Sensitivity of antibiotic resistant coagulase-negative staphylococci to antiseptic piсloxydin

Background. Coagulase-negative staphylococci (CNS), primarily Staphylococcus epidermidis, predominate in the normal microflora of the eye. However, due to irrational antibiotic therapy, resistant strains are widely distributed among CNS. Aim. To study the sensitivity of the antibiotic resistant CNS isolates to picloxydine, an antiseptic. Methods. The species, sensitivity to antibiotics and picloxydine were determined for 39 isolates of bacteria obtained from the conjunctival swabs. The cells morphology under the antiseptics influence was studied by electron microscopy. Results. 33 isolates of S. epidermidis (17 sensitive or resistant to drugs of no more than 2 classes of antibiotics and 16 MDR), 2 S. haemolyticus (1 resistant to 2 classes of antibiotics and 1 MDR), 3 S. hominis (1 sensitive and 2 MDR), 1 S. caprae (MDR) were characterized. In in vitro tests, picloxydine showed high efficiency in suppressing the growth of staphylococci regardless of their sensitivity to antibiotics, as well as bactericidal activity at concentrations of 15.631.2 g/ml, close to those of chlorhexidine. At these concentrations, the antiseptic had a destructive effect on the surface structures of bacterial cells. Conclusion. The picloxydine antiseptic is equally effective against antibiotic- sensitive and antibiotic-resistant coagulase-negative staphylococci

Роль оптической когерентной томографии переднего отрезка глаза в выявлении предикторов офтальмогипертензии при анти-VEGF терапии

PURPOSE. To identify the predictors of increased intraocular pressure (IOP) after intravitreal injection (IVI) of an antiVEGF drug using anterior segment optical coherence tomography (AS-OCT), and to study changes in the iris-lens diaphragm produced by multiple injections in the treatment of neovascular form of age-related macular degeneration (nAMD).METHODS. IOP was measured with an ICare Pro tonometer before IVI, 1 minute after IVI, 30 minutes, 60 minutes and 180 minutes later. Anterior chamber depth (ACD), anterior chamber angle (ACA), and lens thickness were assessed using Revo NX tomograph (Optopol, Poland). The study was carried out before IVI, one month after the first IVI, one month after the third IVI, one year after the start of treatment. Axial length was measured once before IVI.RESULTS. An inverse correlation was found between axial length and an increase in IOP 1 min after IVI (r=0.65, p<0.001). According to AS-OCT data, one year after the start of treatment there was a significant decrease in ACD compared to the data before treatment (p><0.001), as well as a decrease in all parameters of ACA (p><0.05). Shorter axial length (R2 =0.45, p><0.05), shorter ACD (R2 =0.44, p><0.05), smaller ACA on the nasal (R2 =0.37, p><0.05) and temporal (R2 =0.39, p><0.05) sides in patients with their own lens led to a greater rise in IOP 1 min after IVI.CONCLUSION. Predictors of a sharp increase in IOP after IVI of an anti-VEGF drug in patients with nAMD that can be detected with AS-OCT are shorter ACD and smaller ACA. The following prognostic model was determined — with a 1-mm decrease in the axial length, an increase in IOP by 2.3 mm Hg should be expected, a decrease in ACA from the temporal side by 1° leads to an increase in IOP of 0.28 mm Hg>ЦЕЛЬ. Выявить с использованием оптической когерентной томографии переднего отрезка глаза (AS-OCT) предикторы повышения внутриглазного давления (ВГД) после интравитреальной инъекции (ИВИ) анти-VEGF препарата и изучить изменения иридо-хрусталиковой диафрагмы на фоне многократных инъекций при лечении неоваскулярной формы возрастной макулярной дегенерации (нВМД).МЕТОДЫ. В исследование было включено 30 пациентов с впервые диагностированной нВМД. ВГД измеряли тонометром ICare Pro до ИВИ, через 1 минуту после ИВИ, затем через 30, 60 и 180 минут. При помощи томографа Revo NX (Optopol, Польша) оценивали глубину передней камеры (ГПК), размеры угла передней камеры (УПК) и толщину хрусталика. Исследование проводили до ИВИ, через месяц после первой ИВИ, через месяц после третьей ИВИ и через год после начала лечения. Исследование переднезадней оси глаза (ПЗО) проводили однократно до ИВИ.РЕЗУЛЬТАТЫ. Была найдена обратная корреляция между ПЗО и повышением ВГД через 1 минуту после ИВИ (rxy=0,65; p<0,001). Через год от начала лечения на фоне анти-VEGF терапии по данным AS-ОCТ было определено достоверное уменьшение ГПК по сравнению с данными до лечения (р><0,001), а также уменьшение всех параметров УПК (р><0,05). Меньшие размеры ПЗО (R2 =0,45; p><0,05), меньшая ГПК (R2 =0,44; p><0,05), меньшие размеры УПК с носовой (R2 =0,37; p><0,05) и височной стороны (R2 =0,39; p><0,05) приводили у пациентов с собственным хрусталиком к большему подъему ВГД через 1 мин после ИВИ.ЗАКЛЮЧЕНИЕ. К предикторам резкого повышения ВГД после ИВИ анти-VEGF препарата у пациентов с нВМД по данным AS-ОCТ относятся меньшие размеры ГПК и УПК. Выявлена прогностическая модель — при уменьшении размеров ПЗО на 1 мм следует ожидать увеличения ВГД на 2,3 мм рт.ст., уменьшение УПК с височной стороны на 1° ведет к увеличению ВГД на 0,28 мм рт.ст&gt

