Modern Technologies in Diagnosis of Fungal Keratitis (Review).

Traumas and infectious diseases of the eye play a leading role in the development of corneal blindness responsible for 1.5-2 million cases of vision loss per year. To date, the issue of reducing the incidence of fungal keratitis is acute and needs to be solved worldwide. Trauma as a risk factor for corneal fungal disease is thought to be prevalent in developing countries due to agricultural involvement, while in developed countries the onset of the disease is predisposed by medical advances such as contact vision correction and modern ophthalmic surgery. Thorough analysis of the pathogenesis gives the possibility to describe the action of fungal enzymes, biofilm formation, and the resistance mechanism, which on the one hand explains the aggressive course of the disease and difficulties in its diagnosis, and on the other hand, it encourages searching for new methods of diagnosis and treatment. The non-specific clinical picture of fungal keratitis, the variety and availability of antibiotics nowadays become an obstacle for rapid detection of this pathology. Low public awareness and late visit to an ophthalmologist are also a barrier to successful combating the increasing incidence of fungal keratitis. Belated diagnosis, increasing resistance of fungi to antibiotics, and lack of registered antifungal ophthalmic drugs justify poor treatment efficacy resulting in decreased visual acuity or vision loss. Existing diagnostic methods need systematization and detailed comparison, identifying the advantages and disadvantages of each. This review considers causative agents and their influence on pathogenesis of the disease, describes difficulties of fungal keratitis diagnosis and possible ways of overcoming these problems using new developments, and also outlines further prospects of research in this direction.

[Clinical phenotypes of optic nerve damage in patients with neuromyelitis optica spectrum disorder]. / Klinicheskie fenotipy porazheniya zritel'nogo nerva u patsientov s zabolevaniyami spektra opticheskogo neiromielita.

Neuromyelitis optica spectrum disorders (NMOSD) comprise a group of autoimmune inflammatory demyelinating diseases of the central nervous system that manifest as optic neuritis and transverse myelitis. Its manifestation in the form of optic neuritis makes early diagnosis difficult because neuroimaging of the spinal cord is not a part of the routine examination algorithm for such patients. This article presents the results of a comprehensive ophthalmological examination of 4 patients (8 eyes) diagnosed with NMSOD. Optic neuritis was the disease debut in 3 patients and had 1-2 relapses, in all cases partial optic atrophy with moderate to severe loss of visual function occurred. The clinical picture was characterized by a pronounced heterogeneity in terms of both ophthalmological symptoms, and accession of neurological disorders. Treatment of NMOSD requires differential diagnosis with multiple sclerosis, which depends on the awareness of specialists and the inclusion of antibody titers to aquaporin-4 and myelin oligodendrocyte glycoprotein into the examination algorithm of patients with optical neuritis.

[Capabilities of optical coherence tomography in examination of senile scleral plaques]. / Vozmozhnosti opticheskoi kogerentnoi tomografii v otsenke senil'noi skleral'noi blyashki.

Senile scleral plaque (SSP) is a degenerative disease of the sclera manifested by the appearance of gray spots with clearly defined borders anteriorly from the insertion site of horizontal rectus muscles. Even with minimal changes over time changes over time are minor, SSP weakens the structural function of the sclera and creates a risk of a complicated course associated with scleromalacia. Interest in the study of SSP is increasing due to the growing number of transscleral intravitreal injections. PURPOSE: To assess the morphological characteristics of SSP using spectral optical coherence tomography (OCT). MATERIAL AND METHODS: The study examined 13 patients (21 eyes) with average age of 77.1±6.3 years. OCT scanning was performed to determine OCT signs of SSP, the length (parallel to the limb), the width and height of the SSP, as well as the depth and thickness of the overlying sclera. RESULTS: A combination of nasal and temporal SSP was observed in 14 eyes, and nasal only SSP was detected in 6 eyes. In all cases, OCT presented a characteristic picture of SSP observed as an intrascleral cavity with hyperreflective content with lower reflectivity than the surrounding tissues, and clear borders represented by unchanged scleral fibers. The length of the SSP parallel to the limb was 3296±820 µm, the width - 2312±436 µm, the height of the SSP cavity - 482±89 µm. The depth of SSP site was 213±36 µm, the thickness of the overlying sclera - 125±29 µm. CONCLUSION: Updated information about SSP structure can be used in the development of standard surgical algorithms contributing to prevention of postoperative complications.

[Anterior stromal micropuncture for the treatment of persistent corneal epithelial graft defects after penetrating keratoplasty]. / Perednyaya stromal'naya mikropunktsiya v lechenii persistiruyushchei erozii transplantata rogovitsy posle skvoznoi keratoplastiki.

