Vol 14, No 2 (2021)

PURPOSE: To measure lamina cribrosa thickness (LCT) and lamina cribrosa depth (LCD), optic nerve subarachnoid space width (ONSASW) in patients with normal tension glaucoma and in healthy individuals and to compare these data with the results of our own pilot study.

MATERIALS AND METHODS: The 1st group included 13 patients (22 eyes) with normal tension glaucoma aged 39 to 88 years (59.8 ± 10.9 years). The 2nd (control) group included 10 healthy people (20 eyes) aged 40 to 59 years (47.9 ± 5.5 years). All subjects underwent structural and functional assessment of the optic nerve head using optical coherent tomograph (OCT) RTVue-100 (Optovue, USA), Humphrey perimeter (HFA II 745i, Germany-USA), and our own modification of Frequency Doubling Technology perimetry. LCT and LCD were measured by OCT RS-3000 Advance (Nidek, Japan). To measure ONSASW we used a cross-sectional image of the optic nerve taken with Magnetic Resonance Imaging (GE Optima MR450w MRI, USA).

RESULTS: Differences in the 1st and 2nd groups between the mean values of LCT (234.14 ± 27.73 and 336.25 ± 21.0 μm, respectively; p = 0.0000), LCD (461.8 ± 101.7 and 361.65 ± 58.2 μm, respectively; p = 0.0004) and ONSASW (1.371 ± 0.035 and 1.52 ± 0.133 mm, respectively; p = 0.011) were statistically significant.

CONCLUSION: Patients with normal tension glaucoma had significantly higher LCD value with significantly lower LCT and ONSASW values compared to healthy individuals, which is comparable with the results of our pilot study, and confirms the importance of these morphometric criteria in normal tension glaucoma diagnosis verification.

AIM: to evaluate the effectiveness of the platelet-rich plasma lysate (PRP lysate) use in the treatment of persistent epithelial defects (PED) after keratoplasty.

MATERIALS AND METHODS: In the study, 60 patients with PED after keratoplasty were included. The 1st group (24 cases) included patients after keratoplasty with “low risk” of rejection, and the 2nd group – 36 cases after keratoplasty with “high risk” of rejection. Each group was divided into two subgroups – control subgroups 1a (cases 10) and 2a (cases 16), where patients received only standard postoperative therapy, and the main subgroups 1b (cases 14) and 2b (cases 20), in which PRP lysate was prescribed against the background of standard therapy, starting from the Day 15 post-op. As the criterion for effective treatment, complete persistent epithelialization after keratoplasty was considered.

RESULTS: The effectiveness of the use of PRP lysate in the subgroup 1b was 85.7%, while complete epithelialization in the control subgroup 1a was recorded in 70%; in the subgroup 2b, complete epithelialization was observed in 55%, in the control subgroup 2a – in 43.75%.

CONCLUSION: The use of PRP lysate in the treatment of PED after corneal transplantation as an adjuvant therapy is effective and safe in both high and low risk keratoplasty. In the examined category of patients, treatment with blood derivatives increases the frequency and rate of complete epithelialization.

BACKGROUND: Particular difficulties in treatment of children with monolateral strabismus are associated with the presence of severe amblyopia in the squinting eye in combination with a visual fixation defect (acentral or intermittent).

AIM: To assess the anatomical and functional status of children with visual fixation defects, to find out the causes of failures in treatment of this group of patients, to determine the tactics of their management.

MATERIALS AND METHODS: The study included 92 children of preschool age (from 3 to 7 years) with monolateral concomitant strabismus. The follow-up period for the children ranged from 12 to 72 months. The average age of the examined children was 4.6 ± 1.1 years. Three variants of visual fixation were identified in the squinting eye: central visual fixation (CVF) – 68 eyes; intermittent visual fixation (IVF ) – 7 eyes; and acentral visual fixation (AVF) – 17 eyes. All patients underwent a comprehensive examination: visometry; strabometry; autorefractometry; determination of the critical frequency of light flashes; assessment of visual fixation; optical coherence tomography of the retina. All children underwent “passive” and active pleoptics.

RESULTS: The visual acuity of children with CVF significantly increased due to pleoptics. At the same time in cases of IVF and even more in those of AVF, visual acuity remained significantly lower than that of the “fixating” eye, pleoptics were ineffective in this group of patients. In patients with CVF, the critical frequency of light flashes of the squinting eye increased in statistically significant figures, while in IVF and AVF, the difference between squinting and fixing eye remained. According to OCT data, changes in the macular area were detected in 18 (75%) eyes in patients with IVF and AVF, which allows us to distinguish organic pathology from amblyopia.

CONCLUSIONS: In children with monolateral strabismus, it is necessary to determine visual fixation of the squinting eye. At IVF and AVF, it is mandatory to conduct optical coherence tomography of the macular area to exclude organic pathology. In patients with monolateral concomitant strabismus with IVF and AVF, surgery on oculomotor muscles is indicated.

AIM: to carry out a clinical and statistical analysis of patients’ references at the third stage of ophthalmic care in Azerbaijan Republic conditions.

MATERIALS AND METHODS: Materials of the National Ophthalmology Center named after the Academician Zarifa Aliyeva are used. All the cases of primary references during 2019 are analyzed.

RESULTS: The lowest proportion of unjustified references was among residents of republican subordination cities (1.3 ± 0.1%), where the frequency of primary visits is low as well (1.28 ± 0.04‰). The rate of unjustified references of regional centre city residents – (4.8 ± 0.1%), and of those of rural settlements (10.7 ± 0.1%) were significantly different. There were significant differences concerning the rate of primary visits (2.32 ± 0.026 and 2.56 ± 0.024‰). The rate of primary visits between male and female populations also was significantly different (2.58 ± 0.024 and 3.02 ± 0.021‰, р < 0.01).

