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Vol 14, No 2 (2021)

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Original researches

New options for the diagnosis of normal tension glaucoma in the light of Professor V.V. Volkov’s concept of its pathogenesis

Simakova I.L., Suleimanova A.R., Baimuratova N.P.


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.

Ophthalmology Reports. 2021;14(2):5-15
pages 5-15 views

Evaluation of retinal thickness and of pseudophakic cystoid macular edema incidence in patients with primary open-angle glaucoma treated with prostaglandin analogues

Wang X., Astakhov S.Y., Potemkin V.V., Potemkina A.R., Anikina L.K.


Background. Cataract is often associated with primary glaucoma. Prostaglandin analogues use is considered to be a risk factor for pseudophakic cystoid macular edema.

Purpose. To evaluate the effect of prostaglandin analogues and non-steroidal anti-inflammatory drops on the central retinal thickness and the incidence of pseudophakic cystoid macular edema after phacoemulsification with intraocular lens implantation in patients with primary open-angle glaucoma.

Materials and methods. 91 patients were enrolled in the study. 22 patients (22 eyes) were included in the first main group and 22 patients (22 eyes) were included in the second main groups. All patients in main groups had glaucoma and used prostaglandin analogues. 47 patients (57 eyes) without glaucoma were included in the control group. All patients were treated with topical antibiotics and steroids after phacoemulsification. Patients in the main second and in the control groups also received non-steroidal anti-inflammatory drops. The retinal thickness was measured by optical coherence tomography 2 weeks, 2 months and 6 months after the operation.

Results. After the operation, the foveal thickness in patients of the first and the second groups was increased, but it had returned to the preoperative level after 6 months in the first group and after 2 months in the second group. The retinal thickness in the fovea in the control group decreased after the surgery and it has been increasing gradually but did not achieve the preoperative value.

Conclusion. Prostaglandin analogues use after phacoemulsification with intraocular lens implantation does not affect the incidence of pseudophakic cystoid macular edema. Prescribing non-steroidal anti-inflammatory drops after the surgery helps to achieve faster normalization of the central retinal thickness.

Ophthalmology Reports. 2021;14(2):17-26
pages 17-26 views

The platelet-rich plasma lysate use in the treatment of persistent epithelial defects after keratoplasty

Shakhbazyan N.P., Trufanov S.V., Subbot A.M.


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.

Ophthalmology Reports. 2021;14(2):27-35
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The influence of intraocular lens dislocation surgical correction method on corneal endothelium

Potyomkin V.V., Astakhov S.Y., Goltsman E.V., Wang X., Nizametdinova Y.S.


BACKGROUND: Intraocular lens (IOL) dislocation is a rare but serious complication of surgical treatment of patients with cataract. Among the factors contributing to its development, the main ones are pseudoexfoliation syndrome (PEX), high axial myopia, chronic uveitis, history of eye injury and age. There is no universal IOL dislocation correction technique.

PURPOSE: To evaluate the impact on corneal endothelium of two different methods of IOL dislocation correction: IOL repositioning with transscleral suture fixation or IOL exchange to iris-claw one.

MATERIALS AND METHODS: Within the study, 78 patients were examined and operated. All patients were divided into two groups: in the first group, IOL was repositioned with transscleral suture fixation, and in the second group IOL was exchanged to iris-claw IOL. Groups were equal by gender and age. Key estimated indicators were endothelial cell density and coefficient of variation reflecting the degree of polymegatism.

RESULTS: Endothelial cell density was significantly lower both before surgery and at any term after it, in the group with IOL exchange, and coefficient of variation was significantly higher in the group with IOL exchange throughout this study.

CONCLUSION: The choice of technique for IOL dislocation correction is the basis of success in surgical treatment. Certain preoperative examination data should be definitely considered, including the degree of dislocation, IOL type, IOP level, endothelial cell density and presence of concomitant ocular conditions.

Ophthalmology Reports. 2021;14(2):37-45
pages 37-45 views

The features of diagnosis and treatment of unilateral concomitant strabismus with visual fixation defect in preschool children

Kononova N.E., Somov E.E.


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.

Ophthalmology Reports. 2021;14(2):47-54
pages 47-54 views

Organization of ophthalmic care

Clinical and statistical characteristic of references at the third stage of ophthalmic care

Hajiyeva B.K.


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.

Ophthalmology Reports. 2021;14(2):55-61
pages 55-61 views


Silicone oil droplets in the vitreous after intravitreal injections: review of literature with clinical examples

Bobykin E.V.


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.

Ophthalmology Reports. 2021;14(2):63-76
pages 63-76 views

Modern insights into ophthalmic manifestations of rheumatic diseases

Karpova D.A., Savina E.E., Ponomareva M.N., Lushpaeva Y.A., Partikeeva I.M.


This literature review is devoted to the analysis of modern insights into ophthalmological manifestations (according to the data of foreign scientific literature in the PubMed system for 2017–2020) of the most common rheumatic diseases (rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, systemic scleroderma, systemic vasculitis), which are characterized by damage to all structures of the eye and its adnexa: eyelids, orbital tissues, eyeball tunics, vessels, optic nerve and vitreous. Ocular lesion may be an onset, one of the diagnostic signs, or a biomarker of underlying medical condition.

Ophthalmology Reports. 2021;14(2):77-83
pages 77-83 views


Using Stelfrine supra 2.5% for children with accommodation and refraction disabilities

Pekerskaya V.L., Zhuravleva E.V.


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.

Ophthalmology Reports. 2021;14(2):85-90
pages 85-90 views

Case reports

A clinical case of bilateral exudative retinal detachment against the background of severe preeclampsia

Kolenko O.V., Fil A.A., Sorokin E.L.


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.

Ophthalmology Reports. 2021;14(2):91-96
pages 91-96 views

In ophthalmology practitioners

Clinical efficacy of aflibercept treatment in patients with ranibizumab-resistant neovascular age-related macular degeneration

Egorov V.V., Smoliakova G.P., Danilova L.P., Zhajvoronok N.S., Solov'yeva Y.B., Polosina A.N.


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.

Ophthalmology Reports. 2021;14(2):97-104
pages 97-104 views


COVID-19 as a new risk factor for the development of acute vascular diseases of the optic nerve and retina

Turgel V.A., Antonov V.A., Tultseva S.N., Shadrichev F.E., Grigorieva N.N.


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.

Ophthalmology Reports. 2021;14(2):105-115
pages 105-115 views

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