Результаты комбинированного антиангиогенного воздействия на новообразованные сосуды роговицы. экспериментально-морфологическое исследование

Results of comparative experimental and morphological study of activity on corneal neovascularization in rabbit’s eye of photodynamic therapy with Photosense and antiangiogenic therapy with Avastin (bevacizumab) alone, and in its combination are represented. The treatment was performed in regimens: 1) photodynamic therapy with Photosense (single intravenous injection in dose of 0.3 mg/kg 72 h prior to laser irradiation, power density of irradiation 500 mW/cm2, wavelength 675 nm); 2) drug antiangiogenic therapy with Avastin (single subconjuctival introduction at dose of 1.25 mg); 3) photodynamic therapy with Photosense (in described regimen) in combination with subconjuctival introduction of Avastin at dose of 1.25 mg immediately prior to irradiation. Combined photodynamic therapy with antiangiogenic therapy allows to obtain almost complete occlusion in all regions of corneal neovascular bed with shorter time interval comparing with those for monoregimens. In case of blood flow retention in great vessels courses of combined modality treatment may be repeated. The absence of side-effects on surrounding tissues and the recovery of optical characteristics of cornea may allow to use this upcoming method in clinical practice. Приведены результаты сравнительного экспериментально-морфологического исследования влияния на новообразованные сосуды роговицы глаза кролика фотодинамической терапии с препаратом фотосенс и медикаментозной антиангиогенной терапии с препаратом авастин (бевацизумаб) в режиме монотерапии, а также их сочетанного применения. Лечение проводили в режимах: 1) фотодинамическая терапия с препаратом фотосенс (однократное внутривенное введение в дозе 0,3 мг/кг за 72 ч до лазерного облучения, плотность мощности лазерного облучения 500 мВт/см2, длина волны 675 нм); 2) медикаментозная анти- ангиогенная терапия с препаратом авастин (однократное субконьюнктивальное введение в дозе 1,25 мг); 3) фотодинамическая терапия с препаратом фотосенс (в указанном режиме) в сочетании с субконьюнктивальным введением препарата авастин в дозе 1,25 мг непосредственно перед проведением облучения. Показано, что при сочетанном применении фотодинамической и антиогенной терапии можно добиться практически полной окклюзии во всех отделах новообразованного сосудистого русла роговицы, причем в более короткий промежуток времени по сравнению со временем лечения в монорежимах. В случае сохранения кровотока в крупных магистральных сосудах возможно проведение повторных курсов комбинированного лечения. Отсутствие побочного воздействия на окружающие ткани и восстановление оптических свойств роговицы возможно позволит в перспективе использовать предложенный метод в клинической практике.

Влияние офтальмогипертензии на изменение слоя нервных волокон сетчатки и перфузию диска зрительного нерва на фоне лечения препаратом бролуцизумаб у пациентов с неоваскулярной формой возрастной макулярной дегенерации

