Ophthalmology Reports

BACKGROUND: Uveal melanoma is the most common malignant ocular tumor in adults. It carries a high risk of metastatic spread and death. Typical clinical and morphological signs fail to provide accurate disease prognosis. Thus, investigations of molecular markers such as BAP1 expression are warranted to improve survival prediction and optimize treatment strategies.

AIM: The work aimed to determine the prognostic value of the histological type of uveal melanoma and BAP1 expression for survival of patients.

METHODS: We performed a retrospective analysis of the data of 68 patients with uveal melanoma who received curative treatment. A standard procedure was used for the morphological examination of enucleated eyes. BAP1 protein expression was evaluated using immunohistochemistry. Survival was analyzed using Kaplan–Meyer methods and a Cox proportional hazard model.

RESULTS: Median survival in patients with homo- or heterogeneous (focal, mosaic) loss of BAP1 expression was 48 months, whereas patients with homogeneous BAP1 expression of variable degree (mild to severe) did not achieve the median by the end of follow-up. The log-rank test showed statistically significant differences between these groups (χ²=4.344; p=0.037). Mortality risk for patients with homo- or heterogeneous loss of BAP1 expression was 2.6 times higher (HR=2.602, 95% confidence interval: 0.573–0.96). However, mortality risk for patients with epithelioid cell and mixed tumor types was only 1.27 times higher than for patients with spindle cell cancer (HR=1.265, 95% confidence interval: 1.062–2.846).

CONCLUSION: The study highlights the importance of using molecular genetic methods, including immunohistochemistry of BAP1, to predict disease outcomes more accurately.

BACKGROUND: A visual evoked potential test is a common method of electrophysiological examination in ophthalmology. There are no published Russian scientific comparative studies of the results of the visual evoked potential test obtained using different devices.

AIM: The work aimed to perform a comparative analysis of visual evoked potentials obtained using Tomey EP-1000 and Diopsys Nova in healthy participants.

METHODS: The study included a total of 15 patients (30 eyes). The following parameters of visual evoked potentials were assessed: N75/N80 (Tomey EP-1000), P100, and N135 peak latency and P100 and N135 peak amplitude.

RESULTS: The means of the evaluated parameters obtained using Diopsys Nova were higher than those obtained using Tomey EP-1000, except for P100 peak amplitude. A Bland–Altman analysis showed that the mean difference between the P100 peak amplitude values recorded using Diopsys Nova and Tomey EP-1000 was −0.3 μV, and agreement limits of the evaluated parameters varied quite greatly (−5.66 to 4.99 μV). The P100 peak latency varied even greatly and the mean difference between measurements was 3.5 ms, with the quite wide limit of agreement (−4.29 to 11.35 ms).

CONCLUSION: The mean latencies of N70 (pattern 32), P100 (patterns 32 and 64), and P135 (pattern 32) peaks obtained using Diopsys Nova were statistically significantly higher than those recorded using Tomey EP-1000. The obtained results demonstrated that the used measurement methods were inconsistent. However, the performed study is greatly limited by the small sample size, which is a key for interpreting the results. Therefore, to demonstrate that the two methods are consistent, the sufficient sample size should be determined.

BACKGROUND: Zonular weakness caused by pseudoexfoliative syndrome is very common among residents of Northwest Russia. Along with the increasing risk of intraoperative complications, zonular weakness may worsen refractive outcomes of phacoemulsification, as it affects the effective lens position.

AIM: The work aimed to assess the effect of zonular weakness on refractive outcomes of phacoemulsification.

METHODS: The study included data from 282 patients (282 eyes) divided into the following three groups: patients with healthy zonules (n=109; group 1, control), patients with pseudoexfoliative syndrome (n=100; group 2), and patients with grade I lens subluxation caused by pseudoexfoliative syndrome and required capsular tension ring implantation (n=73; group 3). Intraocular lens power was calculated using the SRK/T formula. Optical biometry was performed using IOL-Master 500 device (Carl Zeiss, Germany). The criteria for accuracy of intraocular lens power calculations were the mean calculation error and modulus of the mean calculation error.

RESULTS: The mean calculation errors were 0.00±0.39 D (control), 0.12±0.50 D (group 2), and 0.26±0.59 D (group 3) (p=0.003), indicating a hyperopic shift in groups 2 and 3. The moduli of the mean calculation error were 0.32±0.30, 0.37±0.28, and 0.52±0.45 D, respectively (p <0.001), suggesting lower predictability of refractive outcomes of phacoemulsification in patients with zonular instability.

CONCLUSION: Patients with zonular weakness showed a hyperopic shift caused by a deeper lens position after surgery. To achieve optimal refractive outcomes in this population, A-constant for an intraocular lens should be further optimized.

