Vol 15, No 3 (2022)

BACKGROUND: Nonspecific angio- and retinopathy is one of the clinical manifestations of a new coronavirus infection. The frequency of occurrence of these changes in people with severe COVID-19 does not exceed 55%. The causes, course and consequences of these microcirculatory disorders of the retina are currently not well understood.

AIM: To study and compare of retinal morphometric parameters and systemic endothelial dysfunction markers, as well as the main clinical and laboratory parameters in patients with moderate and severe coronavirus infection during convalescence.

MATERIALS AND METHODS: The study involved 44 patients (86 eyes) who had COVID-19 during the previous 3 months, who were divided into 2 groups: with moderate and severe disease. The control group consisted of 18 healthy volunteers (36 eyes). All patients underwent a standard ophthalmological examination and optical coherence tomography, which included an assessment of the choroidal thickness (CT) and measurement of the mean diameter of the peripapillary arteries (MAD) and veins (MVD). During hospitalization, all patients underwent a laboratory study of venous blood parameters, as well as an assessment of the microcirculation of the sublingual plexus by examining the density of the endothelial glycocalyx (PBR) using the GlycoCheck.

RESULTS: In patients who underwent COVID-19, there was a significant increase in CT relative to the control group, amounting to 308, 344 and 392 μm, respectively. The most pronounced difference was observed between MVD in patients with severe infection and the control group (119.1 μm vs. 99.2 μm). In patients with moderate and severe COVID-19, MAD and MVD were positively correlated with TC, with r = 0.389 and r = 0.584, respectively. MVD also correlated with the level of leukocytes (r = 0.504), the ESR value (r = 0.656). Correlations between MVD and data characterizing the state of the glycocalyx in the sublingual vascular plexus were revealed: the filling of small capillaries with erythrocytes (r = –0.587), as well as the marginal perfusion value in large capillaries 20–25 μm (r = 0.479) and PBR (r = 0.479). Only significant differences and correlations are shown (p < 0.005).

CONCLUSIONS: In patients who underwent moderate and severe COVID-19 during the convalescence period (up to 30 days), an increase in the diameter of peripapillary vessels and TC is observed, proportional to the severity of COVID-19, laboratory markers of systemic inflammation and hypercoagulation (the number of leukocytes, the ESR value, D-dimer and prothrombin), which indicates the inflammatory nature of the changes. The severity of postcovid retinal microangiopathy correlates with indicators detecting a decreasing of the endothelial glycocalyx thickness in the sublingual capillary plexus, which indirectly indicates a connection with systemic endotheliopathy.

BACKGROUND: The most characteristic manifestation of endocrine ophthalmopathy (EO) is the proptosis development in a patient. It is possible to correct the displacement of eyeballs by performing an orbital decompression surgery.

AIM: To evaluate the clinical efficacy of treating patients with endocrine proptosis using transconjunctival internal decompression of the orbit.

MATERIALS AND METHODS: The study included 86 orbits of 43 patients with bilateral proptosis. All patients underwent MSCT examination, proptosis was detected due to an increase in the soft tissue component. Transconjunctival decompression of both eye sockets was performed according to the described method, and the amount of eyeball displacement after surgery was investigated.

RESULTS: Patients’ complaints about constant pressure behind the eye, observed in 39 patients, disappeared during the first day after surgery in 21 patients, in the remaining patients they gradually disappeared within a week. In 32 patients with preoperative diplopia after surgery, in 27 it completely disappeared, in the remaining 5 it remained in the extreme positions. 6 months after surgery, a decrease in proptosis amount from 21.1 ± 1.5 mm to 20.6 ± 1.5 mm was noted, visual acuity was 1.0 ± 0.02, decreased visual acuity remained in 3 cases due to the incipient cataract, IOP decreased from 20 ± 1.2 mm Hg to 19 ± 1.3 mm Hg. There were no eyeball movement restrictions at the control examination.

CONCLUSIONS: Internal (soft tissue) decompression of the orbit is an effective method for proptosis correction exophthalmos in patients with lipid EO form. Carrying out the decompression surgery through the conjunctival access allows to constantly monitor the shape and size of the pupil in the operated orbit, to conduct controlled hemostasis of the orbital tissues. The use of preliminary calculations of the volume of soft tissues to be removed (according to MSCT) makes it possible to obtain a predictable effect of the surgery in variable degrees of proptosis. Transconjunctival decompression helps avoiding cicatricial processes of the eyelid skin.

BACKGROUND: Cytomegalovirus damage to the eye is the leading cause of loss of visual functions associated with HIV. Effective treatment of HIV-infected patients has changed the understanding of the clinical picture of cytomegalovirus uveitis (CMV-uveitis).

AIM: The aim of the work is to determine the prevalence, the structure of clinical forms and to evaluate visual functions in HIV-infected patients with CMV-uveitis.

MATERIALS AND METHODS: The study group consisted of 66 HIV-infected patients with CMV-uveitis (97 eyes), of which there were 27 men (40.9%), 39 women (59.1%). The average age was 39.6 ± 3.91 years. All patients had stage 4B of HIV infection according to V.V. Pokrovsky’s classification (2006). During the work, visometry, perimetry, biomicroscopy, ophthalmoscopy were used.