Persistent corneal graft erosion or persistent epithelial corneal defect is a frequent complication of penetrating keratoplasty. Its development can be contributed by the dry eye syndrome, rare blinking, lagophthalmos, symblepharon, viral infection, autoimmune aggression, and the use of epithelial-toxic eye drops. The article presents three clinical observations of patients who developed persistent corneal graft erosion after penetrating keratoplasty. Due to the ineffectiveness of local conservative therapy for more than 3 weeks, anterior stromal corneal micropuncture was performed. After the procedure, there was a gradual epithelial proliferation, complete healing of the corneal surface was observed 10-16 days after the manipulation, the follow-up period was at least 1 year. The mechanism of action of stromal micropuncture is associated with the creation of a porous surface with better adhesion properties, as well as with the activation of the production of extracellular matrix glycoproteins such as fibronectin, type IV collagen and laminin, which are necessary for stable adhesion of the epithelium. The use of stromal micropuncture of the donor flap in the treatment of post-keratoplasty persistent corneal epithelial defect was proposed for the first time.

[Intraocular lens power in Russian population: distribution analysis]. / Raspredelenie opticheskoi sily intraokulyarnykh linz, vostrebovannykh na territorii Rossiiskoi Federatsii.

Approximately 470 thousand cases of cataract surgery with implantation of intraocular lens (IOL) are performed annually in Russia. The distribution of IOL power in the Russian population has not been studied sufficiently, which makes the IOL procurement planning imperfect. PURPOSE: To analyze the distribution of implanted IOL power and optimize the IOL procurement system. MATERIAL AND METHODS: Retrospective analysis of cataract surgeries performed from 2014 to 2015 in the ophthalmic department of Volga District Medical Centre of the FMBA was conducted. Inclusion criteria: age from 20 to 99 years, no refractive surgery in patient's medical history, primary IOL implantation with an A-constant of 118.4, achievement of planned refraction. The studied parameters were IOL power, gender and age of patients. To assess the effectiveness of the procurement system, we analyzed the number of additional «unplanned¼ purchases and exchanges of IOLs over the course of 5 years (2014-2018). RESULTS: According to the inclusion criteria, 1009 medical records were selected, the age of the patients was 68.7±10.9 years. The distribution of IOL power was similar, but different from the normal, characterized by the mismatch of the median and the mean, left-sided asymmetry and peaked shape. Comparison of 2014 and 2015 samples showed no significant differences and low variability of IOL power. Regression analysis revealed a weak correlation between the IOL power and age and no correlation with gender, a trend was observed for IOL power to increase in patients after 50 years. The use of a procurement planning system based on a mathematical model of the IOL power distribution allows reduction of the additional purchases and exchanges of IOLs with the supplier from 5-7% to 1-2% of the total purchases. CONCLUSION: The specific features of the IOL power distribution are related to the distribution of biometry parameters in the population. The use of a scientifically based procurement system reduces staff time and laboring costs, releasing economical and time resources.

[Fungal keratitis after penetrating keratoplasty]. / Gribkovyi keratit posle skvoznoi keratoplastiki.

The article presents a case of fungal keratitis after penetrating keratoplasty (PKP). A 35-years old patient had previously undergone surgical removal of an intraocular foreign body and developed chronic keratouveitis and epithelial-endothelial corneal dystrophy. PKP and early postoperative period were uneventful. The patient was frequently monitored with anterior segment photos. Two weeks later, fungal keratitis occurred on the edge of the donor flap. Direct microscopic evaluation revealed fungus spores and filaments, but growth of fungi in culture was negative. Instillation of steroids and antibiotics was discontinued, specific therapy included fluconazole and amphotericin B. Despite the ongoing treatment, keratitis has repeatedly recurred, and infiltrates were scraped. Topical and systemic voriconazole was administered instead of fluconazole in combination with regular scarification. After 3 weeks of treatment with voriconazole, stable corneal epithelialization was achieved and the cornea has restored its transparency. During 1.5 years of the follow-up, keratitis did not reccur; sutures were removed, corrected visual acuity increased to 1.0. Patients who had undergone PKP are at risk of developing fungal keratitis. Frequent monitoring of such patients contributes to early diagnosis of infectious complications. In the absence of officinal antifungal eye drops, specialist has to supply the patient with ex tempore antimycotic agents and change the treatment according to its effectiveness in each specific case.

[Papillomacular retinoschisis associated with glaucoma]. / Papillomakuliarnyi retinoshizis, assotsiirovannyi s glaukomoi.

Peripapillary and macular retinoschisis is one of the rare manifestations of advanced glaucoma of different types. The article presents a case report and a mini-review. Peripapillary and macular retinoschisis with visual deterioration was diagnosed in a patient with advanced decompensated open-angle glaucoma and pseudoexfoliation syndrome. Surgical treatment of glaucoma led to intraocular pressure normalization, gradual regress of retinoschisis and improvement of visual functions. The retinal structure fully restored 1.5 years after the operation. The observation period was 3 years, retinoschisis did not recur. The article discusses the pathogenesis and potential algorithm for the treatment of the disease. Risk factors for the development of retinoschisis include high intraocular pressure, significant visual field defects and a wide range of diurnal intraocular pressure fluctuations. The source of the intra-retinal fluid is the vitreous body. Management of the patient consists of medical, laser and surgical normalization of intraocular pressure and regular monitoring. In case of persisting retinoschisis, patient undergoes vitreoretinal surgery or barrier laser coagulation. Retinal structure recovers gradually after the intervention and takes on average 1 year.

