Vol 16, No 1 (2023)

BACKGROUND: Eye injury is an actual problem, occupying a leading position among the main causes of blindness and low vision, accounting for 22.8% in the structure of primary visual disability, of which 53% of cases are due to closed eye injury. Despite the development and widespread introduction into practice of methods of high-tech care for patients of this profile, there are a number of complications that poorly respond to treatment, ultimately leading to the loss of visual function of the injured eye.

AIM: Evaluation of the effectiveness of early vitrectomy in patients with severe blunt ocular trauma, based on clinical results obtained during treatment and postoperative follow-up.

MATERIALS AND METHODS: The study included 34 patients (34 eyes) with contusion-type eye injury. The mean age of patients was 39 years, among them 30 were men (88.24%) and 4 (11.76%) women. Patients were divided into 2 groups. Group 1 included 11 patients (10 men, 1 woman) with an open-type eye injury — with a subconjunctival scleral rupture; upon admission, visual acuity varied from incorrect light projection to 0.01. In group 2, there were 23 patients (20 men, 3 women) with severe closed eye injury, upon admission to the hospital, visual acuity ranged from incorrect light projection to 0.06. In all cases, patients underwent subtotal three-port vitrectomy at an early date (up to 3 days) after injury.

RESULTS: On the 1st day after surgery, there was an improvement in visual acuity in all patients. The follow-up period for patients was 6 months. All included patients had a stable anatomical result, no cases of subatrophy were noted, satisfactory functional results were achieved - visual acuity varied from 0.02 to 0.8. After 6 months, 32 out of 34 eyes (94.12%) showed no signs of proliferative vitreoretinopathy. In 2 patients (18.18%) from group 1, the development of proliferative vitreoretinopathy under silicone oil was revealed. Epiretinal membrane was diagnosed in 2 patients (8.7%) from group 2 and in 1 patient (9.09%) from group 1.

CONCLUSIONS: Obtained clinical results of treatment of patients with severe blunt ocular trauma indicate the expediency of vitrectomy in early stages after injury, which is an effective treatment method. Long-term results demonstrate stable functional results for 6 months. Vitrectomy performed early after injury serves for prevention of proliferative vitreoretinopathy, but does not completely exclude its development. Performing surgery early after injury increases the prospects for preserving visual functions of the eye and is a positive prognostic factor.

BACKGROUND: Optical coherence tomography angiography (OCTA) is a noninvasive method of eye microcirculation evaluation. Few reports are published on the use of OCTA for anterior segment (AS) vessels analysis in healthy eyes and in conjunctival tumors, and their vascular characteristics are still not thoroughly investigated. These questions are of importance, as it is known that tumor’s vasculature is indicative of the patient’s vital prognosis.

AIM: The aim of our study was to investigate the potential of AS-OCTA in evaluation of normal conjunctival vessels architecture as well as that in melanocytic neoplasms.

MATERIALS AND METHODS: 20 healthy volunteers (20 eyes) and 20 patients (20 eyes) with conjunctival nevi and melanomas were examined. AS optical coherence tomography (OCT) and AS-OCTA were performed. Scan analysis included qualitative assessment (vessels pattern, lumen, tortuosity) and quantitative assessment [perfusion density (PD, %) index]. Mean (MPD), maximum (MaxPD) and perifocal PD (PPD) were determined.

RESULTS: In normal group, predominantly radial pattern of the vessels was revealed, their caliber remaining the same along their entire length; larger vessels were more often discovered in deep conjunctival layers. The lowest PD value (29.9%) was registered in the inferior conjunctival segment, and the highest (36.7%) — in the nasal one. In the conjunctival tumors’ area tortuosity of the vessels, uneven vessels’ caliber along their length, and increase in the PD value were observed. Melanomas were characterized by an increase in the “lace-like pattern” and by presence of “confluent pattern” zones; MaxPD value was more than 50%. Significant difference was found between MPD values of normal conjunctiva and MPD values in conjunctival melanoma.

CONCLUSIONS: AS-OCTA is an informative method for the visualization of vessels in normal conjunctiva and in conjunctival tumors. If the tumor’s vessels are unevenly distributed, MaxPD should be measured.

BACKGROUND: Hundreds of studies are dedicated to the negative effects of glaucoma therapy on the ocular surface. At the same time, the state of the eye surface after successful hypotensive surgery, which resulted in the cessation or significant reduction of medical therapy, has not been studied.

AIM: To identify ocular surface changes after glaucoma surgery.

MATERIALS AND METHODS: The study group consisted of 475 consecutively enrolled patients who were operated during 2016–2020 in Saint Petersburg Multidisciplinary City Hospital No. 2 for primary open-angle unstable glaucoma, and then observed for 6 to 24 months. Trabeculectomy (TE) was used as the first hypotensive procedure (418 patients), as re-operation — TE (25 patients) or Ahmed valve implantation (32 patients) were chosen. Using statistical methods, the dynamics of symptoms (OSDI) and signs [tear film break-up time (TBUT) and reflex tear production defined by Schirmer I test] depending on outcome (“complete” or “partial” success and “total failure”) were analyzed.

RESULTS: The cessation of the pharmacological load due to the “complete success” of the surgery was accompanied by pronounced (two-fold) and long (for at least two years) decrease of OSDI scores. The obliged, even partial, return to instillations by patients, who were included into the subgroup of “partial success”, within six months, transformed the achieved differences into insignificant ones. TBUT at “complete” and “partial success” significantly increased at all end-points of the study, significantly differing from the similar indicator in the subgroup “total failure”. The results of the Schirmer I test against the background of “complete success” of the operation showed a statistically significant increase, compared to the baseline , delayed for six months, throughout the whole further follow-up period. Patients entering the “partial success” subgroup in 24 months after surgery, also showed a significant increase in tear secretion. The failure of glaucoma surgery was accompanied by a brief and insignificant improvement in all scores.

CONCLUSIONS: The hypotensive surgery, which lead to “complete success”, was accompanied by a significant improvement of the ocular surface state. Restart of local therapy reduces achieved results. Failure of surgical treatment is associated with minimal fluctuations of the studied parameters.

The article is devoted to the study of surgical methods of retinal pigment epithelium transplantation in experiment on rabbits. The history of retinal pigment epithelium transplantation is briefly characterized in the study. Characteristics of the methods used are presented, their limitations, possibilities, and requirements for implementation in practice are highlighted. The results of transplantation of suspension of retinal pigment epithelium cells differentiated from human induced pluripotent stem cells (IPSC-RPE) without and with the use of platelet-rich blood plasma (PRP) are also considered. According to the results of the analysis we have developed modified methods of IPSC-RPE cells transplantation in the experiment on rabbits, which allow to reduce the number of postoperative complications, which provides the best therapeutic effect. Prospects for further studies are associated with a comparative analysis of the proposed techniques in terms of cell survival at different terms, anatomical integration and functional efficiency in the dynamics.

The most frequent sources of microbial flora inside the eye are the ocular surface, foci of para-ocular infection of the patient. In vitreous samples from eyes with endophthalmitis microorganisms are revealed that are the saprophytic flora of the ocular surface. It is mainly represented by staphylococci, from which epidermal staphylococcus prevails quantitatively. Immunodeficiency states, diabetes mellitus, terminal liver and kidney diseases increase the risk of endophthalmitis development. Eradication of opportunistic pathogenic flora in the source loci, sanation of para-ocular infection, correction of somatic pathology by profile specialists is more relevant for endophthalmitis prevention. The problem of growing antibiotic resistance should also be considered. Thus, when selecting patients for surgery, one should be guided by the data on antibiotic resistance of the identified flora, pay attention to the presence of para-ocular infection and the systemic somatic status of the patient. This will provide a better vector for the development of recommendations for optimal prophylaxis.

Cases of surgical treatment of basal cell skin carcinoma of the lower eyelid are rarely described in the world literature. Perhaps this is due to the search for new non-surgical treatment methods or to the fact that this localization is poorly represented in the total incidence of basal cell skin cancer. However, the operative method, recommended as the main line of treatment by both domestic and foreign clinical recommendations, is still recognized as the most radical and aesthetically acceptable method of treatment. Non-radical treatment of the tumor leads, in turn, to relapses of the disease, to the emergence of systemic metastatic foci due to the lymphogenic and hematogenic spread of tumor cells. In the article we describe the experience of surgical treatment of patients suffering from basal cell skin carcinoma of the lower eyelid of varying degrees of extension.

The article describes a casuistic case of a long asymptomatic stay of a giant foreign body in the orbit and of its removal. Immediately after the injury and at primary surgical treatment, the foreign body was not diagnosed. The patient did not have any complaints for a long time, then gradually there was a periodic double vision when looking straight ahead, a dense formation under the eyebrow began to be revealed by palpation. The foreign body was successfully removed almost a year after the injury.

The Varicella-Zoster virus (VZV) is the etiologic agent of one of the most common infectious diseases among children, chickenpox. In its recurrent form it may cause a far more devastating disease, Herpes zoster. The disease can be manifested as conjunctivitis, episcleritis, scleritis, keratitis, anterior uveitis. Chorioretinal lesions may occur in patients with immunosuppression.

A 14-year-old male patient has been admitted to the Ophthalmologic center after S.V. Malayan with complaints of visual decrease, redness and pains. In the history of the patient the transferred chickenpox was marked a few months ago. By biomicroscopic and fundoscopic examination conjunctival hyperemia, corneal precipitates, severe inflammatory reaction in the anterior chamber, sectoral iris atrophy, posterior synechiae, yellow-white multifocal, peripheral lesions on the fundus of both eyes and pigmented macular scar in the right eye were found out. Laboratory tests showed high levels of anti-VZV IgG. Treatment was prescribed in the form of local instillations and subtenon injections, as well as antiviral tablets. As a result of treatment, remission of inflammatory process and improvement of visual acuity were registered. The specific characteristic of present case study is the description of single clinical manifestations of Herpes zoster, which are necessary to detect for correct and timely treatment.