RESULTS: The main form of the disease is chorioretinitis, diffuse and generalized forms of the disease are diagnosed in 68.0% of cases. In predicting visual acuity, the leading regression criterion was the clinical form of the disease.

CONCLUSIONS: Diffuse and generalized forms of the disease prevailed in clinical practice. Localization of the chorioretinal process of a predominantly diffuse nature predetermined visual acuity, which in more than a third of cases met the criteria for blindness according to the WHO classification (1977).

AIM: To work out the technique of saturation of the preserved amniotic membrane (AM) with platelet rich plasma (PRP) lysate and to evaluate the growth-stimulating effect of a combination of AM and PRP lysate in vitro.

MATERIALS AND METHODS: In the experiment, AM samples preserved in 3 ways were used: silicate drying, lyophilization, cryopreservation. PRP lysate was prepared on the basis of volunteers’ blood. During the exposure of AM with PRP lysate, the optimal saturation time of canned AM with lysate was determined, the volume of lysate that 1 cm² of AM could adsorb was estimated. The growth-stimulating effect of AM transplants was evaluated in the culture of human buccal epithelium. The dynamics of cell growth was evaluated after 1, 2 and 3 days from the moment of sowing.

RESULTS: In the presence of PRP lysate, the mass of silicate–dried AM increased 4.2 times, lyophilized AM — 4.8 times, cryopreserved AM — 1.8 times. AM samples obtained by lyophilization adsorbed PRP lysate most effectively. Five minutes of exposure with PRP lysate are enough to fully saturate the AM. AM without PRP lysate did not give a growth-stimulating effect.

CONCLUSIONS: When comparing experiments with PRP lysate without AM and AM with PRP lysate, it was found that the greatest stimulation of cell growth occurred when using lyophilized AM and PRP lysate. Saturation of cryopreserved AM with PRP lysate was ineffective, and when using silicate-dried AM impregnated with PRP lysate, the greatest growth-stimulating effect was observed on the 1^st day.

This review of the literature is devoted to the comparison of tonometers based on various operating principles, their advantages and disadvantages. The principles of operation of each considered in the review tonometer are discussed. The features of the structure and mechanisms for measuring the intraocular pressure of various tonometers are highlighted, on the basis of which the anatomical features and other factors that have the greatest impact on the reliability of measurement and accounting of the data obtained in clinical practice are determined.

In the present article, cases of lacrimal apparatus conditions emerging after a new Coronavirus infection COVID-19. The aim of the study is to determine the causes of epiphora in patients after Coronavirus infection.

26 patients (30 eyes) were examined, aged from 28 to 70 years, complaining of tearing, which emerged for the first time ever not earlier than 5–14 days from the onset of the laboratory-confirmed Coronavirus infection COVID-19, which had a mild or a moderately severe course and was accompanied by anosmia.

In patients, following conditions of the lacrimal system were revealed: in 22 patients, there were pathological changes of the horizontal portion of lacrimal pathways; in 6 people dry eye syndrome was diagnosed: in 3 people, it was of mild severity, manifested by hyperlacrimia, 3 people had moderate severity of the dry eye syndrome. As concomitant, following signs were revealed: in 7 patients — rhinologic conditions were present, in 2 people — neurologic signs.

In the examined group of patients with epiphora, we found that in 1.5–3 month after Coronavirus infection COVID-19 with anosmia, as a common sign of the disease in more than a half of cases, a development of pathological changes of the horizontal portion of lacrimal pathways was revealed.

BACKGROUND: Adult-onset vitelliform macular dystrophy is one of the pathologic conditions , which successfully masks as age-related macular degeneration.

AIM: To assess the incidence of the adult-onset vitelliform macular dystrophy among patients of a major ophthalmological clinic in the Far Eastern Federal District of Russia.

MATERIALS AND METHODS: We revealed the cases of adult-onset vitelliform macular dystrophy among 1000 patients aged 40 years and older who addressed for various ocular complaints.

RESULTS: Adult-onset vitelliform macular dystrophy was found in 2 male patients aged 43 and 66 years. In the macular area of both eyes of the 1^st patient, round yellow lesions in the foveola, local detachment of neuroepithelium, optically dense material deposits on the outer photoreceptor segments were detected (vitelliruptive stage of adult-onset vitelliform macular dystrophy). In the left eye of the 2^nd patient, in the foveola, a single round yellow focus of 200 µm was found, optically dense vitelliform material was detected between the pigment epithelium and neuroepithelium layers without any signs of choroidal neovascularization (vitelliform stage of adult-onset vitelliform macular dystrophy).

CONCLUSIONS: The incidence of adult-onset vitelliform macular dystrophy among patients with various ocular conditions was 0.2%. Morphological changes in the macula consist in presence of deposits of vitelliform material, localized between the neuroepithelium and retinal pigment epithelium layers.

XXVIII International Ophthalmology Congress “White Nights” — 18 Congress of the All-Russian Public Organization “Association of ophthalmologists” took place in Saint Petersburg from May 30^th through June 3^rd, 2022. At the congress, doctors out of 11 countries of countries of near and far abroad. The number of registered participants was 4133. Besides 124 plenary presentations, 34 more were presented at 11 specialized symposia, organized with a support of Congress partners.