Journal of Ophthalmology (Ukraine)

Cytological conjunctival changes in patients with type 2 diabetes-associated dry eye in the presence of treatment with a combination of trehalose plus sodium hyaluronate

2024-03-03T22:42:58+02:00

Purpose: To assess cytological conjunctival changes in patients with type 2 diabetes mellitus (T2DM)-associated dry eye disease in the presence of treatment with a combination of trehalose and sodium hyaluronate.

Material and Methods: This study was conducted at the Pirogov Vinnytsia Regional Clinical Hospital, the clinical site of the National Pirogov Memorial Medical University, from April to December 2023. We used prospective data of 46 patients (92 eyes; mean age, 62.47 ± 6.24 years).

Results: Most patients (67%) showed abnormal conjunctival impression cytology (CIC) changes (Nelson’s grade 2 and 3) before treatment. Among these, grade 3 squamous metaplasia was twice as common as grade 2 squamous metaplasia; this demonstrated apparent CIC changes in the group of patients, and a substantial prevalence of squamous metaplasia in type 2 diabetics. After treatment with a combination of trehalose 3% plus sodium hyaluronate 0.15%, neutrophil infiltration was observed only in 5 (11%) patients (р = 0.0375), which may indicate an anti-inflammatory effect of the combination.

Conclusion: We found a significant effect of a combination of trehalose 3% plus sodium hyaluronate 0.15% on the state of the ocular surface, with the resolution of inflammatory conjunctival infiltration, in patients with T2DM (p = 0.0375). Because stabilization or slowing of damage to epithelial cells is important for patients with T2DM and was observed in the presence of treatment with the combination eye drop, these patients require long-term treatment with the medication.

Efficacy of Nd:YAG and diode laser transscleral cyclophotocoagulation in the management of neovascular glaucoma associated with proliferative diabetic retinopathy

2024-03-28T12:36:59+02:00

Background: Transscleral cyclophotocoagulation (TSCPC) is most commonly used in patients with neovascular glaucoma (NVG) associated with proliferative diabetic retinopathy (PDR) in whom maximal hypotensive medications have failed to reduce intraocular pressure (IOP) to the desired level, and glaucoma surgery cannot be carried out. Oprions for CPC can be performed using a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser or diode laser.

Purpose: To compare the efficacy of TSCPC performed with the 1,064-nm Nd:YAG laser versus 810-nm diode laser in patients with painful NVG associated with PDR over a 12-month follow-up period.

Material and Methods: A prospective cohort study was carried out on 58 type 2 diabetics (58 eyes) who received a 1,064-nm Nd:YAG laser TSCPC of 810-nm diode laser TSCPC for painful NVG associated with PDR, with regular follow-up visits over 12 months and had no previous history of treatment with CPC. IOP between 6 and 21 mmHg (or a reduction in IOP of ≥ 30% from baseline IOP) and no ocular pain at 12 months was the primary outcome measure.

Results: The success rate at 12 months was 75% and 77% for eyes that received Nd:YAG laser TSCPC and diode laser TSCPC, respectively (p = 0.86). In the Nd:YAG laser TSCPC and diode laser TSCPC groups, the IOP reduced by 46% and 45%, respectively (p = 0.34) from baseline values of 38.0 mmHg and 36.0 mmHg, respectively (p = 0.96) at month 12 after TSCPC. At month 12 after CPC, the BCVA in patients with preserved pattern vision improved in both groups (p = 0.41). The rate of ocular complications was, however, higher in the Nd:YAG laser TSCPC group (71% versus 33%, p = 0.004).

Conclusion: Nd:YAG laser TSCPC resulted in a reduction in IOP to ≤ 21 mmHg at month 12 in 75%, and diode laser TSCPC, in 77% of patients with NVG associated with PDR. The number of sessions required for treatment success was 3.2 times larger for Nd:YAG laser CPC than for diode laser CPC. Both these types of CPC are safe and can be repeatedly used to improve treatment efficacy.

Efficacy of a combination of conservative and surgical methods of treatment for neovaascular glaucoma associated with diabetic retinopathy and central or branch retinal vein occlusion

2024-03-02T22:30:01+02:00

Background: Neovascular glaucoma (NVG) is secondary glaucoma which is often resistant to medical therapy and may potentially lead to blindness.

Purpose: To assess the efficacy of a combination of conservative and surgical methods of treatment for NVG associated with proliferative diabetic retinopathy (PDR) and central or branch retinal vein occlusion (CRVO or BRVO).