PURPOSE. To evaluate the effect of elevated intraocular pressure (IOP) after multiple intravitreal injections (IVI) of brolucizumab on changes in the retinal nerve fiber layer (RNFL) and perfusion of the optic nerve head.METHODS. The study included 20 patients with newly diagnosed exudative form of age-related macular degeneration (AMD). All patients underwent IVI of brolucizumab. IOP measurements were taken with an ICare Pro tonometer before IVI, one minute after IVI, then after 30 minutes and 180 minutes. Thickness of the peripapillary RNFL was measured using Spectralis OCT (Heidelberg Engineering, Germany). The optic disc was examined using OCT angiography on Revo NX (Optopol Technology SA, Poland). All studies were carried out before the start of treatment, after one month, after the third injection, and one year after the start of treatment.RESULTS. Analysis of peripapillary scans in a patient with a history of multiple IVI a year after the start of treatment with brolucizumab showed a statistically significant decrease in perfusion density and fractal dimensions (skeleton) in the entire optic nerve head (ONH) (p<0.001), in the inner ONH area (p<0.001, p=0.01, respectively), in the nasal sector (p=0.03, p=0.04, respectively), temporal sector (p<0.001) and inferotemporal sector (p=0.03) according to OCT angiography. It was determined that a greater increase of IOP one min after IVI was associated with a greater decrease in the density and fractal dimensions of the radial peripapillary capillaries of the inner ONH (p=0.005, rs=0.5; p=0.004, rs=0.6, respectively). A decrease in RNFL thickness was found one year after the start of IVI treatment with brolucizumab (p<0.001).CONCLUSION. According to OCT angiography, vascular perfusion density of the ONH was decreased during IVI of brolucizumab, and RNFL thickness was also decreased one year after the start of treatment.ЦЕЛЬ. Оценить влияние повышения внутриглазного давления (ВГД) после многократных интравитреальных инъекций (ИВИ) препарата бролуцизумаб на изменение слоя нервных волокон сетчатки (СНВС) и перфузию диска зрительного нерва (ДЗН).МЕТОДЫ. В исследование было включено 20 пациентов с впервые диагностированной экссудативной формой возрастной макулярной дегенерацией (ВМД). Всем пациентам были проведены ИВИ препарата «Визкью» (бролуцизумаб). ВГД измеряли тонометром ICare Pro до ИВИ, через 1 минуту, 30 минут и 180 минут. Измеряли толщину перипапиллярного СНВС с помощью оптической когерентной томографии (ОКТ). Исследование ДЗН проводили при помощи ОКТ-ангиографии. Исследования проводили до начала лечения, через месяц после 3-й ИВИ и через год от начала лечения.РЕЗУЛЬТАТЫ. По данным ОКТ-ангиографии, при анализе перипапиллярных сканов на фоне многократных ИВИ через год от начала лечения бролуцизумабом показано статистически значимое снижение плотности перфузии и фрактальной размерности во всем ДЗН (p<0,001), в области внутри ДЗН (соответственно, p<0,001; p=0,01), в носовом секторе (соответственно p=0,03; p=0,04), височном секторе (p=0,001) и нижневисочном секторе (p=0,03). Было определено, что большее повышение ВГД через 1 мин после ИВИ ассоциировалось с бо́льшим снижением плотности и фрактальной размерности радиальных перипапиллярных капилляров области внутри ДЗН (соответственно, p=0,005 и rs=0,5; p=0,004 и rs=0,6). При анализе толщины СНВС в перипапиллярной области было обнаружено уменьшение толщины СНВС через год от начала лечения ИВИ бролуцизумабом (p<0,001). ЗАКЛЮЧЕНИЕ. На фоне многократных ИВИ бролуцизумаба по данным ОКТ-ангиографии были определены снижение ангиографической плотности перфузии ДЗН, также отмечалось уменьшение толщины СНВС через год от начала лечения ИВИ бролуцизумабом

Differential diagnosis of hydroxychloroquine-induced retinal damage

Coronavirus infection is currently en extremely relevant scientific topic due to the emergence of a new serotype that causes a condition identified as Severe Acute Respiratory Syndrome (SARS)-COV-2. Chloroquine and hydroxychloroquine have a long history of use against other infectious diseases, they are available and inexpensive, so the possibility of using them in vivo and in vitro to suppress the infectious agent was examined. Despite the noted therapeutic potential of these drugs, it was necessary to take into account the toxicological aspects that dictate the importance of rational use of 4-aminoquinoline derivatives. This review analyzes literature on the development patterns of hydroxychloroquine retinopathy, basic principles of diagnosis and differentiation of this condition from other types of retinal pathology

Nutritional Supplements in the Prevention of Age-Related Retinal Pathology

Oxidative stress due to the imbalance in the production and detoxification of reactive oxygen species in antioxidant defence system of the body, as well as subsequent chronic inflammation, is believed to be associated with age-related eye diseases. Prevention of chronic degenerative diseases such as age-related macular degeneration (AMD) and primary open-angle glaucoma are of particular interest. In the last decade, tremendous success has been achieved in the treatment of age-related retinal pathology. However, these treatments are expensive and require frequent monitoring and, in some cases, injections, which place a huge burden on both the healthcare system and patients. Consequently, considerable interest remains in preventing or slowing the progression of these diseases. Epidemiological studies have shown that diet is a modifiable risk factor for AMD, and nutritional modification with food antioxidant supplements is a particularly attractive method of prevention because of its potential benefits and relatively low cost. A large number of experimental studies, including clinical studies in animals and humans, have provided supporting evidence that antioxidant food additives inhibit the oxidation of macromolecules, as well as an inflammatory response that occurs in the pathogenesis of involutional retinal pathology, which ultimately inhibits its development and progression. This review discusses the role of antioxidant dietary supplements in the prevention of age-related retinal pathology

