Corneal edema caused by undiagnosed iridocorneal endothelial syndrome after SMILE

The aim. To present a clinical case of a patient with corneal edema caused by undiagnosed iridocorneal endothelial syndrome after SMILE surgery. Iridocorneal endothelial syndrome is characterized by abnormal proliferation of the corneal endothelium beyond the Schwalbe line, blockade of the iridocorneal angle, specific changes in the shape of the pupil and the formation of synechiae between adjacent structures of the anterior chamber angle of the eye, which is accompanied by the development of pretrabecular retention of intraocular aqueous humour, increased intraocular pressure (IOP) and subsequent development of glaucoma in 46–82 % of patients. One of the forms of the disease is Chandler’s syndrome, which clinically in the initial stages may be accompanied by the formation of only moderate ectropion. At the same time, endothelial dysfunction is characterized by a significant decrease in the number of cells, a change in their shape and the appearance of epithelioid cells with a hyper-reflective nucleus (the so-called “ICE (iridocorneal endothelial) cells”), with a violation of their natural pumping function. The article presents a clinical case of a patient who underwent a standard examination and symptomatic treatment after laser keratorefractive surgery for myopia correction. Low visual acuity, diffuse corneal edema, IOP decompensation of unclear genesis were observed in one operated eye. Conclusion. Keratorefractive operations can act as a trigger that stimulates the transition of the latent form into a clinically developed pathological process, which causes a decrease in corrected visual acuity due to the formation of corneal edema and glaucoma optic neuropathy

Optical coherence tomography in the diagnosis and monitoring of congenital and juvenile glaucoma

Optical coherence tomography (OCT) in everyday routine practice is the method of choice for the instrumental diagnosis of glaucoma in adults. As a non-invasive and safe method of visualizing structural changes in the retina and the optic nerve, the method is of particular value in pediatric practice. At the same time, OCT diagnostics in children is associated with certain difficulties, both during the study and when interpreting the scan results.This review summarizes the data from the literature and our own research in the diagnosis and monitoring of congenital and juvenile glaucoma from the standpoint of our own long-term clinical experience in using optical coherence tomography. We consider the physiological changes of the retina and optic nerve, attention is focused on the need to create a pediatric regulatory database of retinal thickness, the factors that determine the normal range of the data obtained and allow distinguishing physiological processes from pathological ones are identified. Clinical cases confirming the value of OCT in combined pathology are presented as examples

The concept of comorbidity of dyscirculatory encephalopathy and vascular optical neuropathy (literature review)

The analysis of literature data on ischemic damage to the brain and the organ of vision was carried out in order to study etiological factors, pathogenetic processes, parallel flow and mutual influence of two nosological forms: dyscirculatory encephalopathy and vascular optic neuropathy. According to the World Health Organization, there is much more people suffering from cardiovascular diseases: atherosclerosis, hypertension, diabetes mellitus and coronary heart disease. These diseases result in ischemic damage to a number of vital organs, including the central nervous system and the visual analyzer. Chronic vascular pathology of both the brain and the eye is one of the leading causes of patients’ life quality decrease of and their disability. The “triggering” causes of brain and eye damage, according to researchers, are cerebral atherosclerosis, elevating/fluctuating blood pressure, coronary heart disease, and carbohydrate metabolism disorders. Disorders of the systemic blood supply caused by these etiological factors lead to a progressive lack of oxygen supply to organs and tissues, followed by the development of intracellular and cellular hypoxia, and an ischemic intracellular cascade of biochemical disorders leading to dysfunction and sometimes cell death.In addition to direct hypoxic-ischemic damage of the nervous and visual systems cells, endothelial dysfunction contributes to the progression of these diseases, leading to a pronounced change in the wall at the level of small vessels, a change in its reactivity and a violation of the coagulation properties of blood, and as a consequence, to a gradual accumulation of ischemic and secondary degenerative changes in brain and eye cells.Knowledge of etiological factors and patterns of development of brain and eye combined ischemic damage can allow clarifying the complex of diagnostic measures, developing preventive measures, as well as prescribe pathogenetically justified treatment of existing pathology

Genetic Types of Inheritance of Retinal Pigment Abiotrophy in Patients Living in “Closed” Communities in the Republic of Buryatia