Material and Methods: Fifty-six patients (68 eyes) with NVG were under our observation. These included 48 patients (60 eyes) with NVG associated with PDR and 8 patients (8 eyes) with NVG associated with CRVO or BRVO. The mean patient age was 64.0 ± 10.0 years. Group 1 (22 patients, 33 eyes) received hypotensive ocular hypotensive medication, retinal laser photocoagulation and intravitreal ranibizumab. In addition to the above treatment, group 2 (34 patients, 35 eyes) received filtration surgery. Of the 68 eyes, 24 received single ranibizumab 0.5 mg injection; 26 eyes, two to four injections, and 18 eyes, five or more injections.

Results: The treatment resulted in a partial reduction in iris neovascularization in 53/68 eyes, and total reduction, in 15/68 eyes. In a total sample of patients, the IOP reduced from 29.1 ± 7.9 mmHg at baseline to 20.4 ± 4.8 mmHg after treatment, and the mean number of IOP-lowering medications, from 2.1 ± 1.1 at baseline to 0.9 ± 0.9 after treatment.

Conclusion: The combination treatment for NVG was found to enable an IOP reduction of 29.9% and prevent a significant reduction in visual acuity in 85% of eyes with NVG.

The Effect of Neodymium: Yttrium Aluminum Garnet Laser Capsulotomy on Visual Acuity and Contrast Sensitivity in Patients with Posterior Capsular Opacity in a Tertiary Care Hospital

2024-03-28T17:29:36+02:00

Purpose. This study was conducted to compare the improvement in visual acuity and contrast sensitivity before and after neodymium yttrium aluminum garnet (Nd-YAG) capsulotomy in patients with posterior capsular opacity.

Materials and Methods. A prospective study of 72 eyes of 60 patients with posterior capsular opacity (PCO) was conducted in the Department of Ophthalmology after approval from the institutional ethical committee of M S Ramaiah Medical college. A complete ophthalmological examination, including a detailed history, best corrected visual acuity using Snellens chart, and contrast sensitivity (before and after Nd- YAG capsulotomy) using Pelli Robson chart, slit lamp examination, IOP measurement, and fundus examination were performed after obtaining informed consent adherence to the tenets of Declaration of Helkinski .

Results. The study comprised 60 patients, age groups ranging from 50 to 96 years, with the mean age of patients in our study being 65.943±8.83 years. BCVA of 62 eyes (86.2%) was between 6/18 and 6/60. After Nd YAG capsulotomy, patients showed great improvement in vision, with 63 eyes (87.5%) having improved BCVA of better than 6/12, and 24 eyes (33.3%) showing BCVA of 6/6 (p < 0.001). The contrast sensitivity of 69 eyes (95.83% ) was between 0 and 1.65 log units, followed by 3 eyes(4.17%) between 1.80 and 1.95 log units. After Nd-YAG capsulotomy, contrast sensitivity of 61 eyes (84.72%) improved to 1.80 – 2.25 log units, whereas the remaining 11 eyes (15.28%) showed contrast sensitivity of 1.20 – 1.65 log units (p < 0.001)

Conclusion. Nd-YAG capsulotomy is an effective and relatively safe procedure for the management of posterior capsular opacity. It significantly improves both visual acuity and contrast sensitivity, thereby improving the quality of vision.

The Short-term efficacy of a monoclonal antibody fragment (brolucizumab) for treating neovascular age-related macular degeneration

2024-03-30T18:45:46+02:00

Aim. To evaluate the short-term efficacy of using a monoclonal antibody fragment (Brolucizumab) for treating neovascular age-related macular degeneration, depending on the morphometric parameters of the retina.

Methods: This study included 48 patients (60 eyes) diagnosed with neovascular age-related macular degeneration (nAMD). The observation period was 6 months. Brolucizumab was administered intravitreally at a dose of 6 mg (0.05 ml, 120 mg/ ml) once a month consistently for 3-4 months. Depending on the morphometric parameters, the retina patients were divided into three main groups.

Results: A pronounced clinical and morphological response was achieved after the first injection of Brolucizumab, and positive dynamics were observed throughout the entire observation period.

Conclusions: The use of the drug Brolucizumab significantly improves the visual functions of patients with neovascular AMD, as well as the morphological state of the retina in short-term follow-up, regardless of the initial morphometric characteristics of the retina, which allows not only to maintain but also to improve visual acuity and prevent blindness and visual disability in patients.

