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Vol 15, No 1 (2022)

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Original researches

Cytomegalovirus uveitis in HIV-infected people: possible complications

Sizova T.D., Khokkanen V.M., Zumbulidze N.G.


BACKGROUND: Cytomegalovirus uveitis is an AIDS-marker disease. If typical chorioretinal foci associated with cytomegalovirus viremia, inflammatory diseases of cytomegalovirus etiology of other organs are detected, etiotropic treatment and antiretroviral therapy are prescribed. Later on, the patient continues to be monitored by an ophthalmologist.

AIM: The aim is to identify the structure of complications, the frequency and the timing of their occurrence in cytomegalovirus uveitis in HIV-infected patients, the relationship with the treatment.

MATERIALS AND METHODS: The study was performed at the St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases and the Department of Ophthalmology of the North-Western State Medical University named after I.I. Mechnikov. The study group consisted of 66 patients (97 eyes).

RESULTS: The development of complications of the disease was detected in 86.6% of patients. In patients, following complications were reported: retinal detachment, complicated cataract, partial optic nerve atrophy, cystoid macular edema, and secondary exotropia.

CONCLUSION: Cytomegalovirus uveitis in HIV-infected patients has a predominantly complicated course.

Ophthalmology Journal. 2022;15(1):7-14
pages 7-14 views

Analysis of optical coherence tomography of the optic nerve head and of the retinal macular area in multiple sclerosis patients

Tkachenko N.V., Belekhova S.G., Kolesnikova E.T., Turgel V.A., Semenyuta V.V.


BACKGROUND: Multiple sclerosis is a chronic autoimmune demyelinating disease of the central nervous system. Early diagnosis of the disease is extremely important for the just-in-time start of specific therapy. Optical coherence tomography (OCT) of the optic nerve head and retina can become an early marker of the neurodegenerative process in multiple sclerosis.

AIM: To determine OCT-changes in the retinal nerve fiber layer (RNFL) thickness and retinal thickness in the macular area being most specific for multiple sclerosis.

MATERIALS AND METHODS: 197 patients were examined, the study group consisted of 136 patients (274 eyes) with an established diagnosis of multiple sclerosis and the disease duration of at least 6 months. The control group included 61 healthy people (122 eyes). All patients underwent a standard ophthalmological examination, OCT was performed on Spectralis OCT (Heidelberg Engineering, Germany) using 2 scanning protocols: ONH-RC-Scan (Optic Nerve Head-Radial Circle Scan) and PPAA (Posterior Pole Asymmetry Analysis)

RESULTS: Only 11 patients (8.1%) had a history of retrobulbar neuritis, the best corrected visual acuity was 0.7 and higher in 83 (81%) patients with multiple sclerosis, while the optic nerve head and retinal nerve fiber layer OCT-changes typical for multiple sclerosis were found in 118 patients (87%). The most prominent thinning of the retinal nerve fiber layer in group with multiple sclerosis was revealed in the temporal part of the optic nerve head (59.9 ± 14.8 in the study group versus 76.6 ± 12.0 in the control group; p < 0.001), the least thinning was in the nasal half (66.6 ± 14.3 in the study group versus 69.3 ± 12.4 in the control group; p = 0.013). The retina in the macular area in multiple sclerosis patients was thinned over the entire area, the most significant changes were in the Outer Nasal 7 zone (303.3 ± 20.4 in the study group versus 324.3 ± 10.0 in the control group; p < 0.001). Cluster analysis found 6 new retinal zones for mapping the macular area using the scanning protocol PPAA. In order to determine the prognostic value of the obtained zones, a logistic regression model was constructed, which with a sensitivity of 87.1% and a specificity of 81.6% allows concluding on the probability of having multiple sclerosis.

CONCLUSION: OCT data using the proposed mapping of the macular area with the mathematical model analysis could be used to diagnose specific optic nerve atrophy, to reveal typical thinning of the retinal nerve fiber layer associated with multiple sclerosis, and in the long run, to become an additional criterion for establishing the diagnosis of multiple sclerosis.

Ophthalmology Journal. 2022;15(1):15-28
pages 15-28 views

Regional hemodynamics characteristics in patients with non-arteritic anterior ischemic optic neuropathy

Antonov V.A., Rukhovets A.G., Astakhov S.Y., Kozlova Y.V., Sharma A.A.


BACKGROUND: Non-arteritic anterior ischemic optic neuropathy (NAION) takes the first place in the total amount of acute vascular optic neuropathy cases. There is no common understanding of pathogenetic mechanisms of disease. This is largely due to the absence of direct optic nerve head blood flow registration method in ophthalmology.

AIM: The aim of this work is to evaluate ocular hemodynamics using different methods in patients with non-arteritic anterior ischemic optic neuropathy (NAION).

MATERIALS AND METHODS: 73 patients were enrolled in the study. 46 patients (46 eyes) with NAION were included in the first group. Control group was composed of 27 patients (50 eyes) with systemic risk factors of NAION without any retinal and optic nerve diseases. Regional hemodynamics parameters were evaluated with ophthalmosphigmography, ophthalmoplethysmography, ophthalmoreography, OCT-angiography and EDI-OCT.

