[Subthreshold micropulse laser treatment of the foveal region in chronic central serous chorioretinopathy (case study)]. / Subporogovoe mikroimpul'snoe vozdeistvie v foveal'noi oblasti pri khronicheskoi tsentral'noi seroznoi khorioretinopatii (klinicheskoe nablyudenie).

The article presents a clinical case of subthreshold micropulse laser (SML) treatment of chronic central serous chorioretinopathy (CSC) in the left eye of a 44-year-old female patient K. with dye allergy. The patient first noticed a gray spot, distortion of objects in February, 2018. During 2018-2020 she suffered 5 relapses, repeated unsuccessful conservative treatment, and completed a course of antiangiogenic therapy in the form of three monthly intravitreal injections of ranibizumab. After experiencing stress on 11.08.20 she noted acute deterioration. Laser treatment was carried out on 20.09.20 with the Navilas 577s navigation system (wavelength 577 nm). After the power titration and calculation, the contact-free subthreshold micropulse laser treatment was carried out without anesthesia in three zones: 200 mW for fovea, 240 mW for parafovea and 340 mW for periphovea. Other settings: pulse duration - 200 ms, spot diameter - 100 µm, duty cycle - 5%. Total number of laser pulses - 1000. The retina reattached completely despite the patient having previously recovered from the coronavirus infection and the use of corticosteroids.

[Age-related changes in human vitreous]. / Vozrastnye izmeneniya steklovidnogo tela.

There are two main age-related changes that can occur in the vitreous body of healthy individuals throughout life: liquefaction (synchesis) and aggregation of collagen fibrils into dense bundles (syneresis). Progressive age-related degradation leads to posterior vitreous detachment (PVD). At present many classifications of PVD exist, in which authors relied either on the morphological features, or on the differences in pathogenesis before and after widespread use of OCT. The course of PVD can be either normal or anomalous. Physiological PVD induced by age-related vitreous changes progresses in specific stages. The review emphasizes that PVD can occur initially not only in the central zone of the retina, but also on the periphery with further spread to the posterior pole. Anomalous PVD can lead to various negative effects on the retina, as well as on the vitreous as a result of traction in the area of vitreoretinal interface.

[Widefield optical coherence tomography as an effective method for detecting imperceptible flap retinal tears (clinical observation)]. / Shirokopol'naya opticheskaya kogerentnaya tomografiya ­ effektivnyi metod vyyavleniya klapannogo razryva setchatki (klinicheskoe nablyudenie).

Certain late peripheral ruptures after acute posterior vitreous detachment (PVD) may remain undetected during the initial examination of the fundus due to the presence of vitreous hemorrhages and other factors, but they can lead to rhegmatogenic retinal detachment in the future. Hence, it is necessary to conduct an additional thorough examination using optical coherence tomography (OCT) of the vitreoretinal interface periphery in the presence of tear predictors: retinal and vitreal hemorrhages, vitreous pigment cells ("tobacco dust") in the anterior segment of the vitreous body, as well as hyper-reflective dots ("starry sky") in the vitreous body according to OCT scans of patients with acute symptomatic detachment of the hyaloid membrane. The article presents the case of a patient with a clinically imperceptible flap tear detected during acute posterior vitreous detachment. Widefield OCT of the vitreoretinal interface was performed by "sliding" from the center to the periphery of the retina, and revealed a flap tear located next to a dot retinal hemorrhage. OCT scanning of the retinal periphery is an effective modern diagnostic method in the ophthalmological clinical practice.

[OCT visualization of hyporeflective lacuna in the retrolental space]. / OKT-assotsiirovannaya vizualizatsiya giporeflektivnoi lakuny v retrolental'nom prostranstve.

PURPOSE: To investigate the vitreo-lenticular interface and anterior vitreous using high-resolution optical coherence tomography (OCT). MATERIAL AND METHODS: This prospective single-center pilot study included 34 patients (68 eyes) - 6 males and 28 females with a mean age of 58.4±12.0 years (age range 24-81 years). OCT scanning was performed on the spectral domain optical coherence tomography (SD-OCT) device SOLIX (OPTOVUE, USA) in the Full Range AC mode with the following scan parameters: from 14 to 18 mm in horizontal length and 6.25 mm in the axial dimension. To improve the signal-to-noise ratio and increase image clarity of the final scan, averaging of eight simultaneous scans was performed. RESULTS: In all healthy volunteers, hyporeflective retrolental cavities-lacunae were observed in both eyes during visualization of the retrolental space in the horizontal and vertical planes. The median distance from the posterior pole of the lens to the lacuna was 697 µm. The median width of the lacuna was 157 µm. CONCLUSION: To the best of our knowledge, we consider this to be one of the first in vivo visualizations of a previously undescribed structure - hyporeflective retrolental lacuna - using SOLIX high-resolution OCT device. The retrolental lacuna may play the role of a buffer system, or belong to the lymphatic system of the vitreous body and the eye.