On the use of immediately sequential bilateral cataract surgery (ISBCS) in Ukraine

2024-03-27T20:39:46+02:00

Cataract surgery is most commonly performed today by utilizing the standardized phacoemulsification technique which results in successful outcomes and low complication rates. At present, most patients undergo cataract surgery in both eyes on separate days, referred to as delayed sequential cataract surgery (DSCS). Immediately sequential bilateral cataract surgery (ISBCS) has emerged as an alternative to traditional DSBCS and is, however, increasingly used in clinical practice throughout the world. The question arises: How safe is ISBCS with respect to postoperative complications?

Utilizing non-histological serological markers in the prediction of recurrence and metastasis in head and neck melanoma

2023-12-27T21:12:27+02:00

There is a need for the development of additional prognostic melanoma (e.g., head and neck melanoma) biomarkers to stratify melanoma patients and reliably identify high-risk subgroups with the aim of providing effective personalized therapy.

Biomarkers play an important role in the diagnosis and prognostic classification of various types of cancer and may be indicators of biological or pathological processes or responses to exposure or intervention, providing a physician with the data helpful for future decision making with regard to patient management.

The advent of novel treatments and modalities for treating various stages of the disease with a notable objective response-to-survival ratio gave us good reason, in this review, to emphasize non-histological serological biomarkers for the correction and improvement in the efficacy of treatment as well as the prognosis of survival in patients with head and neck melanoma.

Bilateral glaucoma attack after flow-diverting stent placement in the left inner catorid artery in the projection of the aneurysm neck: a case report

2024-02-28T22:17:44+02:00

We report a case of the development of bilateral glaucoma after flow-diverting stent placement in the left internal carotid artery (ICA) in the projection of the aneurysm neck. The case confirms the importance of a multidisciplinary approach to the surgical treatment of patients with a supraclinoid ICA aneurysm, and may be of interest not only to ophthalmologists, but also to neurosurgeons and vascular surgeons.

The state of S100-positive glia and the effect on it on the GABA-benzodiazepine receptor agonist, carbacetam, in diabetic retinopathy

2024-02-10T23:06:59+02:00

Purpose: To determine the state of S100-positive glia and the effect on it of the gamma-aminobutyric acid (GABA)-benzodiazepine receptor agonist, carbacetam, in early experimental diabetic retinopathy (DR).

Material and Methods: DR was induced in 30 Wistar male rats (age, 3 months) by single intraperitoneal injection of 50 mg streptozotocin (STZ)/ kg body weight. These were assigned to two treatment groups (30 units of insulin only and 30 units of insulin plus carbacetam at a dose of 5 mg/ kg body weight in 0.5 mL of saline, respectively) and a control group of untreated diabetic rats, of 10 animals each. In addition, five intact animals were used to assess the retina at baseline conditions. Mouse anti-S100 protein monoclonal antibodies (Thermo Fisher Scientific) were used for immunohistochemical studies.

Results: In the intact retina, there was S100-positive staining in multiple polymorphous cells in the inner nuclear layer (INL) and glial fibers surrounding ganglion neurons like a collar. The intensity of S100 staining of Müller cells significantly increased, and their long radial processes were clearly visualized in early untreated DR. Particularly, intensive staining was observed in the outer nuclear layer (ONL), at the junction of this layer with the rod and cone layer, and in the ganglion layer. On day 28 of the experiment, microaneurysms were observed in the inner retina, with high S100 staining intensity in fibers which adhered to them. Animal treatment with insulin only resulted in a reduction in S100 staining intensity, whereas animal treatment with insulin plus carbacetam inhibited S100 protein expression and prevented the development of retinal microaneurysms, with only solitary Müller cells in the INL and the plexus in the ganglion cell layer exhibiting weak staining.

Conclusion: The GABA-benzodiazepine receptor agonist, carbacetam, was found to have an inhibiting effect on the expression of S100 protein and formation of retinal microaneurysms in early DR associated with STZ-induced diabetes in rats.

Relationship between changes in retinal brain-derived neurotrophic factor (BDNF) concentration and morphological changes in retinal neurons in rats with induced diabetes and axial myopia

2024-03-04T22:09:06+02:00

Background: Myopia significantly decreases the frequency and severity of diabetic retinopathy (DR). The proliferative form of this diabetic complication in the retina is known to be very uncommon in diabetic myopes. The mechanisms of this phenomena are, however, still unclear. Studies on these mechanisms and the clarification of the structural changes in retinal neurons in animal models of both diabetes and myopia are critical to the research of the pathogenesis and further identification of therapeutic and preventive targets for these pathological conditions.