Retinal pigment abiotrophy is a hereditary disease with a primary diffuse lesion of photoreceptors and the retinal pigment epithelium, in which characteristic functional changes and a typical picture of the fundus with pigment bone bodies are noted. Retinal pigment abiotrophy is the most common disease of all dystrophies of the retina.Aim. To do a clinical genealogical analysis of the type of inheritance of pigmentary retinitis in residents of Tarbagatai region of the Republic of Buryatia.Material and methods. At the first stage of the study, a round between the residents of Tarbagatai region of the Republic of Buryatia was conducted by interviewing and questioning. At the second stage, people with suspected pigment retinitis and their blood relatives underwent a full ophthalmologic examination to confirm the diagnosis, and a thorough collection of genealogical information was carried out to determine the type of inheritance.Results. 20 patients were allocated from 12 families of 1237 interviewed people aged 15 to 76 years living in a closed community in the territory of Buryatia in the Tarbagatai region, 12 of them with a presumptive diagnosis of retinitis pigmentosa, with signs of Usher syndrome (retinitis pigmentosa + sensorineural hearing loss) – 8 people. In general, the analysis of 20 pedigrees with an established type of inheritance in 89.9 % of cases revealed an autosomal recessive type; in 10.1 % – autosomal dominant type of retinitis pigmentosa.Conclusion. A complete collection of genealogical history is the basis for the diagnosis of hereditary eye diseases

Characteristics of Somatic Status and Individual Biochemical Markers in Patients with Retinal Vein Occlusion

Retinal vein occlusion is one of the most severe vascular lesions of the organ of vision, usually accompanied by somatic pathology.The aim of the study was to study the somatic status and individual biochemical markers in patients with retinal vein occlusion and comparison in groups opposing the effectiveness of anti-VEGF therapy.Methods. 84 patients with macular edema were examined on the background of retinal vein occlusion, who underwent intravitreal injections of an angiogenesis inhibitor for therapeutic purposes. Further, depending on the effectiveness of treatment, the patients were divided into 2 groups, in which a retrospective comparative analysis of somatic status and laboratory data was performed.Results. It was shown that patients with occlusion of the retinal veins have significant impairments in terms of somatic status, blood biochemical parameters and coagulogram. Moreover, there is a direct relationship between the severity of somatic changes and ocular manifestations of the disease. The data obtained reflect a clear tendency in patients with occlusion of the retinal veins to a high risk of cardiovascular complications, including occlusive lesions. In patients with an insufficient treatment effect, a more severe course of arterial hypertension with an increased risk of stratification was detected.Conclusion. The somatic status and laboratory parameters of patients with retinal vein occlusion are significantly different from the norm, which must be taken into account in the prognosis of the course of an ophthalmologic disease

The Analgetic Efficacy of Pterygopalatine Blockade for Pain Treatment in Adults: a Systematic Review and Meta-Analysis

Background. The use of regional blockades for the purpose of analgesia is widely used in all fields of medicine, however, the analgesic efficacy of the pterygopalatine blockade, as an independent method of treating pain of various genesis, has not been studied enough. Therefore, there is a need to analyze the results of clinical trials to evaluate the analgesic efficacy of the pterygopalatine blockade as an independent method of anesthesia.Objective — to investigate the analgesic effect of pterygopalatine blockade as a monotherapy in patients with pain of various origins of oculotemporal area, conducting a meta-analysis of published results of randomized clinical trials.Methods. The methodology involved a systematic literature search by means of PubMed, MEDLINE, EMBASE, and Cochrane Library search engines. The search covered the period of the past 10 years and had the following criteria: a double-blind, randomized, controlled study of the use of pterygopalatine blockade with a local anesthetic versus placebo. For each included study, a standardized magnitude of the analgesic effect of pterygopalatine blockade compared to placebo was calculated, with pain assessing in 15, 30, and 60 minutes after the blockade was performed. Meta-analyses were conducted for each endpoint. Meta-analysis was performed using Stata 11.0 application programs ((The Cochrane Collaboration, Oxford, United Kingdom).Results. Five randomized controlled trials involving 269 patients met the inclusion criteria, and involved analyzing the pterygopalatine blockade with local anesthetic (n=140) against placebo (n=129). In 15 minutes after pterygopalatine blockade was performed, the difference in mean pain intensity compared to the control group was -2.5 points, the mean level was lower in the pterygopalatine blockade group, MD=-2.5 [95% CI -3.7; -1.7]. After 30 minutes: -2.7 points, MD=-2.7 [95% CI -4.5; -1.5], after 60 minutes: -1.7 points, MD=-1.7 [95% CI -4.0; -0.5]. The relative risk of adverse effects, such as nasopharyngeal symptoms, after performing a pterygopalatine blockade with a local anesthetic accounted for (RR =1.31 [95% CI 0.5–3.04]). In this regard, the incidence of complications and their variants that can be caused by pterygopalatine blockade is a matter for further clinical research.Conclusion. The results obtained in the meta-analysis testify to the analgesic effect of the pterygopalatine blockade as a monotherapy in patients with pain of different origins oculotemporal area in 15, 30, and 60 minutes after its performance. These data may be relevant when choosing a method for first-line anesthetic management of pain syndrome of oculotemporal area