[Retrolental amyloidosis of the vitreous body (case study)]. / Retrolental'nyi amiloidoz steklovidnogo tela (klinicheskoe nablyudenie).

Accumulations of pathological amyloid protein in the vitreous can be a pathognomonic morphological sign of systemic amyloidosis, which is characterized by deposition of insoluble fibrillar protein aggregates (amyloid) in various organs and tissues. The article describes a clinical case of a female 65-year-old patient with bilateral vitreous floaters and histologically confirmed vitreous amyloidosis on the right eye. The patient had undergone YAG laser vitreolysis of the right eye 3 years ago on the Ultra Q Reflex system («Ellex¼, Australia) to treat an atypical Weiss ring. Diagnosis of vitreous amyloidosis was confirmed using the following equipment: video slit lamp SL9900 («CSO¼, Italy), optical coherence tomography system Solix («Optovue¼, USA), B-scan Plus («Accutome¼, USA), microscope CX41RF («Olympus Corporation¼, Japan). Due to significant visual deterioration in the right eye, the patient underwent vitrectomy. Microscopic examination of the surgical sample showed the presence of amyloid deposits revealed by the brick-red specific staining with congo red dye and apple-green birefringence of the stained areas in polarized light.

[Non-contact navigated laser retinopexy for peripheral retinal tears and rhegmatogenous degenerations: first experience]. / Pervyi opyt beskontaktnoi navigatsionnoi lazernoi retinopeksii perifericheskikh razryvov i regmatogennykh degeneratsii setchatki.

PURPOSE: To evaluate the first outcomes of non-contact navigated laser retinopexy for peripheral tears and rhegmatogenous degenerations of the retina. MATERIAL AND METHODS: This prospective single-center interventional pilot study included 58 patients (68 eyes), among which 19 males and 39 females aged 47.5±16.9 years with peripheral retinal degenerations and symptomatic retinal tears who received non-contact laser retinopexy with the Navilas 577s navigated laser system and non-contact PRP widefield objective. All patients (68 eyes) underwent laser treatment for the following disorders: horseshoe tear in 13 eyes, retinal hole in 11 eyes, operculated retinal hole in 3 eyes, lattice degeneration in 19 eyes, snail track degeneration in 1 eye, vitreoretinal tufts in 16 eyes, and progressing bullous retinoschisis in 5 eyes. Pain intensity was assessed using a four-point verbal rating scale. RESULTS: All patients were followed up for 5 to 21 months (9.0±3.3 months on average). Stable condition of the retina was observed in 65 cases (95.5%). In 3 eyes (4.4%), newly formed retinal tears prompted additional laser treatment: horseshoe tear in 2 eyes and retinal hole in 1 eye. The mean pain score during non-contact navigated laser retinopexy was 0.9±0.5. No complications associated with laser treatment were observed. CONCLUSION: Non-contact navigated laser retinopexy performed with the Navilas 577s navigated laser system is a safe and well-tolerated procedure with effectiveness comparable to conventional laser retinopexy.

[Preventive laser treatment of tractional symptomatic retinal flap tears: long-term outcomes]. / Otdalennye rezul'taty profilakticheskogo lazernogo lecheniya traktsionnykh simptomaticheskikh klapannykh razryvov setchatki.