Purpose: To examine changes in the retinal brain-derived neurotrophic factor (BDNF) concentration and the relationship of the latter with the structure of retinal neuronal cells in rats with induced both diabetes and axial myopia.

Material and Methods: Rats (age, 2 to 10 weeks) were assigned to four groups: group 1 (myopia only, n = 15), group 2 (diabetes only, n = 15), group 3 (myopia plus diabetes, n = 15), and group 4 (healthy controls, n = 10). Axial myopia was produced in two-month-old animals by surgically fusing the eyelids of both eyes. Streptozotocin (STZ) (15 mg/kg body weight, intraperitoneally consequently for 5 days) was used to induce diabetes. Diabetes was induced in group 3 at 3 weeks after the initiation of the experiment. At 2 months, all rats were euthanized under anesthesia, and their eyes were enucleated. To perform a histomorphological study, serial retinal sections were made and stained with hematoxylin and eosin, and microscopy was performed and images were collected and evaluated on a light microscope Jenamed 2. Rat BDNF enzyme-linked immunosorbent kits (Elabscience, Houston, TX) were used to determine BDNF concentrations in retinal and plasma supernatants.

Results: Rats with both diabetes and myopia exhibited smaller reductions in plasma and, especially, retinal BDNF concentrations compared to rats with diabetes only. Retinal BDNF concentrations in rats with both diabetes and myopia were 36.1% higher than in rats with diabetes only. Unlike rats with STZ-induced diabetes only, those with STZ-induced diabetes in the presence of experimental myopia exhibited a rather high neuronal cell density in the retinal ganglion cell layer. No noticeable change in the cell density in the inner nuclear layer and photoreceptor layer was observed in the latter animals.

Conclusion: Axial length elongation secondary to experimental myopia in animals facilitates the protection against diabetic changes in the retina, which was confirmed at the molecular and morphological levels, with BDNF being a possible component of this protective mechanism.

In vitro and in vivo study of the biocompatibility and adjacent soft tissue response to synthetic polyvinyl formal hydrogel implant

2024-03-04T22:25:49+02:00

Background: Given a rising tendency in the rate of ocular trauma, there is an increasing need in surgeries for orbital, ocular adnexal and periorbital reconstruction. The susceptibility to resorption is a common drawback of the biological tissues used as a plastic material in contemporary orbital surgery. Non-biological hollow porous polyvinyl formal (PVF) hydrogel implants capable of integration with adjacent biological tissues offer a new opportunity for reconstructive surgery.

Purpose: To examine the in vivo and in vitro biocompatibility of a synthetic PVF-based hydrogel implant material.

Material and Methods: Scanning electron microscopy (SEM) analysis; in vitro evaluation of the biocompatibility of the PVF hydrogel implant material in terms of its cytotoxicity, genotoxicity and effects on marker enzymatic activities of L929 fibroblasts; and in vitro study on implant incorporation.

Results: A cross-linked polyvinyl formal hydrogel for orbital endoprosthesis surgery was synthesized. Our in vitro cytotoxicity and genotoxicity tests of the hydrogel and tests of its effects on marker enzymatic activities of L929 fibroblasts demonstrated safety. All hydrogel implant samples, after being sealed into polypropylene bags and autoclaved for 15 min at 121 °C and 1.04 atm steam pressure, were found to be sterile. In all rats in which the hybrid hydrogel implant was placed subcutaneously in the back, there was prompt relief of edema at the site of postoperative suture. The inflammatory reactions seen in the tissues adjacent to the implant included mostly mild diffuse lymphocytic infiltration close to the implant surface, with no inflammatory reactions seen at the sites more remote from the implant.

Conclusion: Our in vivo and in vitro study of the PVF hydrogel demonstrated its high biocompatibility in terms of its cytotoxicity, genotoxicity and effects on marker enzymatic activities of fibroblast cells, with no post-implantation complications, but a step-by-step improvement in the relationship between the implant and adjacent tissues. The findings of this study allow us to recommend the developed PVF hydrogel for further research on the potential for using it as an implant for filling postoperative cavities and endoprosthesis in orbital and periorbital reconstruction.