CONCLUSION: The rate of primary references at the third stage was 4.62 ± 0.04‰ in Baku, 2.56 ± 0.024‰ – in rural settlements, 2.32 ± 0.031‰ – in regional centre cities, and 1.28 ± 0.04‰ – in republican subordination cities; it had significant gender specificities. Within primary visit causes, accommodation and refraction disorders (32.3 ± 0.5%), ocular trauma and that of eye adnexa (19.7 ± 0.4%) prevail.

Currently, intravitreal injections are firmly in the lead as a drug delivery method for treatment of a wide range of eye diseases. With the accumulation of clinical material, knowledge about the complications and side effects of this technique is expanding. One of the undesirable phenomena that has been actively studied recently is the ingress of silicone oil droplets from single-use syringes and needles used to perform the procedure into the vitreous cavity of patients’ eyes. The analysis of the results of original studies on this issue is carried out, and the currently available practical recommendations aimed at reducing the risk of this complication are presented. The article is illustrated with original clinical examples. It can be concluded that the penetration of silicone oil into the eye cavity during intravitreal injections is an urgent problem of modern ophthalmology that requires further investigation and solution.

AIM: To assess the effect of Stelfrin supra (phenylephrine 2.5%) on the condition of accommodation, refraction and evaluate subjective comfort in instillation and adolescents with various refractive disorders.

MATERIALS AND METHODS: Examined 45 people with mild emmetropia and hyperopia with symptoms of habitual excess tension of accommodation (15 people), with mild myopia (15 people), with moderate myopia (15 people) at the age of 7 to 16 years. Visometry, autorefractometry, assessment of the volume of absolute accommodation (positive and negative parts), subjective assessment of asthenopic complaints according to the OSDI scale were carried out before and 1 month after daily instillations of Stelfrin supra (phenylephrine 2.5%).

RESULTS: After 1 month of instillation of the Stelfrin supra, the manifestations of accommodative asthenopia in the vast majority of patients in the study groups decreased, the habitual tonus of accommodation decreased, the volume of absolute accommodation increased, most significantly – its negative part. The uncorrected visual acuity increased by 31% in patients of group 1 with emmetropia and mild hyperopia with habitually – excessive tension of accommodation. The uncorrected visual acuity increased by 23% in patients of group 2 with mild myopia. An increase in the margin of relative accommodation was noted in patients of groups 1 and 2. Instillation of the drug was not accompanied by severe discomfort in the vast majority of patients.

CONCLUSIONS: Stelfrin supra has shown its effectiveness in accommodating and refractive disorders in childhood and can be recommended in the treatment of children with accommodation disorders, asthenopia and mild to moderate myopia.

THE AIM was to evaluate clinical efficacy of aflibercept treatment in patients with ranibizumab-resistant neovascular age-related macular degeneration.

MATERIALS AND METHODS. 13 patients (13 eyes) after intravitreal ranibizumab therapy for 1 year (from 6 to 8 injections with an interval of 1.5 to 2 months). However, in all patients, there was a recurrence of the exudative activity of the process. Aflibercept treatment method consisted of 3 monthly “loading” intravitreal injections with follow-up period of 4 months.

RESULTS. One month after 1st aflibercept injection among all patients, the average index of best-corrected visual acuity (BCVA) increased to 0.41 ± 0.02 and the central retinal thickness (CRT) index decreased to 307 ± 14.5 μm versus the initial CRT value 431 ± 64 μm. After the 3rd aflibercept injection, the CRT index was the lowest and amounted to 189.5 ± 13.0 μm, which was accompanied BCVA increase to 0.42 ± 0.03 versus 0.29 ± 0.05 as the initial value. According to the optical coherence tomography data, after “loading” phase, good anatomical effect was observed with significant edema reduction, complete resorption of fluid in the subretinal space, and decrease of the pigment epithelial detachment’s height.

CONCLUSION. Evaluating the results of our study, we found that the use of angiogenesis inhibitor aflibercept made it possible to suppress the signs of activity of choroidal neovascularization and to obtain additional improvement of visual functions in patients with neovascular age-related macular degeneration, when the therapeutic effect from the early ranibizumab therapy was insufficient or completely absent.

The new coronavirus disease (COVID-19) is a viral respiratory infection accompanied by systemic “endotheliitis”. COVID-19 patients usually encounter changes related to hypercoagulability, hypofibrinolysis, and increased intravascular platelet aggregation. There is also a vascular wall thromboresistance decrease and impaired vasomotor function, which significantly increase the risk of thromboembolic complications. Currently, pathogenic aspects of the relationship between COVID-19 and vascular and inflammatory conditions of the optic nerve and retina are actively investigated. One of the triggers of impaired blood flow in ocular vessels may be a perfusion pressure decrease, observed in the acute period of the infectious process. This is related to both COVID-19 clinical course features and to resuscitation specificity as well. Secondary autoimmune inflammation is being considered as a mechanism of damage to the vascular wall in the post-infectious period. In this publication, possible pathogenic links of these diseases are considered for the first time in a specific context of the example of ischemic optic neuropathy associated with coronavirus infection.

This article describes a clinical case of a bilateral exudative retinal detachment development in a young woman with severe preeclampsia. The data of the ophthalmological examination, as well as those of the dynamic observation of the patient, are presented. The possible mechanisms of the formation of exudative retinal detachment on the background of preeclampsia are considered in detail. The described clinical case is of great interest, since this condition is a rare complication in preeclampsia. Exudative retinal detachment against the background of preeclampsia requires adherence to bed rest, normalization of blood pressure, control of proteinuria and, as a rule, does not require surgical intervention.