[Fatty degeneration of upper tarsal muscle as etiological factor of acquired upper eyelid ptosis]. / Zhirovaia distrofiia verkhnei tarzal'noi myshtsy kak étiologicheskii faktor priobretennogo ptoza verkhnego veka.

PURPOSE: To study the histological structure of the upper tarsal muscle (Müller's muscle of the upper eyelid) in patients with acquired ptosis and to confirm the presence of its fatty degeneration as an understudied etiological factor of upper eyelid ptosis. MATERIAL AND METHODS: A retrospective analysis was performed covering 79 biopsy samples of Müller's muscle of the upper eyelid obtained intraoperatively. Histological examination was performed with samples prepared by waxing. Planning the surgery included determination of basic parameters and the 'transparency' symptom; the Müller's muscle projection area was examined in the inverted upper eyelid, and ultrasound biomicroscopy (UBM) of the upper eyelid structures was performed. RESULTS: Among the study subjects, a group of 11 patients with isolated fatty infiltration of the upper tarsal muscle was identified. At the preoperative stage, in the group of patients with upper eyelid eversion, visibly thickened Müller's muscle advancing on the tarsus could be observed, as well as negative 'transparency' symptom; UBM showed thickened 'conjunctiva - Müller's muscle' complex, and a large number of hypoechogenic inclusions in the muscle in comparison with the intact eye. The removed muscle was thickened, yellow, with increased density and rigidity. Microsection of the histological preparations revealed fat cells located among bundles of smooth muscle fibers of the upper tarsal muscle and dispersion of smooth myocytes on the background of fat infiltration. CONCLUSION: The presence of dystrophic changes in the upper tarsal muscle is proved with clinical, macromorphological and pathohistological methods; they can be one of the independent causes of acquired upper eyelid ptosis.

[Choroidal melanoma and retinal changes]. / Melanoma khorioidei i izmeneniia setchatki.

Literary sources suggest the existence of a new phenotype - retinoinvasive choroidal melanoma (CM). However, the factual evidence of its spreading over the inner retinal surface cannot be dismissed. PURPOSE: To study the capabilities of optical coherence tomography (OCT) in terms of finding the ways CM spreads into the retina based on pathomorphological examination of the eyes enucleated due to CM. MATERIAL AND METHODS: OCT tomograms of 64 eyes with CM (mean tumor elevation - 2.89±0.19 mm, diameter - 9.58±0.43 mm) were studied. Pathomorphological study was conducted on 18 eyes with CM elevated by up to 7 mm and without previous treatment. RESULTS: OCT revealed signs of melanoma invading into the retina in 49 eyes. Among those signs were: presence of retina/CM aggregation (21 eyes), tearing of Bruch's membrane and retinal pigment epithelium, disturbed differentiation of outer retinal layers (15 eyes). Combination of two types of invasion was found in 11 eyes. Pathomorphological study showed low mitotic activity of CM and the presence of a small number of fine-local necroses and hemorrhages. Invasion of CM into the retina was determined in 13 eyes. Retinal invasion began with local destruction of Bruch's membrane (BM) and was often limited by the photoreceptor level, disturbing architectonics of the retina and nuclear layers. Large CMs were accompanied by rough destruction of the Bruch's membrane, tumor cells - in the edematous retina with cystoid dystrophy, in its inner layers, invading into the vitreous body. Infiltration of the retina to inner nuclear layer was accompanied by its transudative detachment and cystoid dystrophy. CONCLUSION: Invasion of CM into the retina affecting all of its layers imposes use of OCT to examine the integrity of the retina, even with a tumor of small thickness. Tumoral infiltration of the retina and localization of tumor near the optic disc are two contraindications for local endovitreal resection. Brachytherapy requires consideration of tumor characteristics and thickness of the retina for calculation of apical radiation dose.

[Extraocular muscles involvement in patients with thyroid-associated ophthalmopathy].

AIM: To study morphological features of extraocular muscles in patients with endocrine myopathy taking into account the duration of the disease. MATERIAL AND METHODS: A total of 16 patients with thyroid eye disease were included in the study. After a routine ophthalmic examination, they all underwent extraocular muscle surgery and orbital decompression. The biopsy material obtained at surgery was studied histopathologically. RESULTS: Particular morphological changes have been found in muscles of endocrine myopathy patients. Their relationship to disease duration has been also established. CONCLUSION: Considering endocrine-related morphological changes in extraocular muscles, the favorable period for surgical correction has been defined.