Tractional flap tears are the main cause of the development of regmatogenic retinal detachment (RRD). The main immediate treatment method for it is laser retinal coagulation. PURPOSE: Case monitoring of tractional symptomatic flap tears after laser treatment. MATERIAL AND METHODS: From 2014 to 2019 we observed 119 patients (130 eyes) with peripheral flap (horseshoe) retinal tears in acute posterior vitreous detachment. Laser coagulation of the retina was performed using Navilas 577s (577 nm), OcuLight GL (532 nm). Laser retinotomy of horseshoe tear flap and dissection of overhanging vessels were performed using Nd:YAG-ultra Q Reflex laser (1064 nm) and controlled with RTVue XR Avanti. RESULTS: At the initial examination before the preventive laser coagulation, the following conditions were found: regmatogenous retinal detachment (RRD) - 8 eyes (6.2%), partial hemophthalmus - 29 (22.3%), preretinal hemorrhage - 15 (11.5%), epiretinal membrane - 9 (6.9%), non-full-thickness macular retinal breaks - 6 (4.6%), peripheral changes: retinal holes - 16 (12.3%), tears with operculum - 5 (3.8%), retinal degenerations - 40 eyes (30.8%). Observation for 5 years after laser retinopexy revealed new pathological changes: flap tears - 13 (10.6%); holes - 9 (7.4%); tears with operculum - 5 (4.1%); vitreoretinal tuft - 6 (4.9%); RRD - 3 cases (2.5%). In 16 patients (16 eyes) with horseshoe tear and pronounced vitreoretinal traction, the flap retinotomy was performed, which eliminated the traction component and prevented the development of RRD. CONCLUSION: Follow-up of tractional symptomatic flap tears for 5 years after preventive laser retinopexy revealed the appearance of retinal detachment in 2.5% of cases. Laser retinotomy of horseshoe tear after barrier retinopexy eliminated the traction component and helped prevent the development of RRD.

[Evaluation of YAG-laser vitreolysis effectiveness based on quantitative characterization of vitreous floaters]. / Otsenka éffektivnosti YAG-lazernogo vitreolizisa na osnove ob''ektivnoi kolichestvennoi otsenki plavaiushchikh pomutnenii v steklovidnom tele.

PURPOSE: To develop methods for evaluating effectiveness of YAG-laser vitreolysis of vitreous floaters. MATERIAL AND METHODS: The study included 144 patients (173 eyes) who had underwent YAG-laser vitreolysis and were under observation from 01.09.16 to 31.01.18. The patients were 34 to 86 years old (mean age 62.7±10.2 years), 28 (19.4%) patients were male, 116 (80.6%) - female. All patients underwent standard and additional examination: ultrasonography (Accutome B-scan plus, U.S.A.), optic biometry (Lenstar 900, Haag-Streit, Switzerland), spectral optical coherence tomography using RTVue XR Avanti scanner (Optovue, U.S.A.) in modes Enhanced HD Line, 3D Retina, 3D Widefield MCT, Cross Line, Angio Retina, and scanning laser ophthalmoscopy (SLO) using Navilas 577s system. Laser vitreolysis was performed using the Ultra Q Reflex laser (Ellex, Australia). RESULTS: This paper presents methods of objective quantitative and qualitative assessment of artifactual shadows of vitreous floaters with spectral optical coherence tomographic scanner RTVue xR Avanti employing an algorithm of automatic detection of non-perfusion zones in modes Angio Retina, HD Angio Retina, as well as foveal avascular zone (FAZ) measurement with Angio Analytics® software. SLO performed with Navilas 577s was used as method of visualizing floaters and artifactual shadows in retinal surface layers prior to surgical treatment and after YAG-laser vitreolysis. CONCLUSION: Suggested methods of quantitative and qualitative assessment of artifactual shadows of the floaters in retinal layers are promising and may prove to be highly relevant for clinical monitoring of patients, optimization of treatment indications and evaluating effectiveness of YAG-laser vitreolysis. Further research of laser vitreolysis effectiveness in patients with vitreous floaters is necessary.

[OCT-morphometric and angiographic parallels between different variants of central serous chorioretinopathy]. / Morfometricheskie i angiograficheskie paralleli pri razlichnykh variantakh techeniia tsentral'noĭ seroznoĭ khorioretinopatii.