RESULTS: Blood flow values in different parts of the choroid did not statistically differ between groups when using ophthalmosphigmography, ophthalmoplethysmography, ophthalmoreography methods. Radial peripapillary capillaries in optic nerve head area were evaluated, and statistically significant difference was found in all sectors.

CONCLUSION: The main component of NAION pathogenesis is a decreasing perfusion pressure in paraoptic short posterior ciliary arteries. Blood flow in choroid does not play an important role in the disease pathogenesis.

Ophthalmology Journal. 2022;15(1):29-37
pages 29-37 views

Modern capabilities of the computed tomography in orbital traumatic injuries diagnosis

Davydov D.V., Serova N.S., Pavlova O.Y.


BACKGROUND: Nowadays the problem of orbital trauma remains extremely relevant. Combined damage of several anatomical structures, globe injury, various clinical manifestations, the necessity of optimal surgical treatment require high-quality, timely diagnostics. Considering the current development of diagnostic equipment, postprocessing of CT data acquires the key role in order to obtain objective diagnostic information in patients with orbital trauma.

AIM: Evaluation of the effectiveness of the developed methods for CT data assessing in patients with orbital trauma.

MATERIALS AND METHODS: From 2016 to 2021 a total of 107 patients (100%) with orbital injuries were examined in Sechenov University clinics. All patients were distributed depending on the injury occurrence time: 50 patients (47%) — in acute and subacute periods, 30 patients (28%) — in the period of formation of post-traumatic deformities, 27 patients (25%) — in the period of formed post-traumatic deformities. All patients (n = 107; 100%) underwent CT data analysis according to the developed protocol: analysis of bone and soft tissue trauma using a specialized algorithm, assessment of orbital volumes, evaluation of defects in the inferior orbital wall, examination of the globe position and of changes in the density of the orbital soft tissues.

RESULTS: In the preoperative period the developed algorithm for orbital volumes measuring additionally revealed a post-traumatic increase in orbital volume in 21 patients (19%). The technique for the globe position assessing additionally revealed the risk of enophthalmos in 9 patients (8.1%), and in 1 case (0.9%) the suspicion of globe displacement was not confirmed. The defects of the inferior orbital wall were classified into small (n = 18; 17%), medium (n = 31; 29%) and large/total (n = 38; 35% and n = 20; 19%, respectively). In 88 patients (82%), the ratio of the defect to the entire inferior orbital wall was more than 6.65%, in 19 patients (18%) — less than 6.65%. Changes in the density of the orbital soft tissues were as follows: soft tissue edema — n = 60 (56%), soft tissue atrophy — n = 28 (27%), hematoma of the orbital soft tissues — n = 10 (9%), density was not changed — n = 9 (8%). In the postoperative period, the developed methods for CT data processing revealed incomplete restoration of the orbital volume in 31 cases (29%), incomplete coverage of the inferior orbital wall defect in 38 cases (35%), globe displacement in 14 cases (13%), which was not determined by the standard CT data assessment without the specialized technique. In 7 cases (6%), a suspicion of an increase in the orbital volume was not confirmed by the developed methodology.

CONCLUSION: The developed methods for measuring orbit volumes, assessing defects in the lower orbital wall, the globe position, and the condition of the orbital soft tissues provide statistically reliable additional diagnostic information about the patient’s condition and personalized approach for preoperative planning for each patient.

Ophthalmology Journal. 2022;15(1):39-47
pages 39-47 views


Disorganization of retinal inner layers: diagnostic and clinical characteristics

Burnasheva M.A., Kulikov A.N., Maltsev D.S.


This review describes the current state of knowledge of the phenomenon of disorganization of retinal inner layers. DRIL is characterized by alteration of microcirculation in retinal capillary plexuses detected with optical coherence tomography angiography, alteration of several inner layers of the retina with the inability to differentiate them on optical coherence tomography, and by an impact on the quality of vision. Disorganization of retinal inner layers occurs in a number of different vascular retinal disorders, which indicates its importance as a clinical biomarker and clinical significance. However, the literature data on disorganization of retinal inner layers are still limited, and questions about the pathogenesis of this disease warrant further investigations.

Ophthalmology Journal. 2022;15(1):49-56
pages 49-56 views

The use of optical coherence tomography angiography in patients with chiasmal compression (literature review)

Gavrilova N.A., Kuzmina A.V.


Optical coherence tomography (OCT) is currently the leading method for the observation and evaluation of microstructural changes in the retina in vivo. In recent years, OCT has been used in clinical practice to monitor the progression of compressive optic neuropathy in patients with chiasmal-sellar region neoplasms. The results obtained in the course of the studies opened up new opportunities for studying the pathogenesis of the development of compressive optic neuropathy in patients of this group. The advent of OCT-angiography (OCTA), developed on the basis of OCT, made it possible to study changes in the blood flow of the radial peripapillary capillary network, superficial and deep capillary plexuses, which opens up many opportunities for further research into the pathogenesis of visual impairment in this group of patients, prognosis of the development of the disease, and selection optimal terms of treatment. The literature review presents and analyzes the currently available results of the use of OCTA in patients with chiasmal compression.