[Complications of intracameral cefuroxime in cataract surgery]. / Oslozhneniia vnutrikamernogo vvedeniia tsefuroksima v khirurgii katarakty.

Intracameral injection of cefuroxime during phacoemulsification is considered effective in preventing endophthalmitis. Its widespread usage has led to the accumulation of data on local and systemic adverse reactions. The analysis of complications of cataract surgery with cefuroxime injections described in literature has allowed identifying a few different clusters of toxic and allergic reactions to intracameral cefuroxime for the first time. These clusters included toxic anterior segment syndrome, serous retinal detachment with macular edema, retinal hemorrhagic infarction and anaphylactic reaction. The first two types develop in the cases of both correct and incorrect dosages, and both have favorable prognosis. Retinal hemorrhagic infarction was observed in cases with more than 50 mg intracameral antibiotic injected in the anterior chamber and was accompanied by persistent irreversible visual deterioration. Anaphylactic shock in response to a standard dose of intracameral cefuroxime was described in patients allergic to penicillin. Every clinical variant has specific complication mechanisms, prevention and treatment options. Antibiotic dilution done by medical staff accounts for the risk of incorrect dosage and related complications. Clinical manifestations of the complications of antibiotic prophylaxis should be considered when specifying the causes of decreased vision in the early postoperative period.

[Serous retinal detachment after phacoemulsification with intracameral cefuroxime (a case-control report)]. / Seroznaia otsloika setchatki posle fakoémul'sifikatsii s vnutrikamernym vvedeniem tsefuroksima (klinicheskoe nabliudenie 'sluchai-kontrol'').

Serous retinal detachment is a rare postoperative complication of phacoemulsification with intracameral antibiotics. Diagnostic and therapeutic strategy in such cases is not well known. PURPOSE: To present a case of serous retinal detachment after phacoemulsification with intracameral cefuroxime. MATERIAL AND METHODS: A retrospective analysis of the medical record of one patient who had underwent cataract phacoemulsification on both eyes; the follow-up period was 5 months. RESULTS: Phacoemulsification of noncomplicated cataract with implantation of intraocular lens in the right eye was completed uneventfully; 1 mg of cefuroxime was administered into the anterior chamber at the end of the surgery. In the first day after the surgery visual acuity decreased to 0.2. Serous detachment of retinal pigment and sensory epithelia in the macula area was revealed by optical coherence tomography (OCT). Fluorescein angiography showed no pathological vascular activity. The patient received standard post-surgery therapy supplemented with subtenon triamcinolone, intravenous dexamethasone injections and systemic acetazolamide ingestion. The retinal detachment status was monitored daily by OCT. By day 6 of the follow-up visual acuity recovered to 1.0. After 5 months, inner retinal profile deformation was revealed. The patient's left eye was considered the 'control' eye; phacoemulsification without cefuroxime was performed on it 5 months after the initial surgery, and no complication occurred during the follow-up. CONCLUSION: Serous detachment of retinal pigment and sensory epithelia during the early postoperative period after cataract surgery may be caused by a toxic reaction to intracameral cefuroxime even when it's administered in standard dosage. This complication has a favorable prognosis, but requires long term monitoring.

[Spontaneous separation of secondary epiretinal membrane]. / Spontannoe otdelenie vtorichnoi épiretinal'noi membrany.

The article presents a rare clinical case of secondary epiretinal membrane (ERM) in a 67-years-old woman. The patient was diagnosed with ERM in the left eye after loss of vision complaints. One year prior to the visit the patient had underwent 2 sessions of laser photocoagulation for proliferative post-thrombotic retinopathy in the left eye. In the context of relatively high visual functions (decimal visual acuity of 0.7 at the time of the visit), observation strategy was carried out. The follow-up period was 2 years. According to optical coherence tomography data, progressive deformation of retinal profile and an increase in diffuse retinal edema up to 391 µm in the fovea were observed in the course of the year, while visual acuity decreased to 0.6. Spontaneous separation of ERM, an increase in visual acuity to 0.9 and a decrease in retinal thickness to 236 µm were found during the subsequent visit. The authors discuss the presumable mechanisms of secondary ERM formation and separation and the impact of such cases in the management of patients with ERM and relatively high visual acuity.

[Ophthalmic manifestations of Huntington's disease].

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by a mutation in the huntingtin gene. The whole nervous system, including visual analyzer, is involved in the pathogenesis of the disease. Various ocular sings can be found in both preclinical and clinical stages of HD. Specific retinal damage, namely, abnormal proteins formation, photoreceptor degeneration and retinal remodeling, has been studied in animal models. Functional changes in occipital lobe activity and its atrophy as well as degeneration of visual pathways can already be present in the early stages of the disease. Oculomotor symptoms of HD include disturbed visual fixation, slower tracking eye movements and saccades, and suppressed vestibulo-ocular reflex. Visual perceptual disorders, such as visuospatial difficulties, problems of stimulus identification and motion perception, along with decreased contrast sensitivity, have also been described. The possibility of using certain ophthalmic parameters as biomarkers of HD is being discussed.