Central serous chorioretinopathy (CSCR) is a frequent cause of vision deterioration. Often it is associated with type 1 neovascularization under the pigment retinal epithelium (RPE). Optical coherence tomography angiography (OCT-angiography) enables non-invasive and contrast-free detection of neovessels in any retinal layer, which makes the method appropriate for diagnostics in CSCR. AIM: to investigate OCT-morphometric and angiographic parallels between different CSCR courses. MATERIAL AND METHODS: The study included 37 patients with CSCR. All the patients underwent standard ophthalmic examination, measurement of the axial eye length (AL) (Lenstar 900, 'Haag-Streit', Switzerland), spectral OCT and OCT-angiography with SSADA algorithm (RTVue xR Avanti, 'Optovue', USA) as well as fundus imaging and fluorescein angiography (FA) (VISUCAM 500, 'Zeiss', Germany). Judging from the results of spectral OCT and intravenous FA, the patients were divided into 2 groups: group 1 - 20 patients with pigment epithelium detachment (PED) and group 2 - 17 patients without PED. AL averaged 23.75±0.27 mm in group 1 and 23.55±0.40 mm in group 2. RESULTS: Comparative analysis of morphometric parameters in the two groups showed that those patients, whose CSCR manifested with only neurosensory retinal detachment (group 2), demonstrated greater choroidal thickness in the projection of the fovea, central retinal thickness as well as the height and extent of neurosensory retinal detachment. Neovasculature was identified in 11 eyes from group 1 (with PED). Structurally, the neovascular network was either loop-like (7 eyes), or tree-like (4 eyes). In loop-like networks, the maximum neovessel diameter averaged 35.474±4.967 µm and the total area of the neovascular complex was 0.581±0.380 µm2. Tree-like complexes were notable for the generally greater maximum neovessel diameter (65.626±17.316 µm) and area (0.225±0.133 µm2). CONCLUSION: Non-PED patients show pronounced transudative symptoms and significantly greater subfoveal retinal thicknesses. According to OCT-angiography findings, half of those CSCR patients, with PED, present neovascular networks of either loop-like, or tree-like structure.

[Macular choroidal blood flow in concurrent age-related macular degeneration and primary open-angle glaucoma]. / Sostoyanie khorioidal'nogo krovotoka v makulyarnoi zone pri sochetanii vozrastnoi makulyarnoi degeneratsii i pervichnoi otkrytougol'noi glaukomy.

UNLABELLED: Ocular circulation disorders are an important factor in the development of primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD). To date, however, there have been no studies on choroidal blood flow peculiarities in case of concurrent AMD and POAG. AIM: to determine distinctive features of choroidal blood flow characteristic of concurrent AMD and POAG and to assess their role in disease pathogenesis. MATERIAL AND METHODS: Macular choroidal blood flow, including blood supply, was assessed in 54 patients (102 eyes) by means of Doppler ultrasound. Three groups were formed: group 1 - 38 eyes with both AMD and POAG; group 2 - 41 eyes with AMD and no signs of optic nerve pathology; and group 3 - 23 eyes with POAG and no signs of AMD. Groups 1 and 2 were subdivided into two subgroups each: А - atrophic AMD and B - macular drusen. The mean patient age was 78.7±8.4 years. The following parameters of choroidal blood flow were of interest: peak systolic velocity (Vps), end diastolic velocity (Ved), time-averaged maximum velocity (Vtamax), and resistance index (RI). RESULTS: Groups 1, 3, and 2A had an evident choroidal hypoperfusion in the macular area (decreased Vtamax) with uncompensated perfusion deficit, despite autoregulation efforts (decreased Vps, Ved, decreased or normal RI). Group 2B demonstrated a significantly higher rate of choroidal hyperperfusion (increased Vps, Ved, Vtamax, and RI). CONCLUSION: Concurrent AMD and POAG are notable for choroidal hypoperfusion in the macular area that leads to inadequate trophism of the neurosensory retina and can aggravate the course of AMD contributing to progression of its atrophic form.

[Optical coherence tomography angiography in the diagnosis of neovascular age-related macular degeneration].

AIM: to determine optical coherence tomography (OCT) angiography signs of classic and occult choroidal neovascularization (CNV) in patients with age-related macular degeneration (AMD) and evaluate their information value in monitoring the effect of anti-VEGF therapy. MATERIAL AND METHODS: The study enrolled 76 patients (87 eyes), including 68 patients (72 eyes) with wet AMD and 8 patients (15 eyes) with no signs of neovascularization. All patients underwent spectral-domain OCT, OCT angiography, and fluorescein angiography (FA). OCT angiography was used to evaluate neovascular networks in terms of their location, shape, size, and extent of visualization. Sensitivity and specificity of the method were assessed separately in a group of 37 CNV eyes and 15 unsuspicious eyes, specific findings at FA being the main diagnostic criteria. To determine the information value of OCT angiography in monitoring the effect of intravitreal ranibizumab therapy, 9 patients (9 eyes) were selected, in whom the exam was performed the day before the injection and then at days 3, 10, 17, 24, and 31. RESULTS: The patients were divided into two groups. Group 1 consisted of 43 eyes with occult CNV, group 2--of 29 eyes with classic CNV. Neovascular loops underneath the retinal pigment epithelium were found in 76.74% of occult CNV cases. In patients with classic CNV, the neovasculature was clearly visible in 82.76% of eyes, loop-like and tree-like networks occurring with similar frequency (51.72% and 42.28% respectively). OCT angiography results obtained prior to and following ranibizumab injection revealed a change in not only the size of neovascularization, but also the density, thickness, and branching pattern of newly formed blood vessels. Sensitivity and specificity of OCT angiography has been shown to be 89.2% and 93.3% respectively. CONCLUSION: OCT angiography enables diagnosis of both classic and occult choroidal neovascularization in patients with AMD as well as dynamic assessment of the size of the neovascular complex during anti-VEGF treatment. The method has high sensitivity and specificity.