The Role of Biologically Active Aqueous Humor Molecules of the Anterior Chamber and Lacrimal Fluid in the Implementation of the Hypotensive Effect of Non-Penetrating Deep Sclerectomy

To date, the factors affecting the course of the reparative process after non-penetrating deep sclerectomy (NPDS) have not been fully determined. There is no systematic information about the regulatory role of the cytokines TGF-β, IL-6, IL-8 and MMP-9, VEGF A 121 and 165 in the formation mechanisms of the newly created pathways consistency of intraocular aqueous humor outflow.Purpose. To determine possible ways of impact of biologically active aqueous humor molecules of the anterior chamber and lacrimal fluid on the hypotensive effect of non-penetrating deep sclerectomy.Methods. A prospective study of 65 patients with open-angle glaucoma before and 12 months after NPDS and 22 patients without eye hydrodynamic disorders with the determination of the initial concentrations of biologically active molecules in the lacrimal fluid and aqueous humor of the anterior chamber. Twelve months after NPDS all patients were divided into three groups, depending on the hypotensive effect of the operation, according to the criteria.Results. Multivariate discriminant analysis showed the greatest inter-group differences, calculated by the square of the Mahalanobis distance, between group 3 with no hypotensive effect of NPDS and the control group (R2 = 8.48, p = 0.001). The most informative features that determine the differences between the 4 groups in the total population, calculated according to the Fischer F-test, were MMP-9 (F = 14.7, p = 0.001) and TGF-β (F = 7.08, p = 0.001) in the aqueous humor of the anterior chamber. In pairwise comparison of groups 1 and 2, the maximum level of significance according to the F-criterion was characteristic of the level of tear IL-6 (F = 21.25, p = 0.001), with approximately equal degree – IL-8 (F = 7.85, p = 0.001) and VEGF (F = 7.12, p = 0.001), to a lesser extent TGF of aqueous humor (F = 4.43, p = 0.001) and MMR-9 (F = 2.23, p = 0.001). Between groups 1–3, the maximum differences according to the Fisher criterion were observed in the IL-8 (F = 20.99, p = 0.001), TGF (F = 8.75, p = 0.001) and to a lesser extent – TGF (F = 5.83, p = 0.001).Conclusion. The analysis of the obtained data showed the decisive role of the imbalance of proinflammatory cytokines, signaling proteins with prolymphoangiogenic activity, and MMP-9 in the aqueous humor of the anterior chamber, as well as in the initial state of the lacrimal fluid in the postoperative healing processes after NPDS