THE ROLE OF ENDOTHELIN-1, HIF1α, HIF2α IN RETINAL VEIN OCCLUSION

The problem of development and course of retinal venous occlusions (RVO) is relevant for today. The etiology of development of the RVO is multifaceted, and has not been fully studied. One of the main reasons for the decline in vision is the development of macular edema. The main problem in the treatment of macular edema is the difficulty in predicting increased visual acuity when disease is combined with retinal ischemia. One of the risk factors for the development of ischemia is endothelial dysfunction, whose important markers are endothelin-1 and hypoxia-inducible factors (HIF1α, HIF2α). Aim of the study was to evaluate the effect of the systemic level of endothelin-1 and hypoxia factors on the course of retinal venous occlusions. Material and methods. Content of the main markers of endothelial dysfunction (endothelin-1, HIF1α, HIF2α) was measured in 137 patients with RVO, among them 59 patients with central retinal vein occlusion and 78 - with central retinal vein branch occlusion. The average age of the patients was 73.35 ± 7.6 years. The level of markers of endothelial dysfunction was determined in serum by ELISA. Results and discussion. A statistically significant increase in endothelin-1 content in patients with optic nerve edema ( p = 0.018) was found. There were no statistically significant data on the effect on the course of the RVO of hypoxia factors HIF1 α and HIF2 α. Conclusion. Assessment of main markers indices of endothelial dysfunction can be used for understanding the etiology of RVO development and the correct tactics of the patients’ treatment forming

COMPARISON OF CLINICAL AND REAL-LIFE TRiaLS OF THE EFFECTIVENESS OF ANTI-VEGF THERAPY FOR age-related macular degeneration

In recent years, the approaches to assessing results have been changed in both clinical and real life trials with the introduction of Aflibercept to clinical practice. In most countries, ranibizumab and aflibercept are licensed for the treatment of neovascular age-related macular degeneration (AMD). The assessment of the treatment effectiveness and economic cost was carried out within the frame of different clinical trials with existing strict limitations. The article reviews the results of studies conducted in various clinical trials. Data on long-term follow-up after anti-VEGF therapy for neovascular AMD form, especially in real-life studies, are limited. In the framework of the HORIZON study, representing an extended four-year follow-up of ANCHOR and MARINA patients, the gradual reduction in visual acuity has been revealed in the first 2 years of follow-up period. The re-examination of 10 % of patients from the initial ANCHOR and MARINA studies has been described in the SEVEN-UP study; herewith the decrement in visual activity has been detected after 7 years on the beginning of the clinical studies examination (loss of 8.6 letters against initial letter). The data obtained can not be directly transmitted into routine clinical practice, due to the patients’ inclusion and exclusion Criterion presence, protocols for the introduction of drugs, etc. A study of the therapy’s effectiveness and economic cost in real time allows optimizing the treatment of patients with neovascular AMD

Maculopathy Development Mechanism in Choroid Tumor Localization Outside the Foveolar Zone

The term “distant maculopathy” (DM) means the changes in the macular region, when the tumor is located at the distant from it. Purpоse: to study the peculiarities of the DM development, according to the tumor localization and present a possible mechanism of this symptom development. Patients and Methods. The study involved 53 patients with choroidal tumors localized outside the macular area, including 18 patients with neuroepithelial detachment (NED) in the macular area. In addition to the standard eye examination, all patients underwent EDI OCT. Results. In 1/3 cases of extrafoveolar located choroidal tumors according to OCT, exudative changes in the macular zone were revealed. In extrafoveral choroidal melanoma (CM), the biometric tumor parameters in patients with DM were slightly higher than the average in patients of this group, however, there was no correlation between the height of NED and tumor parameters. In extrafoveolar choroidal hemangioma (CH), a significant direct relationship between the height of the NED in the foveolar zone and the biometric parameters of the CH was found. In all cases, there was not choroidal elevation in the foveolar zone. The thickness and structure of the choroid in the subfoveolar zone in CM did not differ from the paired eye and the normal values. The thickness of the choroid in CH also did not differ from the paired eye, however, there was a slight expansion of the outer layers of the choroid (as in the paired eye) and an increase in its thickness compared with the norm. When a tumor is located above the macular zone, there is a “gravitational” mechanism for the development of DM, due to the spread of subretinal fluid (or blood) under the action of gravity. In case of juxtapapillar tumor localization, the appearance of DM is caused by microvascular disorders in the foveo-macular region of the retina and impaired axoplasmic current. In CM, the occurrence of NED may be associated with a retinal tension on the steeper side of the tumor. Conclusion. The development of distant maculopathy in CM is a sign of “active” tumor growth, in CH it develops later and depends on the size of the tumor. In identifying a high prevalent NED in the macular area, a careful examination of not only the central fundus zone, but also its peripheral parts is necessary