[Optical coherent tomography in diagnosis of peripheral retinal breaks].

The purpose of our study was to develop an optimal method of peripheral retinal breaks visualization and determine the presence of vitreoretinal traction using optical coherence tomography (OCT). A total of 152 patients (176 eyes) with peripheral retinal breaks were assessed, among them 57 men and 95 women, aged from 18 to 76. To visualize retinal periphery we used RTVue-100 optical coherent tomograph (USA). Photoregistration was done with Nikon NF-505 fundus camera (Japan). All patients were examined with Goldmann lens. OCT application enabled us to determine structural features and configuration of peripheral retinal breaks, the presence of vitreoretinal traction, and morphometric parameters of the defects: the average length and height, retinal thickness in three standard points (prior to the break, at its edge and at the bottom), and also the extent of vitreoretinal fusion and local detachment of retinal neuroepithelium (NE). Two groups of peripheral retinal tears were formed: group I (23 eyes)--retinal flap tears and group II (153 eyes)--perforated breaks. Optical coherence tomography is a highly informative method which enables in vivo evaluation of structural and morphometric characteristics of retinal defects and vitreoretinal fusion, as well as possible vitreoretinal traction and subclinical detachment of the retina. Its use will ensure proper documentation of study results and also provide the possibility to determine indications for laser and surgical treatment and perform a late follow-up.

[Selective trabeculoplasty in combination with vasoactive agents in the complex treatment of primary open-angle glaucoma].

The purpose of the present study was to evaluate the efficiency of complex treatment that has pathogenetic effects on the developmental stages of primary open-angle glaucoma (POAG), by activating the trabecular network via selective laser trabeculoplasty (SLT) and by improving microcirculation with the vasodilator Cavinton Forte. Fifty-seven patients aged 48 to 70 years (72 eyes) who had a developed stage of POAG with uncompensated ophthalmotonus were followed up. Group 1 (a study group) comprised 35 patients (42 years) who received complex therapy (the vasodilator Cavinton Forte 10 mg thrice daily for 2 months along with beta-blockers and prostaglandins. Group 2 (a control group) consisted of 22 patients (30 years) who were first only antihypertensive therapy that did not differ from that taken in Group 1. The complex treatment in patients with the uncompensated developed stage of POAG made it possible to reduce opththalmotonus in 80.9% of the patients to 35% after single application of SLT, to lower intraocular pressure stably, to cause easy outflow of intraocular fluid 2 weeks after SLT, to have positive changes in the stereometric parameters in the optic disk and structural alterations in accordance with the GPS classification, and to discontinue topical antihypertensive agents in 14.3% of the patients.

[Proinflammatory cytokines in the development of bacterial keratitis]. / Rol' povospalitel'nykh tsitokinov v razvitii bakterial'nykh keratitov.

The production of proinflammatory cytokines IL-1alpha, IL1 2b, TNF-alpha and IL8 in lachrymal fluid was dynamically determined in 134 patients with uncomplicated and complicated clinical courses of primary (at exacerbation of the cornea) and secondary (with dystrophic changes in the cornea) keratitis. The level of proinflammatory cytokines in lachrymal fluid was found to essentially affect the clinical course in different types of keratitis.

[Clinico-etiologic features of various types of courses of suppurative corneal ulcer]. / Kliniko-étiologicheskie osobennosti razlichnykh tipov techeniia gnoinoi iazvy rogovitsy.

Clinical observations of 366 patients with purulent corneal ulcers over the period of 1989-1998 helped the author distinguish two major patterns of its clinical course: acute (group 1, 164 patients) and primary chronic (group 2, 202 patients). The acute type was characterized by a fulminant onset, rapid progress of the ulcer, high incidence of complications (23.8%); growth of bacteria from ulcer surface was mainly due to highly pathogenic microflora (65.9%). Primary chronic type was characterized by a subacute onset, torpid course, lower incidence of complications (7.4%); the main etiological cause was opportunistic microflora (74.7%).