Diagnostic Criteria for Macular Edema Associated with Venous Occlusions

Background. Macular edema is considered as a risk factor for a significant decrease in the visual acuity and quality of life of the patient, regardless of its cause. The search for the causes of macular edema in some cases should include an interdisciplinary approach and laboratory studies to correctly determine its etiology and management tactics for such patients. Therefore, the differentiation of the etiology and pathogenesis of macular edema at the stage of diagnosis determines the possibility of preserving not only visual functions, but in some cases the patient's life.Aim: to present clinical cases of macular edema associated with central retinal vein thrombosis of various etiologies. Materials and methods. A prospective study of individual patients with macular edema associated with thrombosis of central retinal vein or its branches was conducted in real clinical practice. All patients underwent a standard ophthalmological examination, as well as optical coherence tomography, and a patient with suspected macroglobulinemia underwent a biochemical blood test.Results. In the first clinical case, macular edema was associated with an exudative form of retinal arterial macroaneurysm. The patient underwent direct laser coagulation of retinal arterial macroaneurysm. 6 months after direct laser coagulation of macroaneurysm, the best corrected visual acuity of the left eye was 1.0. The fundus - macroaneurysm, retinal edema, solid exudates are not ophthalmoscopic. In the second clinical case, macular edema, thrombosis of central retinal vein is associated with Waldenstrom disease. Follow-up and treatment of the underlying disease by a hematologist were recommended.Conclusion. Thus, macular edema proceeding against the background of central retinal vein thrombosis and its branches, having atypical symptoms in the form of ring-shaped deposition of hard exudates, exudative retinal detachment, the presence of a bilateral process, as well as resistance to anti-VEGF therapy require a careful collection of the patient's medical history and the presence of other ophthalmic vascular pathology

Autoimmune polyglandular syndrome type 1 and eye damage

Autoimmune polyendocrine syndrome type 1 (APS type 1) is a disease characterized by a variety of clinical manifestations resulting from the involvement of multiple endocrine and non-endocrine organs in the pathological process. APS type 1 is a rare genetically determined disease with autosomal recessive inheritance. Mutations in the autoimmune regulator gene (AIRE) lead to a disruption of the mechanism of normal antigen expression and the formation of abnormal clones of immune cells, and can cause autoimmune damage to organs. Within APS type 1, the most common disorders are primary adrenal insufficiency, hypoparathyroidism, and chronic candidiasis. Some understudied clinical manifestations of APS type 1 are autoimmune pathological processes in the eye: keratoconjunctivitis, dry eye syndrome, iridocyclitis, retinopathy, retinal detachment, and optic atrophy. This review presents the accumulated experimental and clinical data on the development of eye damage of autoimmune nature in APS type 1, as well as the laboratory and instrumental methods used for diagnosing the disease. Changes in the visual organs in combination with clinical manifestations of hypoparathyroidism, adrenal insufficiency and candidiasis should lead the clinical doctor to suspect the presence of APS type 1 and to examine the patient comprehensively. Timely genetic counselling will allow early identifi cation of the disease, timely prescription of appropriate treatment and prevention of severe complications

Neurophysiological Changes in Patients with Discirculatory Encephalopathy Associated with Ischemic Optic Neuropathy

Background. The most common chronic cerebrovascular pathology is dyscirculatory encephalopathy, in which a decrease in blood supply due to damage to brachiocephalic vessels leads to damage to brain substances and analyzers, including visual, with the possible development of severe damage in the form of ischemic optic neuropathy. Many studies have been devoted to the relationship between atherosclerotic damage to the neck vessels and ischemic damage to the visual organ, but little attention has been paid to the study of the functional activity of the altered visual analyzer in patients with dyscirculatory encephalopathy, and the results are scattered. Aim. To conduct a comparative analysis of changes in neurophysiological parameters of the brain and visual analyzer in patients with dyscirculatory encephalopathy and patients with a combination of dyscirculatory encephalopathy and ischemic optic neuropathy. Materials and methods. 34 patients with the 2nd stage of dyscirculatory encephalopathy were examined and divided into two groups based on the presence/absence of ischemic optic neuropathy of various prescription periods. All patients underwent ultrasound scanning of neck vessels, visual fields determination, electroretinography, visual evoked potentials, and electroencephalogram. Results. The results revealed changes in a number of indicators in the group of patients with a combination of two diseases: more pronounced atherosclerotic lesion of brachiocephalic vessels, a decrease in the amplitude and the alpharhythm prevalence index, a decrease in oscillatory potentials, a change in latency and amplitudes the visual analyzer according, lengthening of time indicators with a simultaneous decrease in amplitudes and depression of retinal sensitivity. Conclusion. Patients with dyscirculatory encephalopathy complicated by ischemic optic neuropathy have a combined lesion of the brain and visual analyzer, which determines the severity of the detected changes and requires a comprehensive multidisciplinary approach to the treatment of these patients