Ophthalmology Journal. 2022;15(1):57-68
pages 57-68 views

Case reports

The acute necrotizing periorbital fasciitis. Clinical case

Haritonova N.N., Gorbachev D.S., Safonov M.S., Kolbin A.A., Kulikov A.N., Kolke A.A., Batyrshin I.M., Zinoviev E.V.


BACKGROUND: A rare severe, characterized by high mortality in some localizations (up to 70%) necrotizing periorbital fasciitis has not been described previously in the national literature.

AIM: to show a multidisciplinary approach to the treatment and rehabilitation of patients with periorbital necrotizing fasciitis on the example of the clinical case.

CLINICAL CASE: Patient with the acute necrotizing fasciitis of both eyelids, with the dissemination to the superficial face and neck fascies, the sepsis development is given. Monitoring of vital functions, homeostasis indicators, repeated inoculations, computed tomography, regular examination by an ophthalmologist included the control of visual functions, anterior and posterior segments, closure of the eye fissure. Conservative and surgical treatment applied by a multidisciplinary team is presented, which allowed to save the patient’s life, overpass the purulent-necrotic, and then the rough scar process and to achieve satisfactory anatomical and functional results.

CONCLUSION: Timely multidisciplinary treatment of periorbital necrotizing fasciitis is necessary for the life preservation, prevention of severe complications from the eye. With the threat of developing lagophthalmos, it is necessary to perform permanent blepharoraphy for 3–6 months after the first surgery and further surgical and pharmacological correction of scarring processes.

Ophthalmology Journal. 2022;15(1):69-76
pages 69-76 views

A clinical case of the development of choroidal neovascularization in a patient with skin melanoma on the background of therapy with MEK and BRAF inhibitors

Tkachenko N.V., Belekhova S.G., Zhukova N.V., Prokopchuk V.S., Chernova N.S.


The emergence of targeted therapy has become a significant breakthrough in the management of cancer patients, but even it is not without drawbacks. The article describes a clinical case of the development choroidal neovascularization in a 42-year-old patient with stage IV skin melanoma during 15 months of therapy with MEK and BRAF inhibitors. Clinicians need to remember that such patients may have not only MEK-associated retinopathy, but also other pathological changes in the retina, in particular choroidal neovascularization, which may be associated with both the chemotherapy they receive and the paraneoplastic syndrome itself against the background of the course of the underlying disease. Timely diagnosis and adequate management tactics allow such patients to preserve visual functions.

Ophthalmology Journal. 2022;15(1):77-85
pages 77-85 views

Phtisioophthalmology section

Phthisioophthalmological sanatarium “Krasny Val” under conditions of Coronavirus COVID-19 pandemic

Ustinova E.I., Simchuk M.N., Astakhov S.Y., Kuznetsova T.I., Bataev V.M., Lyapin S.L., Bezrukavaja T.I.


During the Coronavirus infection pandemic (2019–2021), the admission of patients from antituberculosis dispensaries decreased (2261 vs 2747 in 2016–2018). At the same time, the number of patients with tuberculous haematogenous uveitides decreased significantly (55% vs 76%; р < 0.0001), and that with non-tuberculous ophthalmic diseases by contrast significantly increased (23% vs 43%; р < 0.0001). Among tuberculous uveitides, high amount of chorioretinitis (46%) and of panuveitis (11%) was found. Their severity was escalated by complications (in 77–86% of patients) and frequent concomitant systemic conditions. In 277 patients, the post-covid syndrome was revealed (after prior Coronavirus COVID-19 infection). During the pandemic, the admission to the sanatorium of patients with active (dispensary follow-up care group I) and chronic (dispensary follow-up care group II) forms of ocular tuberculosis significantly decreased: 9% vs 15%, and 18% vs 27%, respectively; that with clinical recovery (dispensary follow-up care group III) – increased (73% vs 58%). Active tuberculosis forms of other localization were excluded.

A reduction in the quality of ocular tuberculosis diagnosis and treatment in dispensaries is related to decrease in number of qualified phtisioophthalmologists, periodical breakdowns in supply of tuberculin and of some medications.

In the “Krasny Val” sanatorium, patients received additional examination, full-fledged chemotherapy, and necessary rehabilitation.

Ophthalmology Journal. 2022;15(1):87-99
pages 87-99 views


In memory of Sergei F. Shkolnik

Beldovskaya N.Y., Fedotova K.


Information about the sudden death of a Doctor of Medical Sciences, Head of the Department of dacryology and ophthalmoplasty of the Cheboksary branch of the S.N. Fyodorov Eye Microsurgery Federal State Institution, Doctor of the highest qualification category Sergey F. Shkolnik.

Ophthalmology Journal. 2022;15(1):101-102
pages 101-102 views

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