BACKGROUND: Allergic conjunctivitis involves an inflammatory reaction that destabilizes the tear film and promotes dry eye syndrome. Topical antihistamines may contribute to ocular surface dryness.

Aim: The study aimed to compare the tolerability and clinical effect of topical dual-action anti-allergic agents, including 0.05% epinastine, 0.2% olopatadine, and 0.1% olopatadine, in patients with seasonal allergic conjunctivitis in a standard clinical practice.

METHODS: The study included 33 patients (66 eyes) with seasonal allergic conjunctivitis. The patients were equally divided into three groups to receive 0.05% epinastine (n=11), 0.2% olopatadine (n=11), and 0.1% olopatadine (n=11). Symptom severity was assessed using the itching scale, Efron grading scale, eyelid edema scale, and Munk scale for epiphora grading. Dry eye symptoms were assessed using the Schirmer and Norn tests. The therapy duration was 14±2 days.

RESULTS: By the study end, mean tear film breakup time in the 0.05% epinastine group almost did not change compared to baseline and was 9.4±1.41 s vs. 9.6±1.39 s (OD) and 9.3±1.34 s vs. 9.5±1.43 s (OS). However, in the 0.1% and 0.2% olopatadine groups, it decreased and was 13.9±3.21 s vs. 11.6±2.88 s (OD) (p=0.043), 14.1±3.25 s vs. 11.6±3.06 s (OS) (p=0.019) and 10.63±1.51 s vs. 8.5±1.41 s (OD) (p=0.003), 10.75±1.28 s vs. 8.63±1.3 s (OS) (p=0.003), respectively. The lowest number of adverse reactions was observed in the 0.05% epinastine group.

CONCLUSIONS: 0.05% epinastine caused less dry eye symptoms and was well tolerated in patients with seasonal allergic conjunctivitis.

Premacular hemorrhages are accompanied by a sudden significant vision loss and may originate from by various causes, the most common of which are proliferative retinopathy associated with diabetic eye diseases, ischemic retinal vein occlusion, macroaneurysms, and Valsalva retinopathy. Small hemorrhages (less than 3 disc diameters) often resolve spontaneously, whereas large hemorrhages under the internal limiting membrane have a significantly reduced probability of spontaneous regression and increased risks of complications associated with the toxic effects of hemoglobin breakdown products. The main treatment method in these cases is Nd:YAG-laser membranotomy or hyaloidotomy. It allows effective and safe drainage of blood into the vitreous humor, where it is completely resorbed. The article presents a clinical case of a long-term premacular hemorrhage associated with retinal arterial macroaneurysm. Though Nd:YAG-laser membranotomy was performed late, it not only significantly improved visual functions, but also prevented invasive vitreal procedures. Three-year follow-up revealed no treatment complications.

Laser speckle flowgraphy is a noninvasive method for quantifying perfusion of the retina, choroid, and optic disc. The method is based on the laser speckle phenomenon, which is the speckle pattern visible when vessels are illuminated with an 830 nm diode laser. LSFG Analyzer analyzes the obtained speckle patterns to provide quantitative data on intraocular blood flow. A patient should be physically and emotionally stable and should not eat or drink any stimulating beverages a few hours before the examination. The analysis provides multiple pulse waveform parameters such as blowout score, blowout time skew, acceleration time index, rising rate, falling rate, flow acceleration index, resistivity index, relative flow volume. Laser speckle flowgraphy provides new opportunities for pathogenesis research, diagnosis, and evaluation of the treatment effectiveness for age-related macular degeneration, central serous chorioretinopathy, retinal vein occlusion, diabetic retinopathy, ischemic optic neuropathy, optic neuritis, and other diseases of the retina, choroid, and optic disc. In addition, laser speckle flowgraphy is used to assess the effect of physical activity, pregnancy, systemic diseases, and medications on ocular hemodynamics.

Glaucoma is the main cause of irreversible vision loss in developed countries. Currently, glaucoma is defined as a group of multifactorial diseases with similar clinical, morphological, and functional manifestations. The main cause of blindness is progressive death of retinal ganglion cells, leading to optic neuropathy. Currently, mechanical and vascular mechanisms are suggested to play a key role in the development of primary glaucoma. The mechanical process includes compression of the axons caused by increased intraocular pressure. The vascular component suggests reduced blood flow and ocular perfusion pressure. Examination methods of the eye vasculature in glaucoma are constantly being improved and range from invasive, including angiography with fluorescein and indocyanine intravenous administration, to high-tech non-contact types such as color flow Doppler and pulsed wave Doppler, optical coherence tomography angiography, and laser speckle flowgraphy. This review provides the assessment of retrobulbar and ocular blood flow in patients with glaucoma and ocular hypertension receiving different therapies. Rapidly advancing technologies allow developing and studying highly informative methods for assessing ocular blood flow, thus contributing to better understanding of eye microcirculation and the development of new effective glaucoma therapies.