Vol 11, No 4 (2018)

Introduction. The threshold laser coagulation leads to irreversible damage of retinal structures, microscotomata appearance in the central visual field, contrast sensitivity decrease, and color vision impairment, being accompanied as well by the release of proinflammatory cytokines. For diabetic macular edema treatment, a method of high-density subthreshold laser coagulation (810 nm) was first developed, based on individualized choice of subthreshold parameters of laser irradiation, and permitting confluent application of laser impacts to the retina. Using multimodal diagnostic approach to the estimation of anatomic and functional treatment results, a minimally invasive character and safety of this DME treatment method were confirmed.

Purpose. The aim of this study was to comparatively evaluate the efficacy of a diode laser (810 mn) subthreshold laser treatment using high-density laser impact application in diode laser coagulation (DLC) and diode microphotocoagulation (DMP) modes.

Materials and methods. To compare the efficacy of subthreshold laser treatment methods (DLC and DMP), patients were divided into two groups, comparable in macular edema thickness and area. The first group (24 eyes) received a macular laser coagulation in grid pattern and MicroPulse diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns. The second group (29 eyes) received a macular laser coagulation in grid pattern and continuous diode laser (810 nm) regimen; biomicroscopically it was predominantly subthreshold high-density application of burns.

Results. After DLC and DMP, there was no statistically significant difference between compared groups in best corrected visual acuity. There was also no significant difference in retinal edema maximal height dynamics, retinal edema area, and central thickness in 2 and 4 months.

Conclusion. Subthreshold microphotocoagulation and laser coagulation methods at the same average power of laser exposure and other exposure parameters in the shortterm follow-up have comparable efficacy in the treatment of diabetic macular edema.

Purpose. To study the main morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma (PEG).

Methods. We included 193 subjects aged from 55 to 75 years. The main study group (PEG) included 96 patients (192 eyes), the primary open angle glaucoma (POAG) group included 36 patients (72 eyes) with POAG, the PEX group included 31 patients (62 eyes) with pseudoexfoliation syndrome without glaucoma. The control group consisted of 30 healthy subjects (60 eyes). Main corneal endothelium parameters were evaluated using a non-contact endothelial microscope EM-935 (Haag Streit, Switzerland). Data were analyzed by STATISTICA 9 software for Windows.

Results. The patients with PEG had lower endothelial cell density (ECD) in comparison to the control group (p < 0.01), and PEX group (p < 0.05). The polymegatism level in patients with PEG and POAG was higher than in the control group (p < 0.001, and p < 0.01, correspondingly). In patients with moderate and advanced PEG, the ECD was significantly lower (p < 0.01), and the polymegatism level was significantly higher (p < 0.01) than the same parameters in patients with early PEG. The lowest ECD and the highest polymegatism percentage were observed in PEG patients with more pronounced PEX manifestations, p < 0.05. No effect of IOP-lowering eye drops on the corneal endothelium parameters was revealed, p < 0.05.

Conclusions. Significant morphological changes of the corneal endothelium (decreased endothelial cell density, increased polymegatism percentage) were revealed in patients with PEG. It was established that the severity of these changes is associated with the PEG and PEX severity. No effect of IOP-lowering eye drops on the corneal endothelium parameters was detected.

Diabetic retinopathy remains one of the greatest challenges for healthcare system worldwide despite the fact that the incidence of visual acuity impairment in diabetic population has decreased due to examination quality improvement and dynamic observation of patients. Visual acuity impairment in diabetic patients is often related to diabetic macular edema. Until recently, laser photocoagulation of the retina was regarded as gold standard for diabetic macular edema treatment. Laser photocoagulation of the retina provides visual acuity stabilization rather than improvement. Since early 2000s, pharmacological approach to this severe disease has been established. As vascular endothelial growth factor (VEGF) is one of the crucial factors involved in the pathogenesis of diabetic retinal disorders, VEGF inhibitors are now recognized as a treatment of choice for diabetic macular edema. This article considers results of different clinical trials investigating anti-VEGF therapy efficacy in DME treatment.

Relevance. Dystrophic processes in the retina and different types of glaucoma occupy a significant place among ocular disabling conditions. In the present article, the institution’s experience concerning a new approach to treatment of patients with dry age-related macular degeneration and concomitant mild stabilized open-angle glaucoma.

Aim. To clinically estimate the influence of the biologically active dietary supplement “Proluksa” on main visual functions and on the quality of life in patients with dry age-related macular degeneration and concomitant mild stabilized open-angle glaucoma.

Materials and methods. Into the study, 60 patients were included; they were divided into two groups. Patients of the first group received the biologically active dietary supplement “Proluksa”, 2 capsules once a day during three months, and instilled IOP-lowering drops; patients of the second group did not take the biologically active dietary supplement “Proluksa”, they instilled IOP-lowering drops only. Both groups were followed during six months. Three times a standard ophthalmologic examination and instrumental investigations (macular electroretinography, vacuum-compression test with control of visual evoked cortical potentials using a “suction cup”, HRT III of the optic disc, OCT of the macular area) were performed in both groups.

Results. There was a statistically significant positive visual acuity dynamics at stable optimal correction for distance in the group 1; the percentage of relative scotomata decreased in the group 1; vacuum-compression test gave negative results at Visits 1, 2, and 3; the p-100 wave amplitude increased – in the group 1 on the background the biologically active dietary supplement “Proluksa” intake; the a-wave amplitude of the macular ERG increased; according to OCT results, there were no reliable changes in the central retinal area; the optic disc neuroretinal rim width at HRT III remained stable during the whole follow-up period.

Conclusions. According to performed investigations, there were: statistically reliable visual acuity increase at stable optimal correction, statistically significant positive dynamics in retinal photosensitivity, and increase in functional activity of external and internal retinal layers in the macular area. To the third month of preparation intake, patients from the group 1 taking the biologically active dietary supplement “Proluksa” noted the enhancement of image resolution, decrease in visual “defocusing”, better color perception.

A case of enhanced S-cone syndrome misdiagnosed as idiopathic retinal vasculitis is presented. Etiology, pathogenesis and clinical features are described below.