high progressive myopia were examined before and after cryogenic scleroplasty (main group) and Pivovarov’s scleroplasty (control group).

RESULTS: A smaller average annual difference in the spherical equivalent of refraction (∆SE_av) and the average annual gradient of the axial length (∆AL_av) were recorded in the group of patients after cryogenic scleroplasty according to the data obtained during the two-year follow-up. ∆SE_av was –0,48 ± 0,45 diopters in the main group and –0,51 ± 0,34 diopters in the control group in children of the younger age subgroup (up to 9 years old); –0,35 ± 0,31 diopters in the main group and –0,69 ± 0,61 diopters in the control group (p = 0,047) in the older age subgroup (9 years and older). ∆AL_av in the main group was 0,15 ± 0,11 mm in children under 9 years of age, 0,31 ± 0,14 mm (p = 0,016) in the control group; 0,29 ± 0,18 mm and 0,34 ± 0,32 mm in children 9 years old and older, respectively.

CONCLUSIONS: The proposed technology of cryogenic scleroplasty has two surgical approaches in the lower-internal and upper-external parts of the eyeball; the scleroplastic material adheres evenly to the sclera, covers all four quadrants of the eyeball; it is fixed under the rectus muscles of the eye; at a 24-months follow-up period showed a good stabilizing effect.

AIM: Report cases of choroidal neovascularization (CNV) in children and describe structural and hemodynamic changes in retina associated with this pathology detected by Optical Coherence Tomography (OCT) and OCT-angiography (OCTA).

MATERIALS AND METHODS: 6 children (4 girls, 2 boys) aged from 7 to 17 years with CNV associated with pathological myopia, post-traumatic choroid rupture and optic disc abnormalities were examined. The activity of neovascular complexes was evaluated by ophthalmoscopy, OCT, and OCTA. The maximum follow-up period was 4 years.

RESULTS: 7 cases of CNV were detected. One child had a two-way process. Myopic and posttraumatic membranes were localized sub- and juxtafoveally and were the membranes of type 2. In children with optic disc anomalies of the 1 type membrane and mixed (1^st and 2^nd) type was located extrafoveally. The decrease in visual acuity was determined by the localization of membranes, the severity of edema, and the severity of dystrophic changes in the retina. On OCT, subretinal fluid and hyperreflective material corresponding to hemorrhages were visualized in the projection of active membranes. OCTA revealed a network of small capillaries with a large number of loops and anastomoses. Intravitreal angiogenesis inhibitors injections were performed in 5 cases. A persistent effect after a single injection was observed in 2 cases. The return of membrane activity in 3 cases allowed us to justify the repeated administration of angiogenesis inhibitors. Along with a decrease in the activity of CNV, progressive dystrophic changes in the pigment epithelium around the membrane were detected.

CONCLUSIONS: High sensitivity of OCT was demonstrated for early detection of structural and hemodynamic retinal disorders, determining the activity of neovascular complexes, predicting outcomes of the disease, and evaluating the effectiveness of therapeutic measures. The progression of dystrophic changes in the retinal pigment epithelium in response to therapy with angiogenesis inhibitors requires long-term monitoring of children and determining the optimal strategy for treating CNV in children.

This review presents data on the use of the method of ultrasonic biomicroscopy (UBM) of the anterior segment of the eye in ophthalmological practice in adults and children. Ultrasound biomicroscopy (UBM) is a contact non-invasive method for visualizing structures of the anterior segment of the eye using high-frequency ultrasound in the range from 35 to 100 MHz. Literature data indicate that UBM can be used to visualize almost all structures of the anterior segment, including the cornea, iridocorneal angle, anterior chamber, iris, ciliary body and lens, as well as the peripheral parts of the retina, vasculature and vitreous. There is data on the use of this method in the study of pathogenetic aspects of glaucoma, pseudoecfoliative syndrome, various types of cataracts, post-traumatic injuries of the anterior segment of the eye, meimobium gland dysfunction and other ophthalmopathologies. The use of UBM in children, due to the peculiarities of its implementation, is not widespread, but due to the specificity of the data obtained using it, it is promising. The limited information about the use of UBM in retinopathy of prematurity and the diagnostic capabilities of the method makes its use especially relevant in this severe retinal disease of premature newborns.

The article presents an analytical review of works devoted to molecular and genetic studies in primary open-angle glaucoma from the perspective of the concept of hereditary inferiority of the connective tissue of the eye (“scleral component”), and the entire body as a whole, as triggers in the development of the disease. The relationship between the main theories of the pathogenesis of glaucoma optical neuropathy and the determining role of molecular and genetic mechanisms of specific changes in the eye tissue is shown. The clinical features of primary open-angle glaucoma in patients with a family history are analyzed. Potentially new directions for preclinical diagnosis of glaucoma and pathogenetically oriented therapy are proposed.

Article is dedicated to the 100^th birth anniversary of the Hero of Socialist Labor, Honored worker of science of RSFSR professor V.V. Volkov. Authors described his life, scientific